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Region of interest
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Site 11: Adequate bone but apical implant position
A 4x11mm cylinder was overlaid on the adjacent images at site 11. Although adequate bone volume is present to accommodate the cylinder at this site, the collar of the proposed implant is apically positioned due to extensive periodontal bone loss associated with tooth 11. This will necessitate the use of a long abutment to restore implant 11.
Site 21: Inadequate bone + apical implant position
A 4x11mm cylinder was overlaid on the adjacent images at site 21. Inadequate buccolingual bone exists for this cylinder to be fully embedded at this site without additional bone augmentation. Additionally, due to severe periodontal bone loss associated with tooth 21, the proposed implant collar is apically positioned. This would necessitate the use of a long abutment to restore implant 21.
Vertical periodontal bone loss on teeth 11 and 21
Teeth 11 and 21 exhibit vertical periodontal bone loss extending to the root apices. The buccal cortical plate overlying the mesial surface of tooth 21 is dehiscent. This extensive area of bone loss has resulted in reduced bone volume to accommodate regional implant placement. The area of bone loss involving tooth 21 is in close proximity to the nasal prosthesis.
1. Nasal prosthesis
A prosthesis forms the external contour of the nose. The inferior aspect of this prosthesis extends to abut the left inferolateral aspect of the anterior nasal spine, and is positioned in close proximity to the periapical area of tooth 21. This may complicate regional bone grafting and implant placement.
Buccolingual views of anterior maxilla
These buccolingual cross-sectional images demonstrate the close proximity of the nasal prosthesis to the periapical region of tooth 21. Tooth 21 exhibits vertical bone loss and dehiscence of the overlying buccal cortical plate, which suggests the presence of chronic regional inflammation.
2. Widened PDL space on tooth 12
The periapical periodontal ligament space of tooth 12 is slightly widened. The existing endodontic obturation is filled short of the radiographic apex. Clinical assessment is indicated to evaluate tooth 12 for persistent periapical pathology.