The evolution of dental implants 197

crown slightly shortened. As the site heals, the tooth will probably be pushed up into normal occlusal position.

Before inserting the tooth, the socket should be free of clots and debris and hemorrhaging checked. If neighboring teeth are to be used as abutments, they should be prepared before reimplantation. If this is not possible, about 3 weeks should elapse after implantation before restorative work is done. By this time, the tooth should be firm. Restorative work should never be done on or near a freshly reimplanted tooth.

If the patient has not been receiving oral antibiotics at least 2 days prior to the operative procedure, intramuscular antibiotic injections should be given at the surgical visit. In either situation, oral antibiotic treatment should continue for 3 days following surgery.

The following case shows the step-by-step procedure for the removal of an abscessed lower right first bicuspid tooth and its successful reimplantation. The infected bicuspid tooth of a 28-year-old woman was carefully extracted. The granuloma was still attached to the apex of the tooth (Fig. 5-113). All tissue inside the socket was completely removed with a variety of excavators and the socket was plugged with iodoform gauze. Hand instruments were used to clean the pulp tissue from the extracted tooth, and then rotary reamers were used until the canal had been widened to the desired size. The apex of the root was shortened about 3 mm.

Gutta-percha was then inserted in the canal with a root canal cement, compressed firmly against its walls, and sealed at the apex (Fig. 5-114). The decayed areas of the tooth were removed with burs for ordinary cavity preparations and then, to give the tooth back its contour, resin material was "brushed on" (Fig. 5-115). The tooth was then sterilized in a cold sterilizing solution for 10 minutes. After removing the iodoforr gauze from the cleansed socket, the tooth was reimplanted (Fig. 5-116) and immediately stabilized with .010 dead soft stainless steel ligature wire (Fig. 5-117) .

When there is enough bone beyond the apex of the reimplanted tooth, a metal extension—or endodontic pin—can be used to give the tooth better anchorage. If some of the root resorbs, the metal extension could remain to support the tooth, as shown in another case (Fig. 5-118). An endodontic pin can also be used to act as an additional root, as shown in a reimplanted mesially tipped wisdom tooth (Fig. 5-119) .

BIOLOGIC IMPLANTS

Recently in France, Bordon and Raphael Chercheve have been concentrating on biologic implants, which are human or animal teeth that have been desensitized by cobalt irradiation.

To prepare a human tooth as a donor, root canal therapy is performed and a metal core—either of

Fig. 5-117. Radiograph showing reimplanted tooth stabilized by wiring to neighboring teeth.

Fig. 5-118. A tooth with an endodontic pin was reimplanted. If the root resorbs, the metal pin could possibly remain to stabilize the crown.

Fig. 5-119. By using an endodontic pin as a mesial root, the tipped reimplanted tooth gained greater stability. This wisdom tooth was the only posterior abutment for a unilateral bridge supported anteriorly by the cuspid and two bicuspids. (From Linkow, L. I.: Pin implants, Prom. Dent., 1st. Trimester, No. 3, 1968.)