Endodontic implants 591

A

B

Fig. 13-14. Stabilization of the only loose tooth in the dental arch. The patient has an excellent set of natural teeth. Stabilization of the only periodontally involved tooth in the arch prolongs the eventual need for a fixed bridge or partial denture. The x-rays show, A, the preoperative site, and, B, the pin 5%s years after insertion. (From Orlay, H. G.: Endodontic implants, J. Oral Implant Transplant Surg., pp. 44-53, 1965.)

A

B

Fig. 13-15. An advanced case of periodontal disease. A, Bone loss and subsequent mobility are evident in the immediate preoperative x-ray. B, Five and one-half years later, the teeth are still functioning members of the dental arch and some bone has regrown. (From Orlay, H. G.: Endodontic implants, J. Oral Implant Transplant Surg., pp. 44-53, 1965.)

plant deeper into the bone (Fig. 13-14). In evaluating the success of the stabilization procedure, clinical soundness and adequate function should be the criteria rather than radiologic evidence (Fig. 13-15).

One of the most obvious uses of the endodontic stabilizer is to reestablish the proper crown-to-root mechanical ratio after an apicoectomy. By introducing stabilizer implants that extend beyond the bone removed at the tooth's apex into dense, undisturbed bone, the proper mechanical ratio is reestablished and the tooth is once again firm (Fig. 13-16).

Endodontic implant stabilization can be combined with post-crowning. This approach is particularly useful for stunted roots (Fig. 13-17) or roots shortened by resorption or mutilating apicoectomies, or when the taper of the root cavity is unfavorably divergent. Using a chrome-cobalt post as a sprue, a model is constructed for a stabilizer-plus-cone by direct inlay technique. The model is then cast in the usual way. After final shaping in the mouth, a jacket is made over the cone. Two or three sessions are required for this combined process, and the borehole