Patient had a defect in porcelain fused to metal (PFM) bridge restoration 11 (23) to 13 (25) and wanted individual teeth again due to difficulty keeping the area clean. Also, patient experienced pain on tooth #14 (26) due to reinfection of failing root canal. Pain and infection persisting for restore for more than 1 year.

The Endodontist Specialist recommend root canal re-treatment. The patient does not want re-treatment. The patient consented for zirconia implant to be placed at #12 (24), and extraction of tooth #14 (26) with bone graft for future implant restoration. The digital treatment evaluation was conducted with Scanora 3DX CBCT, Trios 3 Intraoral scan and the ZERAMEX files in 3Shape Implant studio. Formlabs 2 3D printer was employed for printing of a surgical guide.

PFM bridge, amalgam build up and decay (cavity) were removed with SMART (IAOMT) protocol. Decontamination of the teeth with chlorhexidine and ozone. Build up was done with composite build up material and re-prep for crown and bridge restoration. Surgical guide was used to place an all ceramic ZERAMEX XT RP (zirconia implant). To improve the healing process Protein Rich Fibrin (PRF) and primary closure chromic gut sutures were used on area of #12.

The provisional (temporary) bridge was made with Luxatemp for healing purpose. Surgical extraction of tooth #14 (26) was done. The surgical area was decontaminated with surgical curettes, burs, chlorhexidine, normal saline 0.9% & ozone. Surgical Piezo instrument was used for sinus elevation. Sinus and socket graft were done with PRF, B-TCP bone graft Augma Biomaterials USA Inc., Collaplug by Zimmer Biomet & nylon sutures. The case was conducted under IV Sedation by Dr. Luis A Alicea at Your Desired Smile, Tampa, Florida