Smile Technique – Dental Implants

I want to share with you a recent case I completed.

This patient presented with resorption Tooth #10, fifteen years after a traumatic injury. As noted in the conebeam slice, the resorption was quite advanced and its prognosis was hopeless. In external resorption cases, bone is found within the root replacing tooth structure, so there is limited to no periodontal ligament and the tooth is frequently ankylosed.

Deciphering between tooth and bone is often difficult, but using the high illumination and magnification of a surgical microscope, this task can be accomplished with little insult to the bony socket. If immediate implant placement is the goal, preservation of the surrounding bone is paramount to maximize primary stability and to support the soft tissue profile.

Tooth removal required sectioning the root into multiple sections. The bony invaginations into the tooth were removed and the root sections were dissected from the surrounding socket. 3D implant planning and use of a surgical guide were employed. Note the narrow alveolar process and implant angulation. Planning for an angulated screw channel abutment or cemented restoration were known in advance. Once the implant was placed, a screw retained composite provisional was fabricated and set aside. The socket was meticulously irrigated and visualized under the microscope to remove any debris that may have entered the socket during fabrication of the provisional. Once this was verified, bone grafting of the socket was performed using a mix of cortical and cancellous bone. This was followed by a connective tissue graft to build out the gingival profile to allow for proper emergence profile. No sutures were necessary as the provisional held the graft in place. Only then was the provisional inserted.

This sequence of microsurgical steps, was termed the SMILE Technique by my mentor Dr. Dennis Shanelec – Simplified Microsurgical Implant Lifelike Esthetics. Data from several offices was collected which showed that this specific technique resulted in a long term success rate of over 99%, which is the highest implant procedure success rate that I am aware of.

Pre-Op. Not inflammation from resorption

Narrow alveolus and root resorption

Root fragments

Day of Surgery

Two week post-op