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I 25 case report _ endo-implant algorithm I roots1_2010 implantsothatallthediastemaswouldbeclosedand the dentition properly aligned for this procedure. The patient clearly understood the concept and the logistics of the orthodontic treatment recom- mended but expressed no interest in this approach. _The bigger picture It is very important in evaluating treatment using implantstoconsiderthewholedentitionandnotjust the space or tooth in question. It should be borne in mind that implants, unlike teeth, do not move, so if there are any misalignments in the dentition, orthodontic treatment prior to implant therapy is imperative should the patient proceed with the dental implant at a later stage. If the treatment plan is not in this sequence, the dental implant could be- come a challenging obstacle during the orthodontic treatment. The patient was prescribed Amoxicillin 500mg (one every six hours, beginning two days before the next appointment) and Chlorhexidine rinses (three times a day, also beginning two days before the next appointment). The use of tartar control toothpaste was also recommended in order to avoid staining of teeth.Onthedayofsurgery,thepatient’sbloodpres- sure was 119/73 with a heart rate of 76. Under local anaesthetic (Lidocaine 2% HCl with epinephrine 1/50,000 x 2cpl) and using a dental rub- ber dam, magnification loupes and supplementary illumination, the tooth was sectioned into three pieces. The rubber dam was removed, and using PDL- Evatorelevators(Salvin)allthreerootswereextracted without any complications. Spoons were used to curette the socket in order to clean any granulation tissue and engage the cancellous bone. This crucial step results in some bleeding and thus promotes angiogenesis. The crest of the interradicular bone was engaged with the socket cupped part of a XiVE osteotome (DENTSPLY Friadent), and a sinus lift was performed using the Summer’s technique. Therewerenosignsofasinusperforationbasedon the Valsalva test. The sockets and sinus-lift area were Fig. 6_Guide pin in osteotomy following use of 2 mm pilot drill. Fig. 7_Radiograph showing XiVE osteotome in place during the osteotomy. Fig. 5 Fig. 6 Fig. 7 Fig. 2_Bitewing X-ray after decay had been removed. Fig. 3_Grafted socket following extraction. Fig. 4_Peri-apical film showing healing of grafting material after four months. Fig. 5_Pre-op film on the day of surgery. Fig. 2 Fig. 3 Fig. 4

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