The anatomical crown of the extracted tooth was

The anatomical crown of the extracted tooth was sectioned off and the screw access hole was created on the palatal surface of the crown (Fig. 7). A screw retained provisional abutment was placed onto the implants. The natural crown was steam cleaned, treated, and connected to the temporary abutment rifampicin with flowable composite resin intra-orally with an aid of a position index (Fig. 8a and b). The connected provisional restoration was then removed from the implant and composite resins were used to contour the sub-gingival portion (Fig. 9a and b). It is crucial the subgingical contour supported the peri-implant tissue.
Upon completion of the screw retained provisional restoration, a tall, flat-contoured healing abutment was placed onto the implant prior to the placement of bone graft materials. The healing abutment allowed the grafting materials to be placed and packed against it at the same time prevented the excess from entering the screw channel. A xenograft bone graft material (Bio-Oss, Geistlich Pharma AG) was used to fill the gap between the implant and the buccal wall as well as the space above up to the most coronal aspect of the free gingival margin (Fig. 10). The healing abutment was then removed, leaving the bone graft material intact. The prepared provisional restoration was subsequently screwed onto the implants and the access was sealed with a temporary material (Cavit temporary filling materials, 3M, ESPE). The occlusion was adjusted to clear all static and dynamic occlusal contacts (Fig. 11). The technique resulted in minimum alteration of the patient׳s esthetics (Fig. 12).

Tooth removal results in marked rifampicin in buccal–lingual alveolar bone width [14,15]. Araujo and Lindhe showed that the reduction of the dimension of an extraction site was due to the replacement of bundle bone with woven bone from the inner portion of the socket and the resorption of the outer and crestal portions of the buccal–lingual socket walls [16].
Various techniques have been proposed to place implants immediately following extraction [17]. Assessment of the morphology of the pre-extraction socket is essential. Elian et al. classified the extraction site based on the presence or absence of the labial and interproximal bone, and its overlying gingival tissue and papilla surrounding the compromised tooth to be extracted [18]. When a socket is not compromised, described as a type I socket, the use of bone graft coupled with flapless surgery can help limit the amount of buccal contour change [11,19,20]. The grafting materials are then contained by the provisional restoration.


The main goal of cleaning and shaping the root canal system is to prepare the root canal, thus creating adequate space for copious irrigation and three dimensional obturation [1,2]. Use of inflexible stainless steel instruments in curved canals can cause iatrogenic damage to the original shape of the root canal [3]. This damage can be in the form of canal transportation, ledge formation or perforation [4]. To avoid recessive damage, nickel titanium (NiTi) instruments with shape memory and superelasticity were developed [5]. But NiTi instruments carry inherent risk of instrument fracture and root dentinal crack formation [6,7]. These root dentinal cracks can further progress to root fractures resulting in failure of root canal treatment [8].
Most commonly NiTi instruments are used with two types of movement: first is continuous rotating full sequence and second is reciprocating. Torsion and flexion occur with continuous rotating NiTi instruments while preparing root canals, which can lead to instrument fracture. To avoid this, reciprocating movement was proposed [9]. This movement minimizes the stresses on instrument by counterclockwise (cutting action) and clockwise (release of instrument) movements [10]. Reciprocating movement claims to mimic manual movement and reduces various risks associated with continuous rotating file systems. But reciprocating systems with small and equal Clockwise (CW)/Counterclockwise (CCM) angles have decreased cutting efficiency, thus making progression into canal more laborious [11].