Unconventional implant treatment: I. Implant placement in contact with ankylosed root fragments. A series of five case reports

Objective: Implant treatment presumes that implants are placed in bone, without any contact with root. At ankylosed teeth, complete root removal is often invasive; subsequently, the sites require additional augmentation procedures to complete the treatment. The aim of this paper is to report on a series of five cases that have been treated with an approach that avoided extractive invasive surgery and bone damage. Material and methods: The procedure consisted of preparing the osteotomy site by drilling through the root. At the end of the drilling sequence, the root fragments that were not removed were deliberately left at the osteotomy site. Their mobility was checked with a dental pick and when stable an implant was placed in contact with them. The sites were required to be asymptomatic and inflammation free. Ankylosed teeth were replaced with 13–15‐mm‐long Osseotite implants, four in the anterior maxilla and one in the anterior mandible. Results: All implants healed uneventfully; they have been now loaded for a period of 12–42 months. On peri‐apical radiographs, appearance of the bone–implant interface was similar to osseointegrated implants. The remaining root fragments were visible, in contact with the implants; no specific pathological sign could be detected. A limited resorption of dentine was found at one site after 4 years. Conclusion: This series of cases suggests that implants placed in contact with ankylosed root fragments might not interfere with implant integration or harm occlusal function, at least in the mid‐term. More cases are warranted before this procedure might be considered as a reliable clinical option when, at ankylosed teeth, one wishes to avoid an invasive extraction surgery.