Implant placement
tooth
Atraumatic extraction of the tooth or remaining root using a No. 15c lancet and periotome to cut gingival fibers of periodontal ligaments was performed. In one case, we encountered a fractured root at the apical 1/3, where we carefully separated the root with a surgical bur mesiodistally (Cat eye slit technique) and removed each fragment separately. In another case, the remaining root was luxated but difficult to grip, so we removed it with a large manual file, which engaged the root canal and facilitated the root delivery. (Fig. 
Atraumatic extraction of an endodontically treated remaining root using a large endodontic manual fileThe implants were then placed after sequential drilling using the surgical guide. Any implants recording initial stability less than 35 Ncm weren’t subjected to immediate loading and were excluded from the study. One experienced implantologist has performed all the implant surgical procedures.