Sir, a male 41-year-old army officer presented for a periodic dental inspection. On examination a metal ceramic crown was noted on the upper right central incisor and review of his radiographic records showed a long diodontic implant (material unknown) in place, retaining the crown, and extending almost to the base of the nasal cavity. Surprising is the appearance on the radiograph (Fig. 1), showing extensive root fracturing in the mid and coronal portions. Despite this, there is no evidence of bone loss, resorption or ankylosis radiographically. The tooth presents no associated soft tissue abnormality, mobility or periodontal pocketing clinically.

Figure 1
figure 1

Long diodontic implant

Full size image

As to the history of this tooth, the patient reported having clashed heads during a rugby match aged nine, and this tooth being subluxed well into the palate, with the crown sheared off 'almost to gum level'. The first attendant dentist reduced the luxation on the day, and used the recovered natural coronal portion as a temporary restoration. The patient's own dentist placed the implant a week later, again using the natural tooth as a temporary restoration. The existing crown was placed ten years ago once the natural tooth had become discoloured. The patient's main recollection of the event was that his mother dropped him at the surgery and went shopping for the hour required to complete the procedure.

The endodontic-endosseous (EE, diodontic, or trans-radicular) implant has been in reported use as far back as Pharaonic times. Modern history shows this modality gaining popularity in the 1960s, particularly in the USA.1

For reasons including poor case selection, improper use of materials and poor bone bed preparation for the implant, as well as post operative infection, this treatment modality suffered high failure rates. Common materials used for the implant post were steel, cobalt chrome, vitallium alloy, titanium, as well as hydroxyapatite-surfaced metals.2

The procedure fell into disuse, largely due to the predictability of osseo-integrated endosseous implants, in the West at least. Although the conventionally published literature (mostly case reports and commentaries) peters out for EE implants during the early 1990s3 it seems from wider online searches that this is still very much in use in developing parts of the world including Egypt!