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Jedediah posted an update
What in the Trauma is going on? Ok, you all wanted implants and bone grafting so here ya go…
This was a challenging case to say the least, especially when it’s your mother. She fell and fractured 3 of her front teeth amongst other things. A few hours later I had 3 teeth extracted, extracted sockets grafted, ridge augmentation complete, 8 intraoral lip sutures, and for good measure 10 hand sutures.
A few challenges were: very little keratinized tissue, thin biotype, very little room to maneuver and work from an anatomy standpoint, and the patient had very little bone width from the beginning to work with. In these cases a well done ridge augmentation is a must for the needed bone and biology of successful long term implants. My “go to” for these cases are typically allograft particulate saturated in growth factors received from the patients blood (CGF/PRF) and a resorbable collagen membrane. Proper release of the soft tissue to allow the needed tension free closure with nonresorbable sutures are also a must for me.
Reentry was between 5 and 6 months and we more than doubled this patients bone. Pay close attention to the before and after CBCT cross sections provided to really see the huge difference.
Three single implants were placed and a very palatal incision was made to help improve the amount of keratinized tissue in this case. My perio friend also made an appearance and jumped in to do a soft tissue graft to help thicken and improve the soft tissue around these implants for the best long term prognosis of the implants. Three single implant crowns were made along with a few other crowns to help make this smile complete.
rroque29, mohsen2610 and 5 others7 Comments-
Bro, those are some CRAZY gains
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@ivan-chicchon thanks Ivan. Always nervous for that follow-up CBCT but it feels great when the patient responds and heals like they should.
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Is this basically done in two stages? One for graft and one for implant placement?
Dude you bulked that up considerably. I am always cautious about overbulking to much—just due to nervousness on my end. But you totally disprove that. Do you just go HAM on the amount of allograft as long as you can get passive closure?2-
@ivan-chicchon yes, it’s done in two stages in this particular case. More often than not If there is sufficient bone even though not for the long-term I will actually place the implants and do a simultaneous ridge augmentation at the same time which there is a great research article that shows the success is basically the same when indicated.
You always want to overbuild because you never know how the patients gonna respond to the treatment. In an early case I posted on here We actually tripled the bone and I got a complaint that it was too bulky from the patient, which is probably the best complaint I’ve gotten And that was easy because I can just go in there and smooth out and remove more bone. Proper flap and incision design is crucial in these cases to ensure passive primary closure.
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Incredible job! Was the graft handling like sticky bone?
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@RYAN thanks Ryan, the bone graft handling of sticky bone is amazing and worth doing just for that aspect even though so many other benefits. Especially, is cases like this where ridge augmentations are done it is very helpful to better place, shape, and position the bone graft to help rebuild walls and get more vertical and horizontal bone gains as it adheres to the bone and biology well.
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Great case!! Love to see these. My question is about the collagen membrane chosen, what kind? How much should it last? Why not PTFE reinforced? Thank you all
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