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#20, 19 grafting
#20 is planned for an extraction. Patient wants to know fixed options so my thought is bridge #20-x-x-18 (not the greatest option due to bone loss on both abutment teeth) or implant #20 and #19. The ridge width around #20 is naturally narrow (6.5-7mm – virtual implant I placed Is 3.5×8.5mm). #20 also has 4mm buccal recession/dehiscence (see picture).
From a grafting perspective, how predictable is it to rebuilt these 4mm buccal wall height? What would be your grafting strategy here to achieve this if possible? My thought is to extract then use reinforced PTFE (collagen membrane under PTFE), xeno/allograft mix, take out reinforced PTFE in 6 weeks.
I also drew dotted lines in blue to where I will think the ridge shape/height will be if NOT attempting vertical augmentation with reinforced PTFE.
Also I am concerned with depth of implant if no vertical augmentation is achieved (7.3mm from platform to gingival margin, which is very deep). My plan is to be between 4-5mm for all my implants.
Thank you for your help.
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1 Reply
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Lots of different options and ways you can do this procedure but you need to remember what is best in your hands and what you are best trained and comfortable to do. Reinforced ptfe could be done but is much more extensive of a procedure and tissue manipulation are key for success and you would need to keep that in for a minimum of 5 to 6 months not 6 weeks. for #20 you could just do a socket preservation and put a resorbable collegen barrier membrane on the buccal and come back in 5 months or so and place an implant on #19,20 (if #19 has sufficient bone width) and then do a new crown on #18. If not enough bone on #19 you could do implant bridge as discussed from #18 to #20 but much better to keep #18 if restorable and if no need to extract. I would not do an immediate implant on #20 b/c you would need to bury implant too deep and would be difficult to do well looking at the cross section b/c of buccal placement of the socket and very thin buccal plate with dishiscience. Hope this helps. Good luck!
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