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Infected #8, Pt wants implant
How would you guys proceed with this case? I am assuming we will need to rebuild the facial wall entirely. Thought about using a titanium mesh membrane tacked down after scrubbing the remaining socket out and placing pt on antibiotics. Question is should we go ahead and graft or wait to heal before grafting and membrane placement?
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15 Replies
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This is a great case to extract flapless and then do a semilunar vestibular mucosa flap (imagine you’re doing an apicoectomy). Clean it all out, place resorbable membrane and bone and close with small 5-0 sutures.
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What about this particular case lends itself to doing the VST type technique you mentioned. How is the graft kept stable to avoid movement? Periosteal sling suture? U have a case you can show?
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Graft is stable because its in the bony envelope, so the membrane that spans to healthy bone on all four sides of the defect is enough. Would be hard to tack or suture it down and probably unnecessary
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Question about the bone graft-which mix would you use in a case like this and how long for healing time? I assume 4-6 months, she’s an older pt so I’d lean more toward 6 probably but wanted to see how long you typically let the graft sit.
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Allograft corticocancellous mix, 6 months would be plenty and I agree older patients longer healing
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Hey thanks for your reply! I’m going to look into that, very interesting!
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So here is the result from the surgery. I was actually pretty surprised how simple it was. I will say, the soft tissue around where the infection had eaten through the bone and was into the soft tissue was a monster to try and detach from the periosteum. Anyways, here’s how it ended up. Pretty good result imo. We placed the mixture you recommended for the BG and did a MemLok membrane held in by closing the semilunar flap with 5-0 glycolon suturing, a ton of them haha.
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Awesome dude!
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Heck yeah glad it went so well!
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Great case! I learned a lot from it. Thanks for sharing
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Hi everyone.
Great case, graft looks solid. Pretty awesome advice from Steven V.
One question, just for the sake of knowing better. Wouldn’t be also a case option for non-surgical RCT, or Apicoectomy and grafting, and then, if necessary, an immediate placement?. Thoughts?
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I suppose you could! Would be a similar time frame, but also maybe cost the patient more money? Might be nice to not try to do ‘too many miracles’
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Nice job, Andrew! Send us some updated pictures when you place the implant.
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Coming up on six months would love to see a followup as well!
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I will get one for you, but it looks great! I’ll snap a new ct soon.
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