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Ridge Augmentation
Hi I extracted tooth # 19 about 4 months ago and grafted it with 50/50 cortical cancellous bone and resorbable membrane.
I saw the pt today and felt like the bone could be more dense in the extraction site. Looking at the photos you can see that the ridge was 9.7mm and now it’s 7.8mm after 4 months.
I was going to drop a 4.5x 8.5 in the site, but ideally I wish I could put a 5mm into the area.
My biggest concern is how soft the bone is going to be. I imagine that most of my retention will come from the apex.
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3 Replies
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Hey Anthony,
Thanks for the question.
4 months is usually a sufficient amount of time to wait before placing your implant–unless there is some underlying medical condition. For example, diabetes or smoking can alter healing.
I can definitely see the dimensional changes you mentioned, but the bone inside the socket looks how I would expect it to look.
What I do see that is missing though is a nice cortical shell formation at the top of the socket. If you wait longer, sure, you will get a better cortical plate formation for you to feel more comfortable placing your implant. But I think it is also totally possible to place an implant as is.
As far as size selection, I would be comfortable with a 4-4.5 mm width and a 8mm length. The position of your ruler over the site is not exactly on the bone (the lines extend out a little bit) so I would rather be a bit more conservative.
If you feel more comfortable and the patient is not in a rush, you could definitely wait a little–perhaps 2 or 3 more months before placing your implant. However you would not be wrong to place them now.
Your opinion on this @vorholtdds ?
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Thanks so much for the reply- you would feel comfortable putting in a 4mm in a molar site? I don’t have the mesial distal with of #19 site right now, but I imagine it to be around 10mm.
From my understanding, molar sites should be at least 5mm to prevent implant fracture, and to counter act the force of an opposing molar.
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This reply was modified 1 year, 9 months ago by Anthony.
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Great question. 4.5mm for a molar is okay.
However, it’s hard to give a cookie cutter answer. It comes down to the platform design, the titanium grade, and the occlusion.
So if you have a 4mm implant with a good emergence profile, and its made with titanium alloy and the walls of the platform are not thin, and occlusion is light or non-existant–it will likely be fine.
but conversely if you have grade 4 titanium implant, with thin walls (for example trilobe connection) and heavy oocclusion, you are in for trouble.
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This reply was modified 1 year, 9 months ago by
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