Best regenerative option for immediate implants?

just curious- whats going on with the other anteriors- are they present? Whats your treatment plan? Don't put brand new windshield wipers on a broken windshield. more info is needed....

Where are the other teeth? What teeth does the patient have? There must be a brutal gingival recession. I think you have the feeling you will gain a lot of bone and you won't with simple GBR. You will gain good bone with bone distraction but maybe you should ask a OMFS for help and this only makes sense with a fully rehabilitated maxillae, not just 11 and 21 implants. Once again tell us what teeh the patient has and/or upload panoramic.

I just can't imagine othjer teeth that you don't see here being sound when #8 and 9 are like that..

In cases similar to this we have had clients use the SteriFuse DBM with the Bioactive glass to gain stability and induce osteogenesis at a faster rate. For the membrane our amnionic membrane (BioXclude) is great for soft tissue regeneration due to the growth factors in the amnion necessary for tissue regeneration. You can find case studies and more information at our site. this may be a great option for you. I hope this information was helpful.

Blake, the Bioactive glass induces osterconduction not osteogenesis. I know the terms may be confusing, but there is a significant difference.

What is the status of this persons dentition and overall oral and systemic health?

Just can´t understand that question!?!

Dr Uli Friess, you may want to read the chapters in Dr Carl Misch's text book that relate to bone graft materials, bone grafting and socket preservation. They will get you started in the right direction. Buser also has an excellent book.

If you listen to all the answers posted you will hear the same question: What is your treatment plan? Give a little more information about the condition of the arch. Are 8 and 9 the only remaining teeth? In that case placing implants in 8 and 9 would be of little benefit for the patient. There are several protocols and philosophies for doing what you want. Immediate, delayed immediate, and delayed implant placement. Depending on your prosthetc treatment plan, each has advantages. Please give more information and good luck!

Dr Uli you make good points. We need more information, starting with a medical and dental history, chief complaint etc.

Show me a panorex and a treatment plan.

That's what we may call it Implant Rush!

These teeth are obviously periodontally compromised. It is reasonable to assume that if there are other teeth present they will also be periodontally compromised. Placing implants in a periodontally infected mouth will lead to certain failure. Treating cases like this is becoming increasingly common for periodontists which places everyone in a no-win position. The grafting protocol is not relevant. If you know what you are doing, you can make a lot of different things work. The surgical aspect of implant placement is not as easy as many are led to believe. Every case requires a comprehensive diagnosis and treatment plan. That should be step one in this case.

Stop! Get a 3 dimensional scan. Rethink what "you would like to do". My 2 cents. Best of luck!t

does this scare anyone? The questioner wonders if immediate implants will work in this site and what grafting materials should be used. These centrals and the surrounding periodontium look horrible and there are no other teeth to be seen. I think this patient should be referred to a prosthodontist to evaluate the remaining dentition and work out a treatment plan before deciding upon a surgial protocol. Please, if you are new to implant dentistry, do not take on involved treatment such as this. Take CE courses and start slow. The patient has their trust in our hands and we should respect this and not get too far out of our comfort zone. Why do I say this? I'm a prosthodontist and continually see mismanaged patient treatment that both frustrates the doctor and burns out and makes mad the patient. There is a reason there are restorative specialists so please, use us as a resource. Come to our offices and ask questions. We are more than happy to help, especially before treatment is started!

Well said, Mike. I have to wonder whether this posted question is even legitimate. Anyone who places implants would anticipate the kind of questions and criticisms that have been generated by this one. It is also interesting that we have yet to see any response back from the original poster of the question. I have posted two cases to date and am always eager to see the responses and to reply back to any of the comments.

it is very important to know bone condition fully rather than only for two teeth.the bone seen shows case for extractions and requires plan of tr.in advance.

The last thing this patient needs is two implants. There are no teeth next two the Perio involved centrals. We can see that much, from the scant information provided. Treatment planning, is by far, the most important thing we do!!! Next case!!! Bv

With the decay on the distals of both centrals, I must assume that the patient is wearing a partial denture. This type of bone loss, with a reduced vertical dimension and rotational torque of the appliance, is classic for the premaxilla. You are asking the wrong question. You would obviously add teeth to the appliance following the surgical procedure; graft, implant placement/graft. How are you going to protect the surgical site? How will you prevent microtrauma from the appliance from resorbing the grafted bone or causing micromovement/failure of an implant? Any type of grafting procedure will work, providing you adhere to basic surgical principles. As previous posters commented, success in these cases is in the treatment planning stage, not the surgical execution. RJM

I did not read any of the comments so sorry for any duplication. 1) I dont think you r going to replace 8 &9. You will probBly wind up making an implant retained denture or hybrid. Considering this 8&9 will not be where u want the implants.

Sorry for being late in replying to your posts...i am in a sick leave and have done a knee arthroscopy in my knee..concerning that case, the upper left quadrant is edentulous, and i was planning to place as many implants as i can to restore it , beginning from the 2 centrals posted in the question...

as far as i remember the case, the patient still have a last molar tooth posterior to the edentulous space, which i did not consider in the treatment plan..