Bone Augmentation of the Alveolar Ridge at the Maxillary First Molar Site: Material Recommendations?

Autogenous Block Grafting or Membrane with tenting screws - it's not easy to grow bone occlusogingivally. If you have have never done this or received formal surgical training to do this, I'd refer to a periodontist or an oral surgeon. The above procedures are not something I recommend you experiment on your patients or perform on the fly with minimal instructions from this msg board.

I agree, if you're not proficient at less challenging bone grafting, this is not a good case to learn on. I also agree that the two options Dr. Kong listed would be my first choices. I suggest you refer and plan to go watch the procedure.

Dr. N, No x-rays? History? Hard to advise without more info. Room for short implants? Sinus lifts? Some implant types will help to hold the granules/membrane in place while a clot binds bone to them in one treatment. Sometimes you can nestle a wide implant up against the sinus and use a titanium healing abutment to hold space for new bone. John

Don't anticipate occlusal growth of bone. Let your patient be aware of the risks of bone blocks.

Do you have a tooth on either side? Assuming 2 and 4 still exist and one or both of the plates( buccal/palatal) still exist then this is a relatively easy case. I would not use a block bone graft, but rather a fine, morselized autologous bone, contained with a resorbable membrane and passive closure . The remaining plates either buccal or palatal, will do the work for you. All you need is five mm of bone in order to do a simple sinus lift. Bv

i advice not to go for bone augmentation instead go for boi implants

Dr. N , you might not believe that I'm actually responding in this fashion, if you are at all familiar with this post. I am typically quite critical , sometimes to the point of being sarcastic and even "condescending ", according to some, but I think this might be the easiest bone graft scenario you will run into, as long as you understand that, except for the rare exception ,most of these areas graft themselves , if you can prevent ingrowth of mucosa. I strongly believe that if you can simply get a good resorbable membrane under the buccal and plalatal flaps on sound alveolar bone and LOOSELY close the area with a biocompatable suture that can be taken out at two weeks, it doesn't really matter what material you use. I suggest real patient bone, but demineralized or mineralized seems to work well for this case, assuming you leave the buccal and palatal walls and graft immediately upon extraction. Then, the question has to be raised about the implant. Obviously different opinions exist. I am from the camp of a minimum of 13 mm of length and wide as possible. Some of these can be done without a sinus lift. If so, if there was ever a case for the neophyte , this would be it. Probably the single most important part of what you are doing is removing the tooth. So if you are not certain about grafting, let a surgeon remove the tooth as well. There is nothing that reeks of greed more , than having an extracted tooth sent to you for grafting. The race between the mucosa/ epithelium begins immediately upon extraction. So, in my little opinion , the time to graft is at the time of extraction. Don't tell any patients this, but I'm pretty confident that a well placed membrane, without any graft, in the right patient will generate very good bone??? Ha ha. Hope this is helpful. Good day. Bv

Buccolingual and occlusogingival can still be within the confines of the intact buccal and palatal plates . This is when semantics can bite you in the ass. I suggest , that you be more specific . Bv

You can use a bone block from a bank. Like community health. Use a screw to immobilize. Close gaps with putty. Cover with bioxclude and the most important ... Close it. Healing time 9 mths. Apply all basic skills and technique. Bioxclude is a great membrane. U can use granular bone instead of block

Block allografts?? I saw a patient last week that flew from baton rouge to philidelphia to have a block graft placed at the 9 spot, to prepare for an implant. All that remains is a single exposed screw and absolutely no bone, nine months later. I know this is an absolutely different scenario, but with all that we know today, I'm not certain I can honestly say I don't know of any indication for this product, except maybe as a sandwich graft. Bv

I routinely place implants in this scenario at three months. Nine months is a long time! That's coming from the guy that constantly says, what's the hurry! At the first molar sight, I have had good success placing the implant at the time if extraction. This, in my opinion , depends on the root and sinus anatomy. When you are placing a banked block, the entire graft has to be replaced before it can be used. Personally, this makes little sense to me. Bv

BV , I always like to speak with speakers showing block graft cases after me as we can always show full retention of the buccal profile after 5 or ten years and can thus show big close ups of this whereas they do not. The upper 1 st Molar is always an issue of the sinus and the best way forward can be prevention of bone loss. If there is too extensive bone loss then socket graft the site but if you can get an implant in with good primary stability then place and peri-implant graft ( done 4 cases like this in last two days )before the modelling and re-modelling of the bone occurs. This also has the benefit of retaining the buccal profile which would model if left for a few months. Peter

Peter , I think I agree! But who cares. I definately agree with statement suggesting placing implant immediately with graft, when fixture is torque stable. Bv