Buccal bone defect in upper lateral incisor region: thoughts?

Best to graft a bit and with a fully resorbable material that turns over to host bone , this will also help with the soft tissue stability and biotype .

Flapless ridge split and expansion would be appropriate treatment.

Ridge expansion using osteotome without raising flap would be my suggestion.

Sorry my previous comment was incomplete. I would do remote palatal incision without raising flap and ridge expansion using D shaped osteotome and bury the implant. Second stage in 12 weeks with transitional restoration. Good luck.

The base problem with this site is that even with ridge expansion, you likely won't have enough buccal bone (1.7-2mm is optimal). This is a straight forward GBR case if there is proximal bone low enough on adjacent teeth. Do papilla sparing incisions to preserve what proximal bone there is no matter what route you choose. I'd prefer the GBR and have you start ridge expansion treatments on maxillary posterior teeth as a buccal plate fracture at this site makes it a staged procedure, whereas what you've shown looks like you could place the implant and the bone addition at the same time. Good luck.

The above doctors are all correct, depending on philosophy. I would expand with Densah burs and subsequently graft with a reservable particulate, if needed.

With all things being considered, I think Greg‘s got the best treatment plan and the most predictable result. If you do ridge splitting without a flap, my question is how do you account for the opposing occlusion

Here is a link to a video that was made before we had platform switched implants with internal connections and discovered that implants rarely need to be longer than 10mm. It may have been recorded before we had 3D tomography. Dr. Hilt Tatum was a pioneer and a master clinician. https://www.youtube.com/watch?v=j4Qfnd1tJPs

Since you only have 5.7 mm of bone you would place a 3.0mm implant and graft the facial. The problem is that you will have to place the implant too far to the lingual due to the defect. I agree this should have bone grafting first and then place the implant at 4 months. Versah spreading is an option but to split in a one tooth area in the esthetic zone is much more risky and contra-indicated in my opinion.

I see no problem placing the implant with a particulate contour graft and a thick connective tissue graft all in a single visit

Like Dr Greg K. and Dr Callan suggested, graft bone and GBR to get at least 3mm more B/L width followed by addition to tissue thickness via CT Graft or FibroGuide Graft (new from Geistlich) because your tissue will thin out when you perform GTR. Can't have enough of either for long term stability! Fun case!

bone graft first, implant later. Treat this pt like you would do for your mom!

Ossix Volumax would probably be a great grafting option for that case.