Buccal defect: how to deal with this?

Get some inventory please, if you are going to be placing implants, that's the first step. It's not fair that this patients outcome was poor due to your lack of planning. This is an anterior case. You can't afford to have it not go well. Open up ASAP and graft accordingly. The buccal crestal bone is crucial for anterior implants!!! You sound like you've had some experience with fortoss- that's an allograft, right?? You need to do a proper gbr, and there are many techniques available. But do it right away for your patients sake. If you can't, refer to someone who can.

For consistant results always graft the extraction sites with failing fractured posts especially in the anterior maxilla. Let them heal. I recommend human allograft since it is easier to drill thru and gives a natural result. Then place the implant possibly with a CT graft if needed. The implant will only be as good as the base bone especially in the maxillary anterior. It is not wise to cut corners on site preparation anywhere it will come back to haunt you. This site is full of complications on poorly prepared implant sites. This is tissue biology not technical dentistry like a core build up. Sb OMS has good advice, hopefully the residual bacteria in the failed implant are no longer present and it will heal. You compromised the result and that buccal crest will not grow back well in this area. The crest is important for long term stability other wise get out the pink porcelain. As a big fancy oral surgeon I routinely tell my patients that I do not know what I will find when I enter a site and may have to graft first for a better result they appreciate the extra time and concern. I also tell them that I don't know if an implant is integrated until I uncover it. Surgery is very humbling and I try to do my best to get a good result, we can't control healing. Y

Thanks for the advice.But like all of us, I am forever learning and want improve. I have since spoken to an oral surgeon colleague who recommended that I open the site and place Bio-Oss and a membrane and then aim to restore in 4-6 months. He even suggested Fortoss was fine, but he generally uses Bio-Oss hence his preference. I'll be seeing the patient next week so will aim to graft at the next visit. Anymore constructive comments and advise as always would be appreciated especially with regards to choice of material.

I hope that my comments are taken constructively, instead of working backwards to correct a problem, prepare the site optimally first then place the implant. I get that the procedure is already done and you got the fix from your colleague. Since you stated that you are forever learning then simply change the order of this treatment learning that the site needs to be prepared first. It is a consistent problem on this site which can be avoided. Leaving 3-4 mm of exposed implant with a v shaped defect then placing a patch four months later would not be my first choice. The implant width seems too small on a central but I don't have a film. My advice is given with good intent when I hear a defensive response, deep down I think you know what needs to be done. Please post the final result to see how things tuned out. Thanks for reading

Hi Hammer , there are a number of factors with all of this and maybe need to get more of a basic understanding of what you are trying to acheive and how the body functions . As you will know I have used Fortoss Vital for about 10 years ( It is an Alloplastic material , BTcP in a CaSO4 matrix so the graft is its own membrane ) . In this tiem I have done about 2,000 grafts , and 5 research papers including and animal study with the material although I do not use it anymore as have found another material that moves things on significatly results wise . Firstly root fracture of a post retained crown , ALWAYS and issue buccally and infected site as well . The buccal plate is as well bundle bone dependant on PDL blood nutrients which is disrupted with tooth removal. So a defect will exist as you saw at 10 weeks post xla . The protocol with the use of Vital was not followed and the outcome bears witness to this but it can be repaired and a specific protocol is required . Never be short of materials or Implants leading to the "iI will use what I have" philosophy , Implantology cannnot be a "part time " affair . Maybe e-mail me as or get someone to help you a bit . I think the 2 well known ,very capable surgeons above have said it all . Regards Peter

Hi Paul , just e-mail me at Scarsdale Dental address and we can arrange something . We are all always learning ! Peter

Hi Peter, I've sent you an email at Scarsdale. Hope to hear from you soon.

Hello there, Definitely you need to do a gbr here. You can use bioss, encore etc.. But with a resorbable membrane and with pins or screws to fix it. Always fix your membrane and trust me you will have much better results. Since you are doing a gbr in the esthetic zone i would recommend you to do also a gum graft at the same time . If you read all the articles (kan and al or others) about this subjet, you will be much more convinced. Like they said before, plan everything, do a cbct of the region, even for a single tooth . Good luck with your treatment