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Deficient palatal bone wall: best approach?

Last Updated: Jun 20, 2017

I have a female patient in her mid-forties who is a non-smoker, stable periodontal status, and non-contributory medical history. She presents with missing 12-18 on her maxillary right quadrant. Her chief complaint is that she wants teeth on her maxillary right quadrant replaced.

I have treatment planned her for implants in 16, 14, 13, 12 sites. In 14, 13, 12 sites I have planned closed crestal sinus lifts with GBR. I will allow the graft to heal for 6 months then place the implants. I will use regular platform implants for 14, 13, 12.

After CBCT analysis, I noticed the deficient palatal bone wall on slices 48 and 50. I am not sure what this is. What could it be? Has that wall been lost due to trauma or draining sinus, or is it actually an anatomical structure? What will be the best approach in this case? Should I open the flap and graft and re-enter again at 3 months? Should I leave this implant out from my treatment planning?

9 Comments on Deficient palatal bone wall: best approach?

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Dennis Flanagan DDS MSc

6/20/2017

I'm a lover of flapless split and expand ridge augmentation. Which may work nicely here. However, this cannot be your first ridge split case.

Raul R Mena

6/20/2017

Please enlighten me as to were there is a need for sinus lift of for bone expansion in this case. By the way also explain as where is the need for GBR or what do you mean by GBR in this case?

Merlin Ohmer

6/20/2017

No need for a lift. Expand the ridge. You have lots of length. Measure further down and see if you can get width if you flatten the ridge some.

Cesar Gutierrez

6/20/2017

First I do not recommend you place the implant in the 16 site. You ll have a higher implant failure rate in this region. It's also a uncomfortable place to do the surgery. For what i see Why not a ALL on 4 or ALL on 6 upper jaw. I can not tell you anything because 48- 50 Slide not found.

Carlo

6/21/2017

Where are slices 48-50 in the cross sections? Are you referring to the markings in the panoramic view?

mehrangaroosy

6/21/2017

This image is from slices mentioned above.

Carlo

6/22/2017

Most likely, the result of some pathology. Why were theeth lost /extracted? How about placing implants in 1.2, 1.4 and 1.6 only thus avoiding the area and maintaining some distance between implants?

mehrangaroosy

6/26/2017

I am not sure carlo,even I place one fixture in slice 52,distal wall still will be in the lesion.

Carlo

6/26/2017

Even so, the defect can be grafted at time of surgery after removing/perforating the cortical lining

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