Ridge augmentation for perforated alveolar bone prior to implant placement?
I saw a patient with missing tooth #9. Patient needs a dental implant. Cone beam CT reveals about 4.5 mm bucco palatal width but there is apical perforation of alveolar bone visible about 6 mm apical to the crestal bone. Patient had gone through apical surgery for # 9 in the past and was unsuccessful and eventually the tooth was removed. How do I predictably augment bone in the area of perforation where I am missing both labial and palatal plates of bone? The area of perforation measures about 4 mm in bucco palatal width and 3-4 mm in vertical height.
3 Comments on Ridge augmentation for perforated alveolar bone prior to implant placement?
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Tuss
3/2/2015
I would open up the site, thoroughly curette it as it is probably a mass of granuloma/ fibrous tissue, graft the site then leave for the graft to mature before placing an implant. You should be able to do that with particulate and a membrane
Peter Fairbairn
3/3/2015
Routine , as many case show these areas as we are often dealing with sites where teeth are lost due to peri-apical pathology.
MY standard protocol is to remove tooth , leave for 3 week to get soft tissue healing , raise small flap , currette site very well , place Implant slightly palatally and graft around implant in defect site and buccal plate remnants with a fully bio-absorbable synthetic graft material that sets ( Stable ) without the use of a membrane for improved healing ability .
Load in 10 weeks ...
Peter
CRS
3/3/2015
I concur great technique, I supplement with the nd-yag to disenfect. I do it all at extraction but have to be aware of moving the soft tissue margin in esthetic zone. I only place the implant if socket morphology is amenable to primary stability, it's a judgement call. I will get primary closure with flap release or I'll place a membrane.
