Debriding the sockets and provide Essix: Thoughts on Approach?

This patient has a persistent infection. The buccal bone is most probably gone or severely damaged so that it's repair with simple socket grafts will be unpredictable. You also have quite a bit of bone loss on the cuspid in the radiograph. It is also very unlikely that you will get complete debridement just through the sockets. There is too much soft tissue involvement from the buccal. Using B-TCP for a graft is not a good idea because it takes too long for it to be resorbed and bone volume and quality with that material is unpredictable. You don't want to depend on B-TCP granules for primary implant stability later. A better approach is to do a flap including 2 teeth on each side of your defect, but only a vertical release on the distal, not on the midline. Complete debridement and reconstruction with an Irradiated Cancellous Human Bone mono cortical block. Carry your osteotomy completely to the Piraform rim and remove the Anterior Nasal Spine so your bone receptor site is very flat and uniform. Mortice your bone block in place so it is immovable. Screw it in place with 2 screws and add ICB chips all around. Cover with pericardium membrane tacked in place with at least 2 tacks. Complete, water tight closure is essential. Make sure you don't have any sharp boney corners. You can expect a little vertical growth, but mainly good healthy bone for your implants and soft tissue support later. Prescribe at least 800mg Clindamycin per day for 20 days. The AAID website has a good video by Dr. David Resnick on this very type of graft. Using an Essix temp. is a good idea. Wait 6 months for your implant placement surgery and consider your patient's biotype for a possible frenulectomy/vestibuloplasty.

This case as seen in the radiograph provided, and described in the text, is not a simple case, and certainly way beyond the capability of the doctor who is asking for advise. Implant dentistry is a wonderful discipline to get involved in....but novices must learn to walk before they can run. I think Dr. Hacker's comments are excellent, and he explained the ultimate treatment in great detail... it is not for a beginner......take courses, join the AAID or ICOI, subscribe to Dental XP,etc. ;go to the meetings....get familiar with the techniques and the materials, and a novice can learn to run with the big guys. Gerry Rudick, Montreal, Canada

They look like upper left teeth to me ! You could always just extract the two teeth and debride the lesions through the sockets and any existing buccal defects, then allow to heal naturally without any interference in the form of biomaterials, then reassess in a couple of months. If the patient will accept slightly longer teeth, then the case can be done with GBR done simultaneously with fixture placement at UL1. Perhaps a CT graft at second stage for pontic site development. And warn the patient that the bone loss at the UL3 will mean no papilla will form here. However, if patient has high aesthetic demands then refer to someone with vertical bone regeneration skills and a thick skin ! Regards Paul McDonald

All the above have made excellent suggestions. I recommend a wide flap and deride after extraction and consider a bone ring approach. Dr Thacker's advice may be the ticket. Scan the site and preplan.