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Try to re-graft again or consider a Bridge?

Last Updated: May 12, 2016

This 57-year-old male was referred to me in order to extract two teeth — #7 and 10, complete any regeneration necessary, and place implants in the sites to be restored by the referring dentist. After extracting #7 and degranulating the area, I placed a resorbable collagen membrane on the palatal aspect and human demineralized freeze-dried bone, mineralized cortical bone were grafted into the socket. I did not a lay a flap. I placed a second resorbable collagen membrane over the graft and sutured it in place. Site #10 was a bit more complicated due to the fact there was an apical lesion which extended to the facial as well as the palatal defect, which was extremely large. Again both sites were grafted as before and membranes were placed. Postoperative healing was uneventful. The second CBVT was taken 8 months after the original procedure. Should I try to re-graft #10 as before but lay a palatal flap for the surgery? Or should I quit while I am ahead?

4 Comments on Try to re-graft again or consider a Bridge?

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CRS

5/12/2016

You needed to remove ALL the pathology at the extraction. I would have raised a released flap visualized the defect and repaired it. The collagen membranes are not magic the surgical principles needed to be adhered to. Now a revision is necessary creating more scar tissue in an esthetic area. The implant needs a solid healthy base to succeed. The pathology is significant thru to the palate and at the floor of the nose. I like to send spec to r/o Actino. The area will not regenerate with pathology present and it is now nicely seeded thru the graft. Remove it and start over the optimal way, if you are uncomfortable with this refer. ,

Sboms

5/12/2016

I would want to see more images from your scan. I think what your seeing here may be slices through parts of the incisive canal and foramen. Can you repost with a few axial slices through the anterior maxilla?

Peter Fairbairn

5/13/2016

Haha read the case and as usual CRS has said it all already ... site preparation is vital as well as a material that fully turns over to true host bone ... Peter

yasser niazi

5/18/2016

check her medical history properly...... may be she is taking fusomax . if not ,, any site can be grafted .. but then you should use reinforced titanium membrane and l prf . take care

try to remove abutments but cant find access hole any ideas trouble with parallel dental implants