Dr. T. asks:
I performed a block bone graft with the hopes of having enough vertical and horizontal bone augmentation on the deficient alveolar ridge for placing implants in #6 and #7 sites [maxillary right canine and lateral incisor]. According to the CT scan, the bone is thin and is lacking in density. I’m not sure if I will be able to achieve primary stability. If not, do I have to go back in and to remove the titanium screws that I used to hold the block graft in place? What would happen if they are left in place? If I cannot place the implants, I do not want to do another surgery if I can avoid it.
Should I Remove Titanium Screws to Hold Block Graft in Place?
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No disrespect here, but are you trained in the management of block grafts? Vertical augmentation in the anterior maxilla is THE most difficult reconstructive procedure to do correctly. From your questions it appears that the viability of your graft is questionable. What was the source of your graft? Fixation screws do not need to come out unless they interfere with implant placement. Sounds like you need to go over your scan with an experienced practioner.
That’s probably why we refer them out….
Refer this case out.
Refer the case and pray you do not get sued by the patient if you are not sure what to do about this. Refer to someone you can trust.
Providing you made a good receptor site for the graft and you intend to place implants, give it anout six to eight months, then back out the screws.
Do not it befor placing the implants unless its presence interferes with impalnt path of insertion.
There is a danger of block detachment after healing period due to the fact that implants are wider that the final drill in 0.5 mm.
Why not go ahead and use a mini implant they seem to be the cure all, and you can probably maintain the graft and get an implant into it. Just cure a denture tooth on the mini implant for the crown. You probably wont even have to raise a flap.
Remove the Ti screws after 8 months. Feel for the screw and make a vertical incision (no scar).