The patient is a 39 yo female who underwent extraction of #10 two years ago without socket preservation bone graft. She has worn a flipper in the interim.
She now wished to consider and implant. Evaluation of the available bone shows very narrow bone facio-palatally. Based on ideal implant position, additional bone would be required both on the facial and palatal.
Very few options for reconstruction of bone.
Suggestions?
Thanks.
LG
Herman Comlekci comments:
I would suggest to do a Ridge Split with Piezo bone saws, expand the ridge with Densah burs and simultaneously place an implant. It's important that you have ample experience in performing these procedures otherwise things can go sideways quite fast and you'll be knee deep in #$&@.AJM comments:
Use the versah drills. And a bit of a ridge split tech. Drop in a 3.2 c 10. Graft the buccal. And done.Greg Kammeyer, DDS, MS, D comments:
Unfortunately ridge splitting is a poor option. A one tooth site with a narrow ridge will more likely fracture than split. This is a great case for GBR. Pick up Istvan Urban's book ...an EZ read. Take a course or 2 if you need more information. Happily the bone height is good and horizontal augmentation works well.Dr Jeffrey Hoos comments:
Change the angle. I wish all my implants had this much bone. How about growing bone and then placingTim comments:
Fortunately this is a routine procedure and probably needs only soft tissue augmentation to facilitate ideal contour. This is a nice looking lateral incisor site and you clearly have some neat bells and whistles at your disposal in order to obtain these images. Nothing fancy is required here except for a reasonable degree of surgical competency which contrary to popular belief can not be obtained by a simple to read text or a weekend of corporate sponsored propaganda.MW comments:
I agree with Dr. Kammeyer. GBR and let heal. To those of you who say ridge split or place, you must be a lot better than me and I would love to see some results. Cheers!Greg Kammeyer comments:
I would esp like to see 5 year results on ANY ridge expansion with this little amount of bone. If it's less than 2mm of buccal bone and or manipulated too much, bone die back often occurs. Ridge splitting also puts the buccal/incisal bone plate more apical...so that needs to be considered for esthetics. Herman's comment about "things going sideways" would be expected with a ridge split here.
