Anterior Implant with Augmentation: Precautions?

I have a 43 year old female patient missing her upper right central incisor. She has buccal cortical plate deficiency and I have  treatment planned for bone augmentation with a synthetic graft material (please see photo).  Should I do the graft and implant installation at the same time or should I do the graft and wait for it to heal and then later install the implant?  What other precautions do you think I need to take with this case? Thanks.

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13 thoughts on “Anterior Implant with Augmentation: Precautions?

  1. Hi , after a 14 year period and thousands of cases like this I would always place a the same …not merely to save time and reduce the surgery for the patient but because of the benefits placing brings to the regeneration of the site ..
    Placing the semi-conductive Ti Implant leads to an up-reguation of host regeneration ( Sasaki et al JOMI 2013 ) and earlier loading will lead to a further up-regulation of host bone regeneration . The other factor is the Implant being placed helps stabalise the Graft material for improved regeneration
    The photo of the case shows a few things , even without an x-ray it can be seen that the defect is reasonably large due to the colour and shape of the profile . Another thing is the frenum and using my routine protocol I would do a frenectomy at the time of surgery.
    So I would raise a site specific flap retaining the adjacent papillae , clean the site very well ( I use Degranulation Burs from EK solutions ) as this is very important then place in the optimal position for the restoration and graft ….
    Here use the materials that you are comfortable with …….. I like stable materials allowing me never to use a membrane which impedes the host healing as seen in high impact factor medical research ( reducing blood supply and impeding the SCF induction ) . Regeneration of host tissue is all about blood supply and oxygenation of the site so suture the site closed using monofilament sutures , which I remove after only a few days as again soft tissue healing is improved without the use of a membrane….
    Hope that helps a bit
    But as in all aspects of Dentistry , a lot of methods and materials work well …… I just like to apply the logic of biologic healing
    Regards
    Peter

        1. Hi David ….. must get a beer sometime …. yes as you know I like the osteo-inductive potential of BTcP ………and show 50% new host bone at 10 weeks …
          Regards
          Peter

    1. Probably will need bone and a CTG at time of placing implant. What’s the plan for a temporary?
      If you haven’t done a central incisor case and haven’t taken a course in surgical bone/CTG augmentation techniques or practiced this before, I would definitely recommend doing so before taking on this case. You didn’t mention what her smile line is like in terms of gingival display. Lots of things can arise which can cause compromises in the esthetics of such a case..
      Just my opinion. Good luck!

  2. When I approach a case like this I drill the osteotomy without irrigation at 50 rpms. I save the autogenous bone from the drills and use it as my primary graft material. I place another graft material ( Novabone) over the autogenous bone and place tented barrier.

    Do not throw away autogenous bone. It costs only time and works great.

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