This patient came to me nine years ago before I began placing implants. Teeth #8 and #9 [maxillary right and left central incisors; 11, 21] were already bonded together and super- erupted and showing the gingival and underlying boney defect. We have cleaned up everything else in the mouth and she is ready to proceed with replacing #8, 9 with implants. She is also hoping I can do it for her rather than referring her to a specialist. At this point I am very comfortable placing implants, but I try to keep it straight forward in my office and let the specialist have the difficult patients.
If I were to extract and place immediate implants at the level the bone is at now, without grafting, we would have really long teeth. But that could still be a good option since she really can’t smile high enough even to show her ideal gumline, let alone the central defect.
Those of you who would do ridge augmentation grafting, are we needing a block graft and connective tissue graft, or could you get away with particulate – perhaps tenting with a titanium mesh? And speaking of tenting, would you place the implants in their ideal position where you want the new bone to be, and use those implants to hold the titanium mesh in place? Would this then hold in place the particulate graft that you have packed around the exposed threads of the implants?
PA #8 & 9
photo #8 & 9
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