Buccal bone defect in upper lateral incisor region: thoughts?

There is a visible concavity clinically. But, the width of the bone seems to be sufficient palatally. Is it possible to restore with implants without graft and membrane?





15 Comments on Buccal bone defect in upper lateral incisor region: thoughts?

New comments are currently closed for this post.
Peter Fairbairn
7/1/2019
Best to graft a bit and with a fully resorbable material that turns over to host bone , this will also help with the soft tissue stability and biotype .
mark
7/1/2019
yes, we often forget about the importance of including soft tissue considerations when we plan these cases. It is not only about bone support, especially in the cosmetic zone. My rule of thumb...when in doubt...graft.
Dennis Flanagan DDS MSc
7/1/2019
Flapless ridge split and expansion would be appropriate treatment.
Guru
7/1/2019
Ridge expansion using osteotome without raising flap would be my suggestion.
Guru
7/1/2019
Sorry my previous comment was incomplete. I would do remote palatal incision without raising flap and ridge expansion using D shaped osteotome and bury the implant. Second stage in 12 weeks with transitional restoration. Good luck.
Sunil
7/2/2019
Gbr would be better option to restore aesthetics and function same time
Greg Kammeyer, DDS, MS, D
7/1/2019
The base problem with this site is that even with ridge expansion, you likely won't have enough buccal bone (1.7-2mm is optimal). This is a straight forward GBR case if there is proximal bone low enough on adjacent teeth. Do papilla sparing incisions to preserve what proximal bone there is no matter what route you choose. I'd prefer the GBR and have you start ridge expansion treatments on maxillary posterior teeth as a buccal plate fracture at this site makes it a staged procedure, whereas what you've shown looks like you could place the implant and the bone addition at the same time. Good luck.
Richard Hughes DDS, HFAAI
7/1/2019
The above doctors are all correct, depending on philosophy. I would expand with Densah burs and subsequently graft with a reservable particulate, if needed.
Don Callan
7/1/2019
With all things being considered, I think Greg‘s got the best treatment plan and the most predictable result. If you do ridge splitting without a flap, my question is how do you account for the opposing occlusion
Ed Dergosits DDS
7/1/2019
Here is a link to a video that was made before we had platform switched implants with internal connections and discovered that implants rarely need to be longer than 10mm. It may have been recorded before we had 3D tomography. Dr. Hilt Tatum was a pioneer and a master clinician. https://www.youtube.com/watch?v=j4Qfnd1tJPs
Richard
7/1/2019
Since you only have 5.7 mm of bone you would place a 3.0mm implant and graft the facial. The problem is that you will have to place the implant too far to the lingual due to the defect. I agree this should have bone grafting first and then place the implant at 4 months. Versah spreading is an option but to split in a one tooth area in the esthetic zone is much more risky and contra-indicated in my opinion.
Timothy C Carter
7/1/2019
I see no problem placing the implant with a particulate contour graft and a thick connective tissue graft all in a single visit
Terence Lau, DDS, FICOI,
7/1/2019
Like Dr Greg K. and Dr Callan suggested, graft bone and GBR to get at least 3mm more B/L width followed by addition to tissue thickness via CT Graft or FibroGuide Graft (new from Geistlich) because your tissue will thin out when you perform GTR. Can't have enough of either for long term stability! Fun case!
Boksilee
7/1/2019
bone graft first, implant later. Treat this pt like you would do for your mom!
Glen MIS
7/18/2019
Ossix Volumax would probably be a great grafting option for that case.

Featured Products

OsteoGen Bone Grafting Plug
Combines bone graft with a collagen plug to yield the easiest and most affordable way to clinically deliver bone graft for socket preservation.
CevOss Bovine Bone Graft
Make the switch to a better xenograft! High volume of interconnected pores promotes new bone. Substantially equivalent to BioOss and NuOss.