Missing #7: Predictable grafting suggestions?

I don't see a reason to graft this site if you plan placing a 3mm wide implant.it seems there's enough bone. How long ago he lost his tooth?

One can easily expand the ridge with any number of methods and place a larger implant. Forget minis.

There is no standard technique . Every case needs a certain approach . In this particular case expansion the preparation site after the initial drill ( as proposed in the comments ) . As far as mini implants I sometimes use a two piece mini ( 2.9 with 3.5 platform ) Never one piece

I tend to agree with Richard Hughes.. a 3mm wide implant is a narrow platform implant, and a weaker implant...... according to the scan there is room easily up to 4.2mm in diameter; and Konstantinos' concern about not enough space mesial-distal is not a concern at all....... there was a pre-exisiting normal sized tooth before.... so a mini implant would not be a good idea. In the case of a congenitally missing upper lateral, adequate bone or mesial-distal dimension may be lacking...but not in this case.

What size implant are you calling a mini? I don't consider a 3.0mm implant (like the astra or the implant in the cone beam) a mini. It is a great implant for small spaces. Plenty strong for a minimally functional tooth like a lateral incisor or lower incisor. Anything smaller than 3.0 is what I consider a "mini". They are usually one piece. I don't use them.

I don't really like the position of the implant on your pre-op CBCT scan. The coronal portion needs to be rotated out to the labial more, as well as the crown, to avoid an end-to-end, traumatic occlusion and take advantage of the dense cortical bone at the crest of the ridge. This may give you a mid-level fenestration defect at the time of fixture placement, but this can easily be grafted at that time. A 3 x 13 mm implant is plenty adequate for a #7 replacement. Fairly easy case to pull off successfully.

I would expand, place a Biohorizons or Nobel active 3.8 or so, two piece with screw retention. Graft buccal inlay graft, sonic weld depending on dehiscence. Connective tissue graft. May stage depending on clinical parameters. Long term esthetics are key, these are not simple cases. I have found this best way to go.

One pearl, compare to appearance and size of the other lateral. I doubt much bone was retained due to the avulsion. I try to match the width of the other side otherwise the emergence profiles will vary. I try to remember you are restoring what was lost, bone,soft tissue not just the tooth.

Thanks for the post I am sure on a good day we all have such good ridges. As everyone agrees it is not a case to graft. It is a great case for bone spreading/expansion and take it to a colleague to do this. You will be impressed at the outcome and better understand bone manipulation. 3.5mm implants are narrow daimeter and less than this compromises on strength, emergence profile etc but you may be short of meiodistal space and 3.0 can work for a lateral incisor or mandibular anterior implants. Do look at ortho of course if you need a little more space and mini implants will not be the standard of care for an adult crown in an intact arch (and as Richard Huges said forget them!)

Minis work well in appropriate sites and appropriate occlusal considerations. The more bone and less implant the better with respect to displacement and percutaneous exposure.

Over the last 10 years we have developed our own protocol for lateral crest augmentation. In 90% of the cases we do not need any kind of biomaterial. The technique is simple, reliable and absolutely loved by our patients. Look at the following abstract: If you like what you see, we have workshops on Mallorca on a regular basis. You won't think twice about your case once you have seen this. Sunny regards Oliver

Sorry forgot the pw. It's "Marident"

Thank you