Need buccal bone augmentation for implant – Indication for Bond Apatite?

I would recommend placing the implant, debriding the buccal wall very well and drilling some holes to increase the circulation, and place a titanium mesh shaped to cover the bone pn the buccal and over the crest of the ridge and fastened to the implant with the grafting material underneath. Make sure that the titanium is laying flat on the buccal bone, otherwise the edges may get exposed.....leave for four months...if after a while some mesh exposure happens, it can be managed by polishing off the roughness, or folding in.....Carl Mesh referred to this type of irritation as RAP...Regional Acceleratory Phenomenon.....which will speed up the healing process.

it is a good indication to use Bond Apatite ,the best and most safe way is doing it in two stages first augmentation and at the second stage placing the implant .in order to have the best results the protocol for bone cement should be followed make only one vertical incision in a distance from the defect make sure that the vertical incision will not pass the MGJ by more than 3 mm then reflect the flap by introducing the periosteal elevator not more than 3 mm into the Mobil mucosa only were the defect itself you can go deeper until you can see the border of the defect .after that grasp the mesial corner of the flap with tissue forceps or needle holder and stretch then the middle then the distal ,you can see that it can be stretched about 6 mm ,now clean the defect and remove the granulation tissue ,activate the BA syringe and eject the cement into the site place a dry gauze and press strongly with your finger above the gauze for 3 seconds buccally and occlusal then instead of you finger use a periosteal elevator to press again on the gauze for additional 2-3 seconds .it is very important that the cement will be well condensed .then immediately close the soft tissue by stretching the mesial corner and suture then distal then in the middle MDM and after continue the rest .DO NOT USE MEMBRANE NO PRF AND NO RELEASING INSICION ON THE periosteum .the flap mast be with TENSION not tension free .3 mm of graft exposure during closure is completely fine ,but not more . after 3 months you can place a new implant . do not use removeable appliance .

You seem to need two implants unless his bite force capability is low.

consider ASTRA Profile S implant; made for these types of contours... no grafting needed...

I would think you have several options. Some have been described. You could also consider angulating the implant more which would allow you to place it about 2 mm deeper (it seems from what I can see that would still leave you well clear of IAN). You can use a re-directional abutment after integration. I would probably implant as above and get primary stability and then overlay the deficient buccal area with CA and CP (may be also HA – depends on the size of the deficiency). It is a bit hard to be precise because I would like a clinical examination of the area and also a few different CT views to what you have provided. In the end I think it depends on your preference (and what you are comfortable with) and also what the patient wants (time and money considerations).

Thank you. Can you tell me what you mean by fastening the mesh to the implant? LG