71 yo female pt with a hx of osteomyelitis (lower extremity) and is concerned about implant failure due to another “bone infection”. I gave the pt the option of FPD vs. Implant and is still undecided at this moment. I had my periodontist review the scan and he recommended another scan in 6 mo. The ridge is thick with a healthy band of keratinized gingiva. There is no swelling, no abscess, no fistula, and no drainage at the site.
The bone in this case does not appear dense as compared to other cases that I eventually placed implants in. It appears that I have room for a 5-0 X 11.0 mm Astra implant, but I told the patient that I would get the scan reviewed prior to final tx plan. I’m concerned 1) failure of graft/persistent infection, or 2) slow resorption of graft (need to wait more like 6 mo or more vs. 4 mo). I™m including my operative note and dates for this case¦
(Operative notes from 08/27/2014)
Limited oral eval – medical history reviewed, pain scale 0/10. Exposed and reviewed Per XR – failed RCT w/ large osseous lesion spreading from furcation. Consent for procedure before initiating tx.
Dx: #30 has poor/hopeless prognosis. (Endodontic consult ) recommends ext of #30. Obtained verbal and written consent for ext #30 with bone graft in anticipation of future implant. Pre and post-op vitals WNL.
Tx: Ext #30 and bone graft with local anes. Bite block and throat packed placed to protect airway. Sulcular incisions carried buccal/lingual with minimal flap reflection. Atraumatic extraction #30. Curettage of socket with #4 Molt. Mineralized Can/Cort (allograft) bone graft placed into socket and covered with chorion membrane. Obtained good hemostasis. Discharged pt in comfortable-alert condition. Complications: None. Sutures: Silk 4-0 x 4 suture.
Pt was seen twice for POT™s, sutures were removed at 2 weeks. Healing was WNL. A limited field CBCT was taken on 01/08/2015.
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