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Treatment of Large Bone Defect from Root Fracture

Last Updated: Sep 25, 2017

In this case, a large bone defect, as a consequence of fractured roots of the first molar, was augmented by Bond Apatite bone graft cement.The molar was extracted and a complete debridement of the granulation tissue was performed, followed by bone grafting with Bond Apatite bone graft cement. During the augmentation procedure, the flap was minimally reflected and minimally released. Thereafter, the cement was activated within its syringe and ejected directly into the site. After cement placement, a firm pressure was applied on a dry sterile gauze above the cement for 3 seconds to induce its hardening in place. The flap was placed directly above the cement without a membrane and was maximally closed with moderate tension.

![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/09/85de0d4c5b89dd86d904a7a58d7796a8.jpg)Pre op radiographic appearance

![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/09/4db18828aad0925a5a0b48068ea7ff35.jpg)Soft tissue appearance before reentry
![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/09/c6da194495a844062db48f6ee00ede6a.jpg)Newly formed bone can be seen
![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/09/e874d000ce00d95e61cd53d3557e7e6b.jpg)CBCT image 14 weeks post op
![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/09/119010048d8f9f9442b5215c359ecfe9.jpg)CBCT image 14 weeks post op

5 Comments on Treatment of Large Bone Defect from Root Fracture

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Peter Fairbairn

9/26/2017

Yes this is the way to let the host heal itself more efficiently......simple really .

Dr. Amos Yahav

9/26/2017

indeed when you don't disturb the biology - "the less you do the more you get "

Rainier Urdaneta

9/26/2017

from the clinical picture it looks like the graft has not yet become actual bone. I would give your implant extra healing time to ensure healing has completed. I prefer using L-PRF in those types of cases. Nice case, thanks for sharing

dr. Amos yahav

9/26/2017

thank you doctor Rainier for your comment , due to the graft replacement into the patient own bone the radiographic appearance is completely different than what we use to see with other grafts ,with other grafts it appear always radiopaque since there is no transformation into bone and a minimum amount of bone is formed in between the granules of the graft. therefore it looks more radiopaque . hear instead in this stage already you have class 2 bone which is sufficiently solid . 3 months are suitable time to place your implant in most of the cases .

Rainier urdaneta

9/27/2017

I was referring to the clinical view when the area was exposed after healing and before implant placement. You can still see white particles of grafting on it and it does not have yet the appearance of mandibular bone. I am sure it will get there at some point. Mandibular bone looks compact and it has a certain look to it which this graft lacks at this point. This is not meant as a critizism of your work in any way, just sharing my view.

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