What type of Bone do you use?
What type of Implant do you place?
Whayt type of Membrane?
Dentists on the lecture circuit say ONE ANSWER. It is totally incorrect. You need to know why you are using the materials and what you want to achieve. That being said Here is a case where we use different materials and they were all thought out. HEre we go.
Patient presents missing #5. Here is his Intraoral presentation. For those of you that say you don't need a CBCT. Here you go!
Intraorally looks like he has TONS of bone. Slight dehiscence. Here is his CBCT
The Whole Buccal and Palatal plate is practically missing. So what are my options
1) The August Method: FPD
2) Block bone graft wait 6 months, implant 3-4 months,
3) Simultaneous Implant and Lateral ridge augmentation
So we chose option 3. So we have to achieve certain criteria to make it successful
1)CHoose an implant that is tapered and has aggressive threads so that it can be stabilized in minimal bone. and an implant that is recession occurs can theoretically stabilize the soft tissue.
CHoice: Biohorizons Laser Lok 3.8X12mm
2) CHose a bone graft that will retain space and shape and will resist the pressure from the cheek and flap.
Choice: Dynagraft-D Putty
3) Chose a membrane that will resist pressure and maintain space. Chose a membrane that will not need primary closure in case the flap cannot be approximate
Choice: Cytoplast Titanium Reinforced Buccal Membrane
4) If defect is large have a Prosthetic PLanning Kit available to determine if angle and position of implant will work.
Choice: MIS PROSTHETIC PLANNING KIT
5) chose a Suture that is non resorb able so you can control the healing. Chose a suture that has a very low tissue reaction to prevent scarring and infection
Choice: 5-0 Nylon
With all my materials and procedure thought out prior to surgery off we are to the races and no surprises are there.
Palatal crestal incision with vertical releasing. When doing vertical releasing angle the blade so that reproximation is not butt end but rather slides over and scarring is minimized. Notice Defect.
Notice above the palatal plate is also thin
Notice the abutment its 15 degrees. and fits perfectly. IMportant to try in because if hex is not positioned correctly you won't be able to use a prefab abutment.
Looks buccal placed as it is. BUt palatal bone non existent. Will use Zirkonia abutment and emax crown to restore. Tissue very thick so should be ok.
Bone Graft Placed.Very Clean Very thick
Titanium Reinforced Membrane.
Prosthetic PLanning Kit
Sutures 5-0 Nylon
Notice Bulkiness of the ridge.
Enjoy. As usual COmments Welcomed!