Tuesday, November 15, 2011

Single Implant Trap Door Incision

So patient walks in with PAP on #7. What do you do? Assuming tooth non restorable or patient declines endo and Implant is treatment of choice. Options:

1) a-Extract tooth wait two weeks
b-Full flap and GBR with titanium reinforced 4-6 months
        c- Place implant 3-6 months
d- Restore implant
Timeline: 1-1.5 years
Result? Esthetic? maybe

2) a-Extract the tooth,full flap, implant and bone placement 3 months
     b- restore tooth
Timeline 3-6 months
Pain for patient: ????
Postion of papilla:????
Position of alveolar crest????

I am sure there are lots of options but here is how I routinely do these cases. Completed in 6-10 weeks depending on Ostell Reading. This case was completed in 8 weeks.
Implant: Blue Sky Bio Trilobe 4.3
Membrane: Pericardium
Suture: 5-0 Nylon
Bone: CErasorb M Dental (PH EXCELLENT FOR Infected sites)
Abutment: Zirkonia with titanium base Implant Direct
Crown: Emax
Laboratory: Lifelike Dental Studio (did a kick ass job)
CBCT: Kodak 9500 Full Field of View

So I wanted to keep the position of the papilla the same and I wanted to place the implant that day. I also didn't want the patient to be in any pain.

Here is how he started:

You can't see it in this photo but he had a draining fistula

Here you can see it

Below is the CBCT. Notice how there is a bridge of  bone at the alveolar crest but none at the apex.

So we decided to use this type of incision design

Tooth is extracted Atraumatically.
Socket is curetter. Alveolar Crest Bridge is confirmed
 Implant is palatally placed
Trap Door is done
Bone graft is placed
pericardium membrane

Notice how papilla is still intact
Healing abutment is placed (comes free with the implant)

Ostell is used at 8 weeks to check stability of implant. Reading of 74 is achieved and we are off to the races

Shade Communication with the lab

ANd Final

Comments are Welcome.

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