UPDATED5/21/20: Car accident 28 YO female How would you treat?

312 Rating(s).


Posted on By Ben Lashley In Bone Grafting

I was involved in the hospital treatment of this 28 year old female. She was in a car accident and avulsed number 8 and 9. There was no tissue left and could clinically see communication between the oral and nasal cavity in the ER. Four month post trauma photos show mostly mucosal tissue. First step was to do a CT graft to attempt to bulk up the tissues and have more tissue to work with for impending bone grafting procedures. Photos included of the in op and post op results. The included post CT graft photos are from late September of this year. I am attending the Clinical masters week this upcoming October and traveling to Brazil for the surgical courses as well so I have stalled treatment on this case as I wanted to present it at one or both of those courses. I though I would post it to this forum for broad input as well. CT from September shows bone in good shape on adjacent teeth and palatal bone height is good as well creating a decent three wall defect and not needing significant vertical augmentation. The decision is really what kind of bone augmentation should be performed? Khoury technique, Ti-mesh, Ti-reinforced collagen with GBR? All have the merits and challenges. What is most predictable in this challenging case? Should we expect more than one augmentation in the future? Thanks for input.

Ben Lashley

Four month post trauma
CT graft split thickness

Post CT graft 9/19
CT from 9/19


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16 Comments

Hi Ben, challenging case, but healing from the accident seems to be going well. Khoury works best in my hands. Best bone quality possible, less healing time. Good luck and keep posting!


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Well written and good documentation. I like your CTG as a set up for future Bone grafting solution. Although "many roads will lead to ROME" if performed well, I believe in these "Critical Size" defects where 3D augmentation is desired, Khoury Plates are your best option. Yes, Ti-mesh and BMP-2 can also be effective. We look forward to your participation in the Mastership Hands-on and Live Sx course in Brazil at the Metropolitan University UNIMES in Santos. It is an eye opener for sure. regards Dr. Salama


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Great case, following to see others' responses. Thanks for sharing!


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Hi Ben Lashley, Good luck!!


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Ben; What is the latest on this case? Any updates? Thanks Dr. Salama


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We are doing it tomorrow 1/9/2020 Photos will follow!


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Here is surgical date with Khoury plates. Procedure went well. I now remember that it is easier to close when incision lines are closer to the recipient site. Closure always seems the most difficult because bulk due to not only hard tissue graft but the pedicled CT graft as well. Critique as you will. Thanks to all at Dental XP and others along the way for help to this point. Ben Lashley


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Here is the 2 week post op after suture removal. So far so good. Patient complains only of donor site of course.


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Here is the 5 month update. Tissues look excellent and healing has gone as planned. CBCT will happen at the 5 month mark where we assume bone quality will be as planned as well. It is time for some implants. The questions I would like input on are flap design. I don't want to risk recession on the literals with miss-managed flap but need to get in to remove the anchor screws when we place the implants. I was thinking a combination of full thickness at the crest with split thickness down to the screw heads for removal, possibly one at a time while placing the other implant. Papilla sparing around the Laterals at this point? We have gotten this far, now we want to keep the success going. Would everyone do guided for sure now or placement with a stint. Would love some feedback. Ben

4.5 month post op
4.5 month post op


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Ben this looks outstanding. Just beautiful management. Only one little critique, the plate was moved too close on the left lateral. Next time float a little away from defect as if anything will resorb it will be the plate over time....GREAT GREAT job my friend!!! Dr. Salama


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I agree and caught that in my photos after the procedure was complete. Thanks for the critique! Next steps happen soon so I will continue the update. Hoping for some confirmation on my next steps for flap design and implant placement. Thanks again!


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