Car accident 28 YO female How would you treat?

186 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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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!


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


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


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