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