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Grafting w/ Orthodontics after cyst removal
Posted on 09.25.2012 09:12 PM
By Mark Zwickey
In Orthodontics
15 yo wm s/p cyst removal with impacted bicuspid #20 that was horiz b'tn #19/21. Patient with rather large clinical defect on the lingual from removal of tooth and cyst with exposed roots, but appears to be continuing to heal some with soft tissue at 3 months. 3D imaging shows intact buccal bone with only small defect but intact superior alv bone. Interproximal bone defect as depicted on PA. Question is what role can orthodontics play if any for regeneration. Patient in need of ortho anyway. Would pt benefit from graft and then slow ortho movement into grafted site at 4-6 wks. Thanks
4 Comments
Stefano Petti says on 09.26.2012 12:53 AM
Magnification of this image reveals the bone covering interprox. surface of 19 /21 and the presence of an intact although soft peak.
I think the bone is growing inner so you can start ortho therapy and finally decide if to implement with GBR.
Maurice Salama says on 09.26.2012 11:41 AM
Stefano. Nice thoughts. Biggest diagnostic question is does it probe and where exactly does it probe?
This would give us a better understanding of the location of attachment on both teeth.
Only then would I make a decision of GTR before ortho?
Perhaps you can attach your clinical photo and CBCT section?
Dr. S
Mark Zwickey says on 09.27.2012 10:42 AM
Thank you for the comments so far. When I saw him, I did try to probe, but he was a squirrely 15yo, but there did not seem to be a significant pocket that I dropped into. The gen dentist described a "large area" of exposed root, but when I saw him he had what appeared to be cont secondary healing and had very little if any clinically exposed root. I agree there appears to still be attached bone especially on the mid alv to buccal ridge. There is a small perf of buccal bone from cyst.surgery but the strut of sup bone has been maintained. The buccal attachment/perio is fine.
Stefano Petti says on 09.27.2012 02:38 PM
I would take every 15 days in a 30 days a measurement of lingual soft tissue attachement at root level. If you'll observe an effective improvement in absense of probing, take an other endo rx (same exposure and slide inclination), probabily the bone density is increased and you can start ortho....otherwise...GBR..20 days...ortho
Normally cystic cavity takes several months to complete ossification it depends by several factors like dimension, age, number of intact bone walls, vascularization ecc...