Large Class 3 Defect in the Maxilla

708 Rating(s).


Posted on By Maurice Salama In Bone Grafting

Patient presents after failure of 2 implants in the Maxillary premolar region. CBCT reveals large bone defect. Management is displayed including post op implant placement. Thoughts and considerations. Thanks Dr. Salama

Defect with Tent Screw
CBCT 3D plan

PRGF Fibrin
6 months post


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25 Comments

Nice result.. Mesh was not used, didn't you ?
Did you do 2nd bone graft on the buccal ? Thank you DS


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Yes, DS. I did a Contour Bone graft at implant placement. I used Sonic Weld on this case. Video coming shortly on main site. Thanks Dr. S


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Maurice, Very nice. Tenting screw and PRF alone? I am curious. Thank you for sharing. Chuck.


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Chuck; I used Sonic Weld PLA membranes and PRGF with mineralized allograft and BMP-2. The Box Technique. Video coming soon on main XP site....Happy Thanksgiving Maurice


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Happy Thanksgivukkah. Once in a lifetime.


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Yes, Chuck, I understand. All the best. I hope to see you in Miami this June? Bring some colleagues, gonna be GREAT! Maurice


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How are you Maurice. Did the implants fail due periimplantitis and/or soft tissue defect. The eight months post photograph illustrates some soft tissue scarring and what appears to be possible frenum pull just buccal to the head of the tenting screw. If so, there should be a plan to address these forces.Also have you perform any connective tissue graft on this case.

Thank you and Please continue the sharing of the know.
Vincent Carey


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Thank you and Please continue the sharing of the knowledge.

Vincent Carey


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Vincent; how are you? Yes, we will deal with soft tissue at uncovering with FGG. This often needs to be addressed when advancing flaps for tension free closure. As for implant failures, yes peri- implantitis. Regards Maurice


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Maurice, Excellent result. Is it meant to be that the tenting screw exposes 8 months after grafting? Thanks.

Vincent


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Vincent; No, it was not intended to expose head of tenting screw. We used the "Box Technique" with PLA resorbable barriers and BMP-2 with overlying pericardium. Video will be on XP soon. The screw exposure occurred after 6 months without any issues and was removed the same day as implant placement. Dr. Salama


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Maurice,

Great plan and execution by the expert as usual. It is not very clear in the picture, it seems the attached gingiva is very limited on the site. I am curious to know your criteria in deciding when to do soft tissue graft first or bone graft first in such situation ?

Thanks for sharing,

Omar


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Omar; Tough question. It really depends on remaining KT and future location of MGJ. thanks Dr. S


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What was the cause of failure ?,and what about the AG , what you did was good management


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This case corresponds to this week's featured video....
http://www.dentalxp.com/video/3d-vertical-augmentation-the-maxilla-512255.aspx
regards Dr. Salama


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Congratulations for the case, my first option is always autogenous bone. But, obviously, you can obtain excellence results with many different materials. Thanks for open my eyes to another ways of doing.


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Dr Salama,

Congratulations on another great case. Tough situation and a tight area to be working in.

Thank you for sharing this wonderful technique with us.

Ehab


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Juan and Ehab; thank you for the kind words. Always looking for new methods especially for larger vertical deficiencies. This is just another option without the need for a secondary donor site. regards Dr. Salama


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Maurice,
very nice case. Interesting to me is the virtual anticipated plan on pct#2: implants could be slightely above, at the end of bone reconstruction if placed as planned.
More critical informations are required in order to achieve a more predictable anticipated results.
What's your opinion about it?


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Armando; That is the entire point. I we placed implants WITHOUT 1st Bone Grafting the VERTICAL component of the DEFECT we would have had many exposed threads and a poor outcome. See the video of this case on the main page of DentalXP this week for the entire surgical case including the 2nd stage uncovering and implant placement into the REGENERATED BONE. regards Dr. Salama


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Maurice.
I ask myself about the economical cost of the biomaterials…
Nice case as always and a good alternative to bone blocks…
regards
Ramón


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Nice case Maurice.
I would use 14 mm long pin from sonicweld as a tenting pole instead of metal screw. It can be welded with the membrane in order to prevent piercing through the gingiva. Also it would had allowed more B-L gain. Metal screw pierced through the sonicweld due to resorbtion of the latter.


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Healing follow up

Healing at 6 months
Healing at 6 months


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Follow up to older posted case.

Lab Phase
Finals after 3 years


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Not most esthetic result but stable bone and tissue levels....after augmentation. Dr. Salama


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