Large Posterior Mandible 3D Defect..Treatment Part 3

151 Rating(s).

Posted on By Maurice Salama In Bio-modifiers: BMP-2 / PRGF

Following failure of 2 implants in this area a Large 3D Defect was in need of reconstruction. Additionally bone loss was noted on the buccal aspect of an implant in area of #28. Options and Solutions. Provided Treatment GBR with Tenting Screws Autogenous Bone Chips and BMP-2 with Ti-Mesh. Latest images at 8 months followup, CBCT and 2nd stage surgery. Thoughts? Discussion. Dr. Salama

Preop Axial
8 months Axial

Preop Sagital
8 months Sagital with Hounsfield density

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Maurice, Great case and documentation. It appears everything is healing as expected. Looks like a lot of cancellous bone has regenerated. Will be interesting how much and type remodeling that occurs. I noticed from your other post, you placed your implants slightly sub crestal. Is this in anticipation of remodeling? In addition to the questions already posed, what type implant did you use here and why? This is a fantastic learning experience. Thanks so much. Chuck.


Chuck; I had to place implants slightly subcrestal due to too much vertical augmentation. Great problem to have but must leave restorative space and interarch space for Lab and emergence profile. As for density, please see density posting...Houndsfield units were very high on this case. 450-1200 hu. Remarkable result and by far my best BMP-2 3D augmentation of my entire career. Please see "Related Posts" Part 1 and 2 of this case on top Right of screen. I placed Zimmer Trabecular Metal Implants (insertion torque 45-50 Ncm) here as an effort to stimulate early bone "ingrowth" and osseointegration even though I will not attempt early loading.
Thanks Maurice



excellent result-truly amazing- I think a key point is that you waited 8 months- Also in my opinion ( maybe this was said in an earlier post) - I think the type of mesh used is important- the neo mesh is almost like aluminum foil and has good pore size, so adapts well unlike some of other brands that may more rigid and may lead to higher exposure- I also like the " screw within screw" design- of course your surgical skill plays a role also! Thanks



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