Lingual plate destruction

204 Rating(s).


Posted on By Ben Lashley In Implants

This is a 42yo female is a recent adult ortho case. After brackets were removed the left lateral was noted to be mobile. CBCT confirms bone loss on the lingual aspect of the root with buccal plate intact. probable defect around more of the tooth is noted by the PA. What would be the consensus course of treatment hear? MIVAN technique? Immediate implant with GBR and CTG? I would entertain some thoughts on how to handle this unique case.

Ben


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9 Comments

Definitely do this STAGED....Also, high risk because what appears to be IHB loss on adjacent teeth. Prepare patient for possible loss of papilla heights. Would suggest Extraction and debridement. Allow healing and then re-evaluate after 8-12 weeks. Dr. Salama


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If occlusion permits, one winged (to cuspid) emax maryland bridge could be a solution for replacement of this tooth.


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Thank you for the feedback! We have a consult with her coming up. Ben


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Tough case, I would approach this in a staged manner as well. Flapless extraction/socket grafting stage 1, implant placement stage 2 (flapless if possible). With the interproximal bone loss evident you will definitely lose papilla height each time that tissue is manipulated so I would try and avoid flaps if possible at each stage. If access is required for placement of a bone or tissue graft at the time of implant placement, you can make a vertical or horizontal incision and tunnel laterally or from the vestibule down; but try and avoid flapping of the marginal gingiva. Your CBCT shows good width that should regenerate a nice volume of bone once healed after grafting. The soft tissue on the palate should help guide your graft to heal. I have had cases like these regenerate extremely well, the key in my cases was no flaps, complete degranulation of socket, and oh did I mention no flaps :)! Good luck!


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I feel I can do this flapless and tunnel no problem. Just a lingual "ice cream cone" technique?


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For sure ....no immediate implantation . Extraction and socket preservation , ESSIX or Maryland bridge as a temporary......re evaluation with CBCT and late implantation


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"Lingual ice cone" sounds good. I treated some cases like this with tuberosity bone, flap less too. Very important for each approach is to remove all palatal inflammatory tissue, otherwise, it will occupy the bone graft place. Good idea is to left this tissue pediculated on the palatal and utilize for the socket closure.
Thank you for sharing
Snjezana


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Thank you Dr Pohl! I have a case coming up that will be interesting as well that I performed after seeing you lecture in Atlanta. It is PET but remove the bad and save the good. I will post it to the forum for all to see. This is the second case like this one I have had in a week. I performed the first last week as was discussed here The case only had a lingual dihissance so I felt good about the procedure at the time. It has only been about a week so we shall see how it works out as it was a perfect "Tarnow style" Ice cream cone only on the lingual. I will share that one as well upon opening and implant placement.


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This sounds promising, can‘t wait!
Meanwhile I posted one of my cases with missing lingual bone and managet with tuberosity block.
Best regards, thank you for a nice discussion.
Snjezana


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