Socket shields with Osseodensification &Indirect Sinus floor elevation

27 Rating(s).


Posted on By narayan tv In Implants

Dear friends, I'd like to share a recent case where several techniques were amalgamated to achieve the objective. This is a 32 y Female with both maxillary left premolars requiring extractions. Both teeth had been previously root treated and were not restorable. I decided to do socket shields on both, with a proximal shield on one of them, to maintain the IHB, Indirect sinus lift on the posterior site, using the Osseodensification via Densah burs, Osseodensification on the anteriror site to expand the Interradicular septum, and implant placement at > 40 NCm at both sites to install screw retained provisional restorations in 24 hours. In this case I used Jorge Campos Aliaga's protocol of raising a miniflap for visualisation of the shields for finishing them in the optimal manner. There are relevant annotations on the slides themselves where I've not added photo titles. Enjoy and leave your critique. Cheers

Pre-OP



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12 Comments


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Good job Narayan, compliments. These burs are really good, and at the time of procedure we can actually feel the difference. Thanks for sharing this case.


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Thanks Ashok


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Narayan, very well studied and managed case! Great service for your Young lady patient. I am not so sure about the real need of the flap on PET. Opening it, two things can be noticed: a thin bone wall seems present (CBCT may not detect it) and enamel is still present as if teeth are partially erupted. Implant placed a bit deeper may allow you a better emergence profile as crowns seem very short. Thanks for sharing this excellent case. Armando


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Thanks Dr. Ponzi. This is the first time I've raised a flap in over 60 Socket shields.I'd discussed this with Jorge Campos at the last DentalXP meet in February at Fort Lauderdale, just took me several months to try it. I did find merit in Jorge's way in the ease of finishing the coronal ends of the shields more precisely. Just yesterday I reentered a SS case where I had implant failure and had left the shield in place for 10 weeks before replacing the implant, and on raising the flap, I did feel my shield preparation was not satisfactory enough. Perhaps worth exploring the clinical outcomes of flapped Vs flapless SS ?? Thanks once again for your comments.


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Narayan, well done! Ass dr. Ponzi says I´m not so sure that in this case mini flap was necessary, but it won´t make any problem. My only concern here is that I would do horizontal papilla cut leaving the papilla intact and conected to its vascularization.
Any way, if the IHB is preserved, the papilla will be stable.
Please keep us posted with actualizations.
Regards
Jorge


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Thanks for your comments Jorge. Will update the final restorations when done. Cheers
Narayan


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congrats Narayan for amalgamating several techniques to achieve the common objective.Does rct treated infected shield lead to further breakdown of bone and osseointegration difficulties?Does flap reflection achieved the goal of preservation of papilla as well as buccal bone?,does osseodensification achieved the goal to expand and preserve the interradicular septum after implant placement are some of the questions that came in to my mind. looking forward for your future posts .


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Thanks Thomas for your comments.


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