What would you do case? Very difficult!

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Posted on By Jorge Campos In Anterior/Esthetic

Young patient in her 30´s. Implants placed 5 years ago in other dental clinic. She comes referred from a former student...
Both upper canines are with a severe periimplantitis with pus drainage BUT clinical gingiva apearence is quite good. So she was no conscious about the problem. See CBCT images, bone loss is maximum.
Ideas for case solution.
1) GBR ?
2) Khoury?
3) Is there any other option? (a guess game)
Regards
Jorge




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8 Comments

hi Jorge,
it is a pity that in a short time the patient has that bone loss of the implants, some problem of occlusion? Canine guide was fine? Anyway, the khoury technique seems to me a good treatment option to begin to solve it.
regards
Vladimir


Reply

Hi Vladimir.
Occlussion is nt a problem here...
Really dont k ow what happened here.
My aim is to disvuss what wiuld you do in a case like this that wad referred for a former student.
A..with such THIN biotype...Khoury?
B...Would compromise neighbor teeth gingiva retraction?
C...No pallatal wall on left canine. May be not even mesial wall...only a nude roit. Would this scenario fullfill our expectation?
D...predictability? After raising a flap and implant xtraction...gingival level wiuld raise?
Thanks for answering my fruend.
This are my diubts on this approach.
Regards
Jorge.


Reply

Hi Jorge,
the idea for khoury technique is cause i see you have bone in apical, and the buccal and palatal plates it could be fixed with 3 osteosynthesis screws for each canine, the first screw transaxial in the apical bone and the other screws transaxial but only for fix and stabilized the plates, one in the middle and the other in coronal portion, fill all the space only with autogenous particulate, PRF membrane. As for the gingiva CTG is always there and you can first modified the tissues with your preference techniques for this purpose before build hard tissues. I have performed similar treatments like this case you present with blocks and khoury in central incisor and premolar getting good results.
Despite this there are many ways to get to Rome.
and it would be interesting to see more ways, tools and material.
thanks for post
regards
Vladimir


Reply

Indeed Vladimir, there are many ways to get to Rome. But for me the Khoury, in this case, looks risky in my hands. That´s why I´m exploring a different way, that I´ll post after the solution.
Hope you have patience.
Thanks for sugesting!
Regards
Jorge


Reply

Jorge that is indeed a very difficult case.

Papillae is already going down hill and I wonder about the prognosis of the adjacent teeth.

In case the adjacent teeth can be saved; One thought I had was: Remove the implants and do GBR (Autogenous/allograft - resorbable membrane) +CTG then wait and move the premolars in canine positions and place implants in the premolar positions in order to have your implants in native bone and manipulate the soft tissues with the ortho.
However, my biggest question with these cases is:
What will you do differently in order to avoid this from happening again? These patients, for a good reason, ask us "if i go through all this, will the result be satisfactory and last over time?" I personally find it hard to answer this question..

Ioannis


Reply

Ioannis, that´s the point! I´m looking for a solution that can really assure a long lasting outcome, minimall invasive, short treatment time and less pain and swelling to my patient but with a NICE outcome.
I like the idea of moving premolars to the site of cuspids. But notice that you have very poor gingiva contour on laterals and bicuspids...
Thanks my friend and see you at JTI, Madrid.
Regards
Jorge


Reply

Your ex student still believes that you are magician.
Even with ortho extrusion of adjacent teeth, ridge augmentation and bridge the final outcome is unknown.
As we spoke yesterday (both of us joining IDR course), may be ridge augmentation in IDR technique...but ortho extrusion still required and outcome still uncertain.
Good luck
Snjezana


Reply

Ha ha....hope you have a good hands on today!
Yes, the ortho extrusion is the begining of the way. May be can be completed with some IDR in this case, who knows?
I´ll keep you posted!
Regards
Jorge


Reply


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