which is the best solution for my case

Posted on 10.10.2012 01:10 AM By TRI DUNG NGUYEN In Implants

Dear my colleagues,

I would like to hear your advice about my case.
Patient is female, 63 years old. General health is good.
She had many implants placed over 5 years. Now, they're all still OK.
Now, the tooth 25 (left second premolar) is loosing because of bone loss (periodontal disease) and need to be extracted. The tooth 26 and 27 also not so good condition, especially tooth 27. Generally, tooth 26 : mobiled (level 1), gum recession, pocket mesial and distal about 5mm; tooth 27 : mobiled (level 2), gum recession, pocket (+) (mesial and distal about 5mm). She lost tooth 37. So the function of tooth 27 is not so much. She also had 01 implant with socket sinus lift 5 years ago at position tooth 24.
My question is that :
- Should we try to keep tooth 26 and 27 and only place 01 implant for 25? If we do that, it’s not so safe for future because tooth 26 and 27 will be worse and worse. And is it difficult to place 01 implant with socket sinus lift in this area, next to the old socket sinus lift 5 years ago?
- Should I take out all 25, 26, 27 than wait 02-03 months for gum healing? After that, CT scan and the plan for sinus lift, place 02 implant for 25, 26 and connect 02 crowns together. The tooth 27 is not necessary.
Patient had socket sinus lift with the graft at tooth 24. Is there any difficulty for me to do the sinus lift this time, especially, if I do socket sinus lift with osteotome? I prefer using osteotome for socket sinus lift than lateral sinus lift with window. What is your advice for this case. Lateral window sinus lift or 02 socket sinus lift?
- Should I put something in the socket to preserve the bone or speed up the healing process (for example, collagen plug) or put nothing inside the socket?
Thank you very much for your help.
Best regards,
Dr. Tri Dung.