- Anterior/Esthetic (827/23)
- Implants (2267/129)
- Full Arch & Dentures (185/5)
- Failures (218/2)
- CBCT & CAD/CAM (119/8)
- Periodontics (304/12)
- Endodontics (176/6)
- Orthodontics (255/3)
- Practice Management (35/1)
- Other (446/9)
After 2 failed ramus grafts and GBR, what would you do? Part 1
Posted on 12.14.2017 02:15 PM By Maurice Salama In Failures
After 2 failed ramus grafts and GBR, what would you do? Patient is in her early 20's and wants to improve her esthetics and have permanent teeth. regards Dr. Salama
Add a comment to the discussion on After 2 failed ramus grafts and GBR, what would you do? Part 1
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Comment has been updated.
Anton Andrews says on 12.14.2017 02:57 PM
Tough case Maurice. Before planning another attempt I would analyze what had caused the previous graftings to fail. Was it a “Kiss of death” from a flipper or too much tension on soft tissue?
Could be a good case to try Dr.Foti’s fibrin sealant or/with sinus plates.
Maurice Salama says on 12.14.2017 05:01 PM
Not sure my friend....both blocks failed and then GBR as you can see sequestered through flap.
snjezana pohl says on 12.14.2017 03:53 PM
Khoury technique, PCTG and Emdogain for the left central incisor...orthodontic extrusion. Maryland bridges...later implants. Or alternative ridge augmentation and bridges.
Tough case due to missing papila on the left central incisor. How does bone look like on the distal root surface?
Maurice Salama says on 12.14.2017 05:02 PM
Snjezana; You have a great eye....diagnostics is KEY!! Bone on distal of Left Central an issue....Dr. Salama
Vincenzo Foti says on 12.15.2017 07:56 AM
Very difficult case Maurice on site 22! The regeneration of distal papilla on 21 is unpredictable or impossible because there is lack of the bone peak. How to regenerate this peak? Maybe orthodontic extrusion, as suggested by Snjezana Pohl. Khoury technique is predictable also for new bone peak on a tooth? Alternatively, after soft-tissue stability I would try a rotated pedicle palatal graft and after 3 months a CTG by VISTA. My prosthetic rehabilitation would be a Maryland attached only on central incisor.
Omid Moghaddas says on 12.15.2017 09:49 PM
What a case Maurice.
Orthodontic extrusion, Soft tissue graft and then GBr
Omid Moghaddas says on 12.15.2017 09:50 PM
Any cbct availabe?
Maurice Salama says on 12.16.2017 06:10 PM
The 3D is from the CBCT....but nothing really changes with sagital sections here...
Maurice Salama says on 12.16.2017 08:45 AM
1st SOFT TISSUE reconstruction.
Maurice Salama says on 12.16.2017 08:53 AM
Soft Tissue grafting right side
Maurice Salama says on 12.16.2017 08:55 AM
Day of Soft Tissue Sx sutures & After Soft Tissue Grafting.
Maurice Salama says on 12.16.2017 08:57 AM
Before & After Left side
Maurice Salama says on 12.16.2017 06:11 PM
Omid; Yes, which sequence?
Vincenzo Foti says on 12.16.2017 09:45 AM
Excellent result after the right soft-tissue surgical management!
richard martin says on 12.16.2017 03:01 PM
Nice work coming along beautifully few questions for you- 10 site would you consider bonding in a ovate Maryland bridge to help shape the mesial papilla ultimately you will most likely still have a little defect there however someo pseudo papilla could be achieved also a touch of pink prosthetics consider to manage number 9 when doing final on 10. lastly Maybe a touch of orthodontic intrusion then re-extrude to bring a little bone down ? and consider splinting 9and 10 together for stability
Just some thoughts
See you in January
Maurice Salama says on 12.16.2017 06:10 PM
Richard; Good thinking my dear friend and happy holidays. Yes, we have more to do but eventually orthoor "pink" will be needed to get over the hump on Left side....Will see you in January in Atlanta and then February in Florida at XP. regards Mo
Maurice Salama says on 12.06.2018 11:04 AM
Krishna Gorantla says on 12.06.2018 09:29 AM
Do you have any follow up to this case Dr. Salama?? Thank you
Maurice Salama says on 12.06.2018 11:03 AM
Krishna; Yes, I do and will check and post follow up in next few weeks. Dr. Salama
mikhail lyakhovetskiy says on 12.07.2018 01:34 AM
Additional CTG after the maturation of the first grafts, two conventional 3 unit bridges with some crown lengthening on # 8 if needed. Distal of #9 looks much better after the first surgery. If you decided to go with implants, then Khoury plates , CTG etc. Great case for discussion.
Charles Schwimer says on 12.07.2018 06:55 AM
Well done. CTG is my first choice even before Ramus grafting.In addition, we as a profession need to promote more Orthodontic site optimization. Chuck
Emad Salloum says on 12.12.2018 03:36 PM
Very tough case for a high demanding patient with a previous failure history .....to make the best of it ...start with soft tissue enhancement to give better chance for future bone graft at a later stage ....the most important is ...one miracle at a time