Anterior Defect Rehab. Post-Trauma

104 Rating(s).

Posted on By Jonathan Blansett In Bio-modifiers: BMP-2 / PRGF

Good evening, this case is a healthy mid 40s male, history of trauma to #8 site at age 13. Pt presented from referring dentist with ridge defect after the tooth "fell out on its own one day." Restorative plan is a fixed partial denture, either 7x9 or 6xx9 (more likely), but pt wanted to try and salvage #7 if possible, and refused other options (full mouth ortho for ideal spacing and OJ/OB relationships and site development for #7 implant by forced eruption w/ cantilever #8). Clinically there was a soft tissue defect that probed 8mm from the ridge crest, no communication with nasal floor radiographically. #7 s/rp, site opened, debrided, conditioned root surface with EDTA, particulate allograft (50:50 mix dfdba and xenograft) hydrated in enamel matrix derivative and condensed into defect and against root surface. EMD applied to root surface. PRF membranes placed over allograft mix, CTG harvested and placed to thicken tissues. Final layer of PRF placed and tension free closure. Will re-evaluate #7 after healing and if needed do forced eruption #7 to develop site for implant (try again to convince pt if necessary instead of a long-span FPD). Any thoughts about how else/better to manage this defect in this case? Surgery performed by Dr. Charles A. White (I was photographer on this case).

Initial radiograph #8
Clinical Photos

Debridement of site and EDTA application
Bone graft with fibrin

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Johnathan. Orthodontics would be a significant plus here. In addition, a Palatal Pedicle graft would help with site preparation. Good luck . Chuck


Jonathan; I agree with Chuck. Additionally, I find that a single TENTING screw can be of great assistance to support the SPACE for Regeneration and avoid collapse. Thanks for sharing this case. Dr. Salama


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