Considerations in Tooth Replacement with Thin Bone and Soft Tissue Biotype in the Lower Anterior Segment

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Posted on By Hamid Kazemi In Anterior/Esthetic

Patient with advanced gingival recession #24 and #26 and missing #25. CBCT shows severe thin bone biotype in the anterior mandible. #24 and 26 are guarded but extractions will result in severe 3-D defect. What are your considerations in managing this patient? Extractions and 3-D bone grafting? Gingival graft to correct recession and a restorative solution to replacement of the missing tooth?

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Wow, difficult case. I would start with extraction of #24-25 with large CTG graft ONLY and resin bonded retainer from #23 & #26. Re-evaluate defect for further grafting as needed. Likely Tuberosity Tissue for pontic sites.....or Large GBR-Khoury Plates for bone augmentation in preparation for future implants. regards Mo


Tremendously difficult case-please dont refer to me :-). Seriously-good luck
What do you think cause issue-ortho? tongue?


Extremely difficult case indeed. No history of ortho. But significant thin tissue and bone biotype. A severe case of lower incisors with pedunculated attachment to the mandible. #24 and 26 have 1+ mobility and are guarded. Extraction will result in immediate loss of more horizontal and vertical bone. A staged extraction, followed by CTG in 2 months (once some spontaneous soft tissue has filled in), followed by bone augmentation techniques. Depending on final position of the ridge, considerations for distraction to correct vertical deficiency, followed by GBR or khoury technique. At least 2 bone grafting stages might be necessary based on quantity and quality of soft tissue. Patient education and awareness of the risks and benefits can not be understated.


perhaps consider three -unit bridge-it will splint these compromised teeth and provide greater stability. First do soft tissue graft to eliminate the frenum pull, increase keratinized gingival quality and quantity .


Hm, the case is really challenging and interesting at the same time. I would start with the extractions of 23 and 26 because the recession is way too significant. I'm not sure a 3d bone grafting will work, but it's worth to try it. Also, I wouldn't opt for a bridge, because the lateral incisors are extremely weak, and they won't provide enough stability. Anyway, I would like to take a look at the real situation of this patient. I'm working at , so if you haven't created a treatment plan yet, let me know. I'll be happy to work together.


The clinical study involved patients with partially edentulous anterior maxillae, chronic apical periodontitis and dental root fractures in the absence of possibility to restore these teeth with orthopedic structures. To identify the main criteria determining smile aesthetics, the detailed analysis of changes in the bone and soft tissues of the alveolar processes was made based on tooth extraction causes and dates.


Henry Schein
Magnetic Mallet