Large Anterior Bone Defect; Management

138 Rating(s).


Posted on By Maurice Salama In Bone Grafting

Patient presents with large anterior bone defect on buccal and lingual aspects as well as vertical deficiency. Thoughts on management and choice of regenerative methods. Dr. Salama

Defect Occlusal View
Defect Anterior View

Defect Palatal View
CBCT Cross Sections
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9 Comments

So looks like lateral is missing and prepped central? root looks short on prepped tooth- If you can save there is good interprox bone- My management depends on what happens to prep tooth- to control address ability to graft vertical and restore width also-IF you keep tooth tenting screw with curve membrane and biologic modifer or choice


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dear Dr.salsama
in such casea it is prefer to use autogeous bone block coverde by xenograft materials.and reinforced membrane.hope it will be great result!!!!


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Yes. Central incisor IHB is KEY to success here.
Dr. S


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Maurice, Although bone grafting is important (I prefer particulate) soft tissue grafting and abutment / crown contour are key here. Chuck


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Maurice, my choise here is only laminates-first stage and second stage is implantation if you save 11. If 11 will be removed ,then immediate implantation 11, adding any bone graft and CTG.12 will be a pontic.
Or,I guess , you can do submerging of the root 11, bone graft 12 then implantation 12, in this case 11 will be а pontic.It would be Maurice style)
In short, a lot of possibilities for creations.


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Viktor; Very creative options...that is my point in showing this case. We should NOT only look at the DEFECT but the TREATMENT OPTIONS that are available when looking more COMPLETELY including the ADJACENT TEETH and BONE SUPPORT. thanks for sharing. Maurice


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Maurice,

I would consult my orthodontic colleague for the possibility of erupting the central incisor even if the prognosis of the tooth is poor and going to be replaced by implant to correct IHB. This will considerably reduce the difficulty of the case. As vertical augmentation is the least predictable in cases where the IHB is not at the correct level.

Omar


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Omar; Nice idea BUT also WHY has no one yet considered LATERAL BODY MOVEMENT of the Central Incisor INTO the LATERAL POSITION?? This would bring the Bone and manage the defect WITHOUT the need for sophisticated surgical modalities. Thoughts?? Dr. Salama


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Well,
my friend you tell me- is moving central bodily a predictable move ( how long) considering the "hole" in bone from buccal to palate- and being that you have good IHB - worth it?
Also what does #9 look like?


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