Large Anterior Ridge Defect Part 3

536 Rating(s).


Posted on By Maurice Salama In Soft Tissue Enhancement

A patient presented with a large ridge defect in the anterior region around the maxillary left central incisor. A complete lack of the labial plate and significant soft tissue recession present. Please see the preop images. The patient desires an implant if possible. Treatment in progress. Palatal Bone Block ala Howie Gluckman, GBR and CTG Maxilla. Thoughts Dr. Salama

Palatal Bone Block
Palatal Donor site after Harvest

Block secured with fixation screw
After addition of bone and PRGF


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16 Comments

Dr Salama.

EXCELLENT !! Love this case.

Thoughts on IHB on #8,10?

Any restorative treatment planned for incisors?

Best regards,

Ehab


Reply

Ehab; We will wait and see the results of augmentation and then make decisions for Part 4. Currently considering crowns on centrals and then Veneers for Final smile Transformation using DSD....regards Maurice


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Hi Maurice, did you fix the collagen membrane?


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No Andoni. I had several layers of fibrin over my graft and then used a "drapeable" pericardial membrane that fits to the site without the need for tacks or screws. Dr. Salama


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Hi Maurice:
Perfect management. Congrats
What type of particulate bone do you use over your block graft?
Will you access flapless at implant placement and screw removal through soft tissue?
Immediate loading or maryland bridge with ovate?
Do you use dermis to avoid recession?
Thanks for sharing
Nicolas


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Nicholas; Hello, yes it is a possibility to do next stage without incisions if we see excellent regeneration on follow up CBCT. I think immediate provisional in regenerated area is additional risk I would not take here. Yes, Dermis was used here to help gain root coverage in surrounding areas. regards and thanks Dr. Salama


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Thanks for the info and great points Maurice.


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This case is really a step to step show of how you can build all the tissues around an implant.
The important thing is the correct timing for doing each step.
Thanks for showing progress.
Regards.
Jorge


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Mo. Suberib case management treatment. In addition to the high diagnostic and skill level required, what I find most difficult in such cases is the ability to covey the extent of treatment necessary to the patient (or Dentist). Most view this type of case as a single tooth issue. Usually refered for " implant tooth #10". How would you manage this case If the patient said " I only want an implant and my tooth back...the other teeth don't bother me and I don't want them touched"? It seems to me (as Gerald points out) treatment may possibly be expanded even further. This is a most difficult case in many ways. Thank you for sharing. Best regards. Chuck,


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Great case and it's management Dr. Maurice. What do you prefer and feel it's more comfortable while harvesting palatal bone ? Piezo or Trephine burs. Thanks. Ashok


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Absolutely brilliant Mo. Love it. Im honoured. Truly amazing. I have moved away from the trephine a lot and do more piezo as you can get a bigger and better shaped block. Love the multiple treatment strategies as well. Not many can do all this in one go. Awesome.


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Howie and Ashok; Thanks for the kind words. Howie, who developed this technique is probably correct that the piezo may offer a wider range and shape flexibility than a trephine drill but from a ease of use I do like the Large diameter 6-7-8mm trephine drills with clear depth marks. Either way, this technique is outstanding especially for single sites where there is a large volume labial defect. Thanks Maurice


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Amazing


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Thank you Miguel


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Great job Dr. Salama. You made it look easy.


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Thank you my friend....nothing is easy for sure! Dr. Salama


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