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Surgical Management of the Central-Lateral Dilemma
Posted on 03.13.2019 12:09 PM
By Maurice Salama
In Soft Tissue Enhancement
Patient presents in her late 20's with significant esthetic dilemma with papilla loss and ridge collapse. Combination Autologous Bone Graft followed by single Implant in Central Incisor region and Soft Tissue from Tuberosity to add vertical height in papilla space. A case in progress. Other thoughts? Dr. Salama
Central Lateral Dilemma
PA of resorption of teeth
Preop CBCT after extraction of these teeth by other office
Autologous bone plate
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10 Comments
Maurice Salama says on 03.13.2019 12:12 PM
2 weeks healing after uncovering and additional Soft Tissue Graft
Maurice Salama says on 03.13.2019 12:18 PM
PA radiographs
Maurice Salama says on 03.13.2019 12:20 PM
Preop and Post images....
andoni jones says on 03.13.2019 06:40 PM
Superb Maurice, The more autogenous I do the more I like it. Beautiful management, I think I would have done the same. 1 implant and pontic. I can see some tacks, did you do GBR as well? Regards
Gregory Mark says on 03.14.2019 08:40 AM
I would add palatal roll to add palatal, buccal and vertical thickness prior to restorative stage. Gregory
snjezana pohl says on 03.18.2019 01:41 PM
Great planning and brilliant execution!
It doesn`t get any better than this.
How do you plan implant uncovering? In a few cases like this one it gave me a hard time to get rid of marginal frenulum insertion.
Thank you for sharing!
Best regards
Snjezana
Maurice Salama says on 03.20.2019 11:56 AM
Snjezana; Yes, removal of frenum and muscles is often overlooked in regenerative surgery. We will utilize DFCTG from Tuberosity for Pontic site and Palatal pedicle roll for Implant site.....Thnx Maurice
Maurice Salama says on 03.20.2019 05:49 PM
Thanks for all the good comments here. Keep it going. Snjezana, hiw would you do your 2ns stage uncovering. Regards
snjezana pohl says on 03.22.2019 08:04 AM
Maurice, tuberosity for the lateral and PCTG for the central incisor sounds very good! Do you plan afterword vestibuloplasty or in the same procedure?
It is going to be an another show case from you and Atlanta team!
Meanwhile I utilize for almost all cases in maxilla the buccal sliding palatal flap. This way the vestibulum is not flattened, mucogingival junction and frenulum insertion are not displaced (at least Implant placement with GBR (CTG also) plus guided soft tissue augmentation plus buccal sliding palatal flap gives very nice results. The procedure is predictable if fixed provisional teeth protect the augmented area.
Best regards
Snjezana
Maurice Salama says on 10.21.2019 06:50 PM
Snjezana; I will post follow ups soon....did CTG and Tuberosity and GSTA "Guided Soft Tissue Augmentation" with healing abutment. Used only 1 implant......Rotated pedicle just does not provide the BULK I feel you need in these indications. regards Maurice