Blog Author: Jeremy Bewley
.....to place an implant and graft simultaneously and achieve an acceptable outcome in this case?
Let me give you some background: the patient is a 74 yo male, medical history includes type 2 diabetes and hypertension, for which he takes meds and both conditions are controlled. He had #19 extracted at another office approximately 8 months prior to the CBCT images you see above. He has adequate thick attached tissue and restorative space. He has had a couple of other opinions provided already.
His ask is this: he wants an implant placed and any defects grafted in one procedure. He is aware that he will have to return at some point later on for the crown, he just does not want to have multiple surgeries if at all possible. He desires this because he's not getting any younger and doesn't want to spend any more time than he has to away from his job and his vacation house.
What do you think? Tell him he has no choice but to perform a ridge augmentation first? Go for it with the understanding that there may be complications that require more surgeries to correct?
Nice Job JB
One of the things about having the in house ability is allowing you to rethink these cases. The provisionalization- not that is simpler, but it allows doing things you would probably not do if there was a lab involved from a cost or time standpoint
I was working up a case referred by a colleague recently and part of the referral, in addition to an implant, was that the patient complained about a chronic dull ache ever since he'd had a tooth extracted a few years ago. A PA from the referring dentist demonstrated that there was a retained root:
Sidexis CBCT image demonstrated it this way:
As I was planning his implant for the number 5 position in Galaxis I was trying to decide what to do about this root tip when it hit me:
I figured there was an accessible path for an osteotomy that would allow access to the root tip, and if I couldn't deliver the fragment I could simply drill through it. I didn't much feel like cutting a huge hole in his palate and risking damaging the vital #3, so I designed a pair of CG2 guides and printed them.
After delivering the implant I accessed the root
I was unsuccessful trying to deliver the root tip intact, so I drilled through it, felt confident that it was obliterated, grafted and closed, and here's the postop:
After using this method for guided implant osteotomies for so many years so successfully, I had every confidence that I would be able to access the root tip and minimize the risk to the adjacent tooth. Guided root extractions.....I love what Sirona technology and a little out of the box thinking can do for our patients!