Block Graft at #6/7 or Immediate Implant at #5

A 51-year-old woman lost the teeth #6 and 7 due to odontoma removal ~30 years ago.  The area was restored with a FPD.  The latter is removed with immediate implant at #8 8-9 months earlier.  Particulate bone graft does not repair the bone deficiency at #6, 7 (Fig.2,3), although the soft tissue looks bulky (Fig.1).  It appears that the palatal defect also needs a piece of bone block to fill in (Fig.4).  The block will be harvested from the chin (Fig.5,6).  If the block graft turns out to be impracticable, the periodontally compromised tooth #5 (bone loss, Fig.2,3,7) will be extracted for immediate implant.  Initial osteotomy will be established in the palatal socket (Fig.8,9).  Either a 2- (Fig.10) or 1- (Fig.11) piece implant will be placed.  After wound healing, impression will be taken for a lab-fabricated provisional FPD.

An asymptomatic erythema develops at #8 10 months postop (Fig.12 *).  A fistula forms 11 months postop (Fig.13 < ) and is associated with implant thread exposure (Fig. 14 >, as compared to Fig.2).  It appears that bone graft and possible block graft are needed with PRF after debridement with Titanium brush. 

Return to Upper Canine Immediate Implant, Armaments, Metronidazole, #2,14,15

Xin Wei, DDS, PhD, MS 1st edition 05/28/2018, last revision 07/26/2018