Surprise, surprise, failed graft.

Categories ; Posterior, Grafting, Multiple Implants, Nobel Biocare

Patient reports loss of two molars about 1 year ago

2

Molar site appears to have grafting material

3

Mandibular canal identified on PA radiograph

4

Two implants planned

5

# 19 site

# 18 site

6

BLPâ&#x20AC;&#x2122;s placed in relation to bone volume, bone width and screw retained crowns.

7

BLP’s lock in the bucco-lingual and shoulder of the implants

8

Mesio-Distal ideal positioning

9

BLPâ&#x20AC;&#x2122;s overlap sufficiently, radiograph is diagnostic , no need for correction, so 0degree rotation blocks ( green) are indicated

10

Poor integration of graft material.

11

# 18 site prepared for 8.5 mm implant

12

# 18 , a 1.5 mm alveolectomy planned due to a pointy ridge. Note defect in # 19 site

13

Due to failed bone graft, osteotomy has to be increased from planned 8.5 mm to created adequate initial stability. 10 mm osteotomy ( 23 – 10 = 13 – red flexistop @ 3 = 10 MM )

14

11.5 mm osteotomy

15

11.5 mm osteotomy, decision is made to increase to 13 mm, due to safe distance to mandibular canal

16

Note large defect around osteotomy # 19

17

Prep and placement of 4.3 x 8.5 Nobel Active implant # 18 site. Using Astra Facilitate drills.

18

13 x 4.3 MM Nobel Active for # 19 site

19

4-5 mm of implant exposed, buccal and lingual cortical plates are intact.

20

Grafting with “ Socket Graft Putty”

21

Covered with Resorbable collagen membrane for covered healing

22

Implants placed in planned position, only # 19 is 4.5 mm longer to created adequate initial stability

23

Turn static files into dynamic content formats.

Create a flipbook