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Keyhan Alavian Replied at Sun, Jun 4, 2017 11:37 AM

Thank you so much for your replies, and you have all passed the test with flying colours!!!. That is indeed a failed deciduous molar , and someone, I am not going to say who, (me) did not do gbr post extraction.There was too much infection there at the time of exo, and then patient went overseas. (Excuses. Excuses).

but I am going to do a wax up and reverse plan this as you all suggested. Place implant GBR with cover screw and go from there. He is a young guy and I do not want to make compromises. 

 Will keep you posted. 

Thank you. 

K. 

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Keyhan Alavian Replied at Sun, Jun 4, 2017 11:34 AM

Thank you so much for your replies, and you have all passed the test with flying colours!!!

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Ho-Young Chung Replied at Sat, Jun 3, 2017 2:20 PM

Yep.  Must have been baby molar or the largest premolar known to humankind

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Mark Kwon Replied at Sat, Jun 3, 2017 6:59 AM

Thanks for the upload.

One of those case where baby molar failed without permanent replacement molar?

looks like cl2 tendency. 

I would always start with waxup  and check occlusion. And start reverting tx planning  

- mark

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Ho-Young Chung Replied at Fri, Jun 2, 2017 2:02 PM

Oh wow.   That is a big span for a premolar.  Let's plan for at least 4.5 diameter implant and a molar crown.  

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Majid Sherkat Replied at Fri, Jun 2, 2017 1:19 PM

Just a note that tooth position is #3.5  not 3.6

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Ho-Young Chung Replied at Fri, Jun 2, 2017 12:17 PM

"Narrow" not "Barros".   Sorry.  Was autocorrect 

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Ho-Young Chung Replied at Fri, Jun 2, 2017 11:29 AM

Hi Keyhan.  

This case exemplifies what happens often after extraction without socket grafting over time.  Even with a very thick buccal plate, bone resorption has occurred.  

The question is do you place implant where bone is or do you place it where you will have a better final crown?   It appears to me that with a bit of bone contouring on the buccal at a slant, you can place an implant a still achieve a screw retained crown.  

However, I think the final crown without GBR will still be somewhat compromised.  The edentulous site is wide in BL and MD dimension as many 1st molars are.  

Without GBR in this case, your final crown will be Barros BL dimension and patient may be prone to having food accumulate on the buccal of that crown.  even if implant is placed slightly deeper than what you have planned out, prosthetic can only make up so much.   

Silver lining is that this area is within the graft envelope and if you follow the principles of GBR, then you will likely obtain a good result.   

Ho-Young