[Surgery]  exposed threads on Buccal on placement of two NPx8 Replace implants

Hi guys,

I just placed a NPx8 Replace implant in both the 46 and 47 areas.  I was limited to this size due to narrow bone buccal lingually as well as vertically from the superior border of the Mn nerve.  I was able to get 40-50Ncm of torque on both implants and implants are both surrounded by bone on the lingual up to the height of the implant but there was about 4mm of exposed thread on the buccal.  I mixed some PRF and Raptos allograft and placed this on the buccal of each implant and then covered with a PRF membrane.  Is there anything else that I could have done in this case and what can I expect regarding the initially exposed threads and long term prognosis?

by San Bhatha at Wed, Mar 6, 2013 4:47 PM

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San Bhatha Replied at Thu, Mar 21, 2013 6:49 PM

Thanks for your input Mark. I have informed the patient that she will probably need another bone graft at some point. My question is it okay to wait to see how thing progress with the tissue and amount of threads still exposed and do a bone graft at a later time even after the restorations placed? For future, would it have been prudent to if room allowed to have done some alveoplasty to contour the Lingual bone down to ensure all threads under bone and to have allowed wider implants?

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Mark Kwon Replied at Thu, Mar 21, 2013 6:19 PM

Well explained by Dr. Albert Lui. Buccal thread exposure can be address like what you have done. Your technique works well for minimally exposed buccal thread ie. 1-2mm More buccal thread exposure can be predictably covered using Smart Membrane like how dr. jin describe on recent video casting. Also pay attention to buccal tissue. Healthy attached buccal gingivae will provide good long-term protection despite some exposed threads. Plat-form shifting seems to provides not only better bone level maintenance, but also better tissue health as well. The thing that concerns me is the long-term bio-mechanics on these two NP -short implants. biomechanical over-load may become more of an issue than the buccal thread you noticed. - mark

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San Bhatha Replied at Wed, Mar 6, 2013 9:55 PM

Thank you very much for your wonderful insight and taking the time to give me such great info and love your humor as well:) I think this will probably be my last Replace as I just placed to conical connection platform shift implant in the max anterior last week and see the benefit as outlined in that great video clip that you sent. I was considering placing a membrane but thought that I could achieve with the PRF membrane but I see your point about it slipping down just as the CT grafts can if they are not sutured in place. So do you think it would be okay to bring her back next week to place and tack down that Neomembrane which we have used before glad to hear you are using them? I have not tacked in any membranes in the past, so I would need to order some supplies. Would you mind suggesting what type and instructions on how you go about doing this in your office?