[Surgery]  Extraction, socket graft, CAS Kit and implant

Thought I would share this case from yesterday.

The photos and case were done under the dental operating microscope, and the images put into my Mac Practice software and a screen shot taken....sorry if they are smaller in this format.

This was a case where I extracted the upper right first molar 2 years ago, grafted it with allograft and waited as the patient was unsure whether they wanted any restoration let alone an implant mainly for financial reasons.

Patient finally wanted a single molar replaced and maybe when the first premolar fails they might have a bridge placed.

In the meantime there was 5 mm of bone remaining on the CBCT so I decided to do the implant with a crestal sinus lift.

So we did an implant today, with a crestal approach to the sinus ( HiOssen CAS Kit) where even with the septum in the sinus I was able to get a nice result I think.   Last two photos show before and after the hydraulic lift ( kind of cool to see the sinus up close like that).

Two things I want to bring up. I asked the patient to see an ENT but he would not go and the sinus was inflamed from the upper molar that I extracted ( Palatal root), and also the question in my mind was would I be able to lift the thickened sinus membrane with the hydraulic lift ( saline in a syringe and it worked well ) and I used Piezo as well to lift it. I am sure that some would have done it differently and time will tell. The bone was allograft with clindaymycin. Patient also on systemic antibiotics....hope its of interest.

by Glenn van As at Sat, Jul 19, 2014 6:34 PM

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Glenn van As Replied at Thu, Jul 24, 2014 8:40 PM

Thanks Bernhard...that is awesome information. I am preparing to do the PRF more for patients. ITs one of those things that you want a positive result the first time you do it..... For this case...I am a little worried. Some have suggested that the back molar might be non vital causing the lesion in the sinus but so far the patient has been asymptomatic. IN Irvine California right now preparing for a 2 day course on lasers in perio and implantology....hope you are well and thanks for the nice comments. Glenn

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Bernard Jin Replied at Thu, Jul 24, 2014 3:10 PM

Hi Glenn Nice job. Thanks for sharing. I have encountered such lesions (yellow arrows) in the maxillary sinus antrum with my cases too. Sometimes I am able to work around it successfully and sometimes I can\'t (or rather, i find out later that I couldn\'t). Well done with the implant placement. As for the PRF question - I am able to perform venipuncture successfully approx. 90+% of the time. I have occasionally encountered ladies with tiny, self-retracting veins surrounded by thick dense fascia and adipose tissue - well those cases can pose a problem. Also, things get tricker if they are NPO for sedation reasons then now we have to contend with dehydration.

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Glenn van As Replied at Sun, Jul 20, 2014 5:05 PM

Hi Albert...first off thank you for your comments and kind words. I had a surgical essix guide made from a waxup to verify that I was in the right location. I still ended up being 1mm palatal from the 3d ideal placement but it was the best I could do. In future if the patient loses the bicuspid we will remove the SCRC on the molar, use the fixture and make a three unit bridge. Clindamycin liquid is fabricated (compounded) for me by the pharmacy overtown ( Fairmont building in Vancouver). I have to look at the exact dosage but it comes in a syringe. Shelf life is limited to 6 weeks or so. I mix the Clindamycin liquid with the allograft and get it just moist ( it replaces the saline we ordinarily use) . I tend to use the Clindamycin in cases where the socket is infected or in a case like this where the sinus lining was enlarged. The Clindamycin tastes awful and when I say awful...I mean its disgusting..the patients really struggle with it so its tougher in the mandible to keep the tongue away. I have taken the PRF course and now plan to integrate it more into my practice. Need to get going on that. Yes not all patients are easy to draw blood on.....glad you mention that. I would love to hear from the experts like Mark and Bernhard what % of patients they cannot do PRF on....1%, 5%, 20%?? Thanks again for your comments....hope that helps Glenn