[Surgery]  Need feed back about implant case-Jag

 60 yrs old female with High BP and thyroid, wants implants on UL quadrant. Bridge form 25-27 is in about to fall out. Bridge from 22-24 is failing too as it is evident form bone loss. I was thinking about sectioning the bridge distal to 22 and then do GBR with titanium mesh(Cytoplast) and Cortiocancellous+PRF+ Bioss.Temporise with Partail for 5 months and place 4 implants.Now my concerns are:
There is no Buccal and palatal walls in some areas.What's is Predictiblity of graft,Its huge defect..How to stabilize and maintain the volume of Graft.?
Any recommendations on this case.Since her Bridge is loose ,she wants it ASAP started.
Best regards.

by Admin BITES at Thu, May 21, 2015 7:11 PM

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Jagjot Randhawa Replied at Thu, Jun 18, 2015 3:21 PM

Mark,HY , You guys were spot on. Unfortunately I have already done with the case and facing the same issues you mentioned in Forum.3 weeks since surgery.The membrane was exposed by 2nd week by 3-4 mm and I was maintaining it with new PRF membrane every week.3 rd week ,The membrane was all over.10-15 exposure with obvious purulent discharge.I have put the patient on Augmentin 500mg /Metronidazole 250 mg/Peridex.Planning to keep membranes to act as scaffold to guide soft tissue to creep and close.Then I can plan for another bone graft. Whats your thoughts on situation now. Much regards Jag

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Mark Kwon Replied at Sat, Jun 13, 2015 7:54 PM

Ah..YES, HY is definitely right. If this was in my office, This will be Ao4 full arch case ^^ - mark

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Mark Kwon Replied at Sat, Jun 13, 2015 7:52 PM

Hi Jag, Hope you are well. Wow! what can I say ~ You have the most interesting cases !! lol I would stage this case: 1. Extraction first and provide temporary partial denture; let her get used to it because she will be wearing this temporary for a while. The reason i do not recommend to do Socket and Sinus grafting at the time of this extraction is from looking at the CTscan, the tissue may likely be infected and very fragile which may cause difficulty with primary closure and supporting the proposed "ti-mesh" approach 2. once the tissue heals up nicely, I would do GBR: Socket augmentation + Sinus Grafting ; I've been doing a lot of i-PRF as per Dr. Jin's recommendation ; utilizing 'Two-Spin' protocol and i must say it has been doing wonders for Sinus grafting and Vertical ridge augmentation as this. No need for Ti-mesh and no need for fancy membrane stuffs. 3. Once bone heals up nicely in few month, you are ready to place your implants. One thing you have to make sure is that temporary PUD does not impinge on Graft materials during the healing phase; i-PRF or T-mesh can give you support but it still won't be strong enough to resist pressure coming from dentures; Thus make sure you take that side out of occlusion if possible. Hope this helps! - mark

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Ho-Young Chung Replied at Wed, Jun 10, 2015 3:49 AM

Hi there, This is a huge defect! not only are you looking at horizontal and vertical build-up, but you also need to do an SA4 with a septum. If you have a patient wear a partial during the healing phase, graft will likely fail or get exposed especially considering the extent of the site. left sinus appears to have thickening of the membrane. Please compare it to the right side and assess for pathology. Is the patient a smoker or have chronic allergies? It is that time of the year. This actually reminds me of the last case that Dr. Lui and Dr. Kwon discussed at last night's study club on Free End Saddles. In my humble opinion, this case needs to be looked at as a whole and at the very least as an arch. There are many failing teeth on both UR and UL. There are some indications here that a full arch case may be the most predictable approach. Ho-Young