Dental Bone Graft Membrane Exposed

Are you considering dental implants? Do you have questions about the extraction process, grafting, and implant placement? Look no further! In this article, we will take you through the diagnosis, planning, and treatment for the extraction of maxillary first and second bicuspids, with the immediate placement of Hahn tapered implants.

Dental Bone Graft Membrane Exposed
Dental Bone Graft Membrane Exposed

The Case Presentation: A 61-year-old Female

Let’s begin with a case presentation. A 61-year-old female presented to the dental practice with symptomatic maxillary left first and second bicuspids. The teeth had previously undergone failing endodontic treatment, and the porcelain crowns had fractured. Upon evaluation, it was determined that the teeth had poor prognosis, and extraction was the best option for treatment. With no contraindications present, the patient was treatment planned for extractions, grafting, and dental implant placement.

Dental X-ray

The Extraction Process

The teeth were atraumatically removed using physics forceps from Goldendale solutions. A special technique was employed to ensure minimal trauma to the surrounding tissues. The instrument was carefully inserted, engaging the palatal surface of the root. With a simple wrist rotation, the tooth was lifted out of the socket, maintaining the facial bone.

Addressing Facial Defects and Bone Loss

Following the extractions, it was discovered that there were facial defects on the walls of the socket caused by root fracture and subsequent bone loss. An orb and knife were used to create a controlled incision, and an envelope flap was created to expose the bony defects. It was crucial to maintain a passive position for subsequent placement of the protective membrane.

Grafting and Implant Placement

Mineralized cortical cancellous allograft blend was chosen as the graft material, as it allows for a mix resorption rate by the osteoclasts responsible for bone growth and healing. The membrane was trimmed to cover the defects and engage healthy bone, extending past any defect on the facial and palatal aspect. Osteotomies were created, and the Hahn tapered implants were placed. The tapered shape and aggressive thread design of the implants ensured primary stability.

Dental Implant Placement

Correcting Facial Bone Defects

After implant placement, the facial bone defects were evident. The defects were corrected using the allograft material and a resorbable membrane. The membrane was folded over the crest of the ridge to protect the graft material on the facial aspect of the implant site. Maintaining consistent bone volume was crucial, and the mineralized cortical cancellous allograft material was placed between the implants and the facially positioned membrane.

Post-Operative Care and Final Restoration

The surgical site was sutured, and a post-operative CB CT scan confirmed optimal implant positioning. The sutures were later removed, and the implant sites were allowed to heal for another four months. The patient then returned for final impressions, custom abutments were fabricated, and the final single-unit crowns were cemented over the abutments. The result was a natural and aesthetically pleasing restoration.

Achieving Predictable Results

In conclusion, immediate implant placement and eventual final aesthetic reconstruction require careful planning and execution. Minimizing extraction trauma, utilizing minimally invasive surgical techniques, and achieving initial stability are critical. When facial defects are present, proper grafting techniques ensure optimal contours and ridge preservation. Custom abutments can be utilized to control the margins and aesthetics of the final restoration. With proper techniques, predictability can be achieved in dental implant integration and final prosthetic excellence.

For more information on dental implants and other dental procedures, visit Make You Smile, where we are committed to providing you with the highest quality dental care and a smile that will make you proud.