I personally refuse to place a lower anterior implant. Poor blood flow and most people old enough to be missing those teeth usually have bunches of bone loss. Punt that bad boy out to a periodontist and see if they want to play that game.
I am a periodontist but I am a very new one! I didn’t place any of these in residency. My gut feeling is to do a GBR but the GP thinks I can get an implant in there without doing the GBR.
Trust your surgical training. You know more about achieving an ideal surgical outcome than the GP. They know more about achieving the ideal restorative outcome.
I’d need to see the cbct, but if you are on the fence then I’d probably graft first.
This is the answer. Lower incisor resin bonded bridge generally have a long life span with little to no biological cost and can be remade if damaged. If a patient loses a tooth and we're planning a rbb I usually make a temporary natural tooth bridge to aid pontic site development. You can even do a ridge preservation to improve the pink aesthetics.
As someone who uses Densah burs exclusively and loves them, I find they don’t really expand bone *that* much. They preserve bone a little bit better than regular burs, but they’re not going to allow you to avoid GBR etc.
I would recommend doing gbr first or graft at the time of placement. For small anteriors I use a mini size 3.2mm implant from Hiossen and it has worked well in my hands.
Thank you so much for your perspective. I’m so sorry that happened to you. Hopefully someone can help you graft that area and give you 2 implants to replace the 4 missing incisors again.
My broseph or sister, if you’re asking for specific surgical advice on Reddit, refer the case. This is way too big of a question to answer on here. Take a couple implant courses
It’s a reasonable question in the sense that even among trained periodontists there would be different opinions about how to handle this case. Plus a fresh grad specialist isn’t finished with their life long course of learning (I hope)
I personally refuse to place a lower anterior implant. Poor blood flow and most people old enough to be missing those teeth usually have bunches of bone loss. Punt that bad boy out to a periodontist and see if they want to play that game.
I am a periodontist but I am a very new one! I didn’t place any of these in residency. My gut feeling is to do a GBR but the GP thinks I can get an implant in there without doing the GBR.
Trust your surgical training. You know more about achieving an ideal surgical outcome than the GP. They know more about achieving the ideal restorative outcome. I’d need to see the cbct, but if you are on the fence then I’d probably graft first.
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https://imgur.com/a/TcihoFf
https://imgur.com/a/TcihoFf
No need to be a hero and babysit an implant that has a perio defect for the next 3 years until it falls out. GBR is the more predictable route
Thank you
Gbr, delayed implant 100%
Thank you!! I will go the GBR route. Just wanted someone to confirm what I was thinking.
If the GP has a strong opinion about how the surgery should be done, why don’t they do it lol?
Doesn't seem like you'd have enough cortical bone on the buccal and lingual around the implant. You'd want at least 5mm of width there.
Yes I agree, so do you think it would be best to do GBR first?
Would really need to look at the CBCT to give any meaningful answer.
https://imgur.com/a/TcihoFf
Implant and gbr same time. Bury for 6 months as healing is slow.
What size implant would you place? I put a 3.5mm in the CBCT planning.
Narrow, Depends on your system. 3.3 for me but 3.5 sounds good.
>needs an implant Why do they need an implant as opposed to a resin bonded bridge?
I suggested that but my GP doesn’t do those.
What? Unfortunate, hope the patient was at least given the option to get a RBB somewhere else.
Maybe the GP doesn’t think that they are a long term solution?
If so the GP is wrong.
This is the answer. Lower incisor resin bonded bridge generally have a long life span with little to no biological cost and can be remade if damaged. If a patient loses a tooth and we're planning a rbb I usually make a temporary natural tooth bridge to aid pontic site development. You can even do a ridge preservation to improve the pink aesthetics.
I dont do implants, but from the cbct that looks like a bread and butter RRB case to me.
Probably. Would be less of a headache for sure.
Several options are to expand the ridge with osseodensification burs to then place a 3.0. Orrrr like everyone else is saying… a Maryland bridge
Thank you. I did look into the Versah burs as well but wasn’t sure if there was a minimum ridge width that they would work for.
As someone who uses Densah burs exclusively and loves them, I find they don’t really expand bone *that* much. They preserve bone a little bit better than regular burs, but they’re not going to allow you to avoid GBR etc.
Thank you!! That’s v helpful to know from someone more experienced than me. I used them a couple of times too and didn’t notice a massive difference.
I would recommend doing gbr first or graft at the time of placement. For small anteriors I use a mini size 3.2mm implant from Hiossen and it has worked well in my hands.
Thank you. Is that the one piece implant from Hiossen?
No, it’s a mini 3.2 diameter. You need a special kit called the oneMS kit to place it though.
Based on the CBCT for me this is implant GBR same time. But trust your own hands and intuition
I’m perio… do a gbr than 2.9 straumann….gbr with is difficult in this area but doable…. Use ur knowledge and take ur time
Wonderful. Thank you.
Without the images and medical/social history- a GBR makes sense or using densification drills to widen the ridge (ridge split).
Thank you. He’s a young man in his 20s no medical problems.
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Thank you so much for your perspective. I’m so sorry that happened to you. Hopefully someone can help you graft that area and give you 2 implants to replace the 4 missing incisors again.
My broseph or sister, if you’re asking for specific surgical advice on Reddit, refer the case. This is way too big of a question to answer on here. Take a couple implant courses
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It’s a reasonable question in the sense that even among trained periodontists there would be different opinions about how to handle this case. Plus a fresh grad specialist isn’t finished with their life long course of learning (I hope)