This is a 65 year old male who previously underwent extraction of #18 and #19 with socket preservation bone grafts. Review of implant planning files show minimal crestal bone on the buccal of both implants. I'm planning placement of implants as shown with cover screw and augmenting of buccal crestal bone. Primary closure. Uncover in 4 months and place healing abutments. Any suggestions? Thanks.
dr gilani comments:Depends on how you want to augment buccal. As it is you might get dehiscence buccal within 1 year post op, but you might not. Hard to predict. 70/30 it's gonna be fine. If you are good at grafting and patient is patient enough, do a buccal autogenous block graft and go back after 6 months.
Jason Larkin comments:Move 2mm apical and 1mm buccal. Use bone off of drills to do mini buccal veneer graft.
Dr.Mahijeet Singh Puri comments:There are many options. 1.place smaller diameter implants like 4.3 or 4.5 mm and increase the length a bit ,10 mm or 10.5mm in both. you will have .5 to.7 mm more bone all around. so less chances of bone loss and marginal bone loss will also be less. use bone graft with resorbable membranes. 2.if want to use same dia implants 5.0 by 9 stick to the principles of GBR with resorbables membranes e.g JASON membranes by BOTISS (straumann). 3.can use ridge split options. 4.use passive design implants in this region as cortical bone is more in this region.
Lalaali comments:1.what are passive design implants? 2. Would you use bone tacks if you perform bone grafting in this case?