The tx plan is the lateral bone graft and simultaneous 4x10mm implant placement, 1st premolar. What type of membrane would you prefer to use in this kind of case and would you use bone tacks? staged?
Tim comments:I see no need for a membrane and certainly no need for tacks in the event that you want to place a membrane. About 10 years ago I heard Dr. Block talk about there always being more B-L bone than what appears on a CBCT and have found this to be true. In this case I would most likely place a bovine graft and/or connective tissue graft purely for contour as the bone appears adequate.
Aquiles Mas comments:Ok. As far as I am concerned this is a slam dunk case. You have an excess of vertical bone in a triangle shape. I also agree with the other doc. There is almost always 1/2 mm of more buccal lingual width than you think. Look. Number 1. Your implant seems short for the site. You should consider sinking that implant deeper also. I always err on the side of deep versus shallow unless vital anatomy does not permit. You get better esthetic outcomes. And you also have thicker bone. I believe that no grafting. Tacks or other, what I call implant heroics are needed for this case. Use a 10-11.5. Go low. Go long and you should be fine the next question is. Should you cover? Or leave the soft tissue healing cap poking through. Well, that I don’t determine from an x ray. Good luck. And go for it
Russell Ollerton comments:I would not place a membrane. I would do a graft to thicken the buccal plate a la SMART grafting technique (Dr. Ernesto Lee).
Jigsaw comments:If I were to place a membrane. It would be 1 that drapes. No memory. A non crosslinked porcine resorbable membrane such as biooss. Versus a bovine crosslinked resorbable membrane with memory. 🧐🧐🧐🧐