Case 46: Complete surgical phase: Maxillary arch 4 implants and Mandibular arch- Guided Bone regeneration with Titanium mesh and Autogenous bone graft and collagen membrane

-
Case 46: Complete surgical phase: Maxillary arch 4 implants and Mandibular arch- Guided Bone regeneration with Titanium mesh and Autogenous bone graft and collagen membrane

  Here is a case which is affected by generalised periodontitis in both maxillary and mandibular arch along with failed implants in the lower anteriors with severe bone defects.

All the teeth were mobile and the plan was to go in for a total extraction followed by a wait period of 2-3 weeks before going ahead with implants in the maxillary arch ( 4 numbers) and a bar supported hybrid prosthesis with shortened arch. In the lower arch Guided bone regeneration at the lower anterior defect site extending from 4.3 to 3.4. Since the plan is to place implants in the sites of A to E (According to Misch) and a lower hybrid prosthesis with shortened arch over 5 implants.

The first phase or the surgical phase was handed over to me to place the implants and the guided bone regeneration procedure.

After a span of 2-3 weeks we opened the maxillary site for implants. Prior CBCT assessment made us plan 4 implants in the site of 13 and 15 in first quadrant and 24 and 26 in the second quadrant. A complete flap was raised to visualise the bone from molar to molar region and a palatal holding suture was place for easier visualisation and flap handling. The bone was irregular and was flattened using an osteotomy bur in a straight hand piece. Straumann implants RC were placed at the desired sites.








After a week the lower arch guided bone regeneration was carried out. A full flap was raised from 3.7 to 4.7 and the defect site was curetted before grafting as the site was a previous failed site of implants. Then Autogenous bone was collected from 4.7 and 3.7 sites and a total of 0.5 cc collected from the Bonesier drill. This autogenous bone was mixed with 0.25 cc of Bio-oss xenograft to attain more bulk.




Later the defect was packed after creating multiple bleeding sites created on the site on the surface of the boneusing a small round bur, where the graft is intended to be placed to fulfill its blood supply. The graft is packed and then a Titanium mesh35x 45 mm was used and adapted on the labial aspect and tac screws were placed to hold the mesh. the mesh was wrapped around and held again on the lingual side by a set of tacs. Further collagen membrane was placed over the mesh before achieving a complete closure of the soft  tissue.






The lower arch is to be planned for implant after 6 months. In-between there is a possibility of the mesh to get exposed. If that happens anytime sooner than 6 weeks then it is ideal to wait till 12 weeks before removing them. Until then hygiene measures are to be employed by the patient.
this cas ewas done by me at Parasu Dental Hospital, Chennai.


Comments

Post a Comment

Popular posts from this blog

Case 50: Full mouth rehabilitation-Digital Dentistry-Digital Smile Design of a patient with Amelogenesis Imperfecta.

-
Image
Case 50: Full mouth rehabilitation-Digital Dentistry-Digital Smile Design of a patient with Amelogenesis Imperfecta. Amelogenesis imperfecta is a developmental defect where the developement of enamel is affected. The condition may vary from simple white flecks of enamel hypoplasia to severe pitting with brown-yellow discolored teeth. Here is a patient who was a teenager and was emotionally & psychologically affected because of his unesthetic teeth. Reason is, he had amelogenesis imperfecta which was severe involving all his teeth with yellow brown discolorations along with pitting in the posterior teeth. Transforming smile and improving his psychological level can be achieved by first gaining the confidence and trust. This emotional dentistry can be fulfilled by Digital Smile design. As discussed in many of my cases, I use Adobe photoshop for my smile designing part. The very same day the patient walked in, photographs and videos were taken to plan the smile and re-enforce th
Read more

Guest Speaker 4: Photoshop smile design and Indirect laminate veneer preparation- 2 days hands on program

-
Image
Guest Speaker 4: Photoshop smile design and Indirect laminate veneer preparation- 2 days hands on program At Parasu dental hospital, we organised a 2 days Hands on workshop for a group of  10 dentists from varied specialities and GPs. The first day was kickstarted by Dr.Chelliah Venkataraman, the founder and Head of Parasu Dental Hospitals and the head of CVR dental Academy, Chennai. Day 1 of the program involved candidates learning about the basics of Dental Photography, The protocol to be followed for Smile designing using Adobe Photoshop and using Adobe photoshop for 2D smile designing. In-fact, I have written a detailed article on fabricating your own smile design templates which can be used for 2D designing, as a tool for patient education and treatment planning which can be seen i my earlier posts in my blog. So, day 1 was completed by candidates learning the protocols for Dental photography for smile designing as well as the use of adobe photoshop to create a smile design t
Read more

Case 48: All on 4 Maxillary implants+ Immediate loading+ Defintive Malo bridge

-
Image
Case 48: All on 4 Maxillary implants+ Immediate loading+ Defintive Malo bridge Another case of an immediate loading All on 4 maxillary prosthesis and after 6 months went ahead with a malo bridge made of milled Ti frame with PFM crowns. This patient had fixed prosthesis in the upper arch with multiple root caries which required extraction of all the maxillary arch teeth. The patient requested for an immediate denture or fixed prosthesis on the same day of extraction due to esthetic concerns. Phase 1: Involved a diagnostic impression and mounting & articulation along with cast modification in the maxillary arch for the fabrication of an interim immediate acrylic denture. This denture is used as an index and used for splinting the impression and conversion of the provisional denture into a fixed prosthesis. The entire surgery was done under local anesthesia. Total extraction was carried out followed by placement of two axial implants in the maxillary anteriors and angulated impl
Read more