Extraction with simultaneous bone grafting to include rhBMP-2 and mineralized allograft (Mineross). 

 

This is a 64 year old caucasian male that was referred to me for evaluation of failing maxillary left second molar (Figures 1-3). As you can see from Figure 3, CBCT sagittal section shows significant vertical and horizontal bone loss associated with this failing tooth. No sinus pathology per se is noted. Probing depths were consistent with the pathology noted.

 

The treatment plan included conservative extraction with simultaneous bone grafting to include rhBMP-2 and mineralized allograft (Mineross). Figures 4 and 5 show the post extraction site along with fistulous tracts evident both palatally and facially. Figures 6, 7, 8, 9 show sequentially the use of rhBMP-2 (0.7cc) plus Mineross and the use of a Cytoplast titanium reinforced PTFE membrane. Figure 10 shows the membrane remnant being removed at 6 weeks. Figures 11 and 12 show outstanding bone incorporation of the graft complex. A core biopsy was obtained that ultimately revealed excellent bone formation as is viewed histologically at 7 months (Figures 13, 14). A BioHorizon tapered internal Laser Lok implant 5.8 mm diameter x 9.0 mm length was placed with an insertion Osstell reading of 71 (Figures 15 and 16). At 4 months the Osstell reading was 80 (Figures 17, 18, 19). An implant was subsequently restored with a full crown (Figure 20). Note the radiographic comparison at one year with the pre extraction scan (Figures 21 and 22).

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