Extraction, Bone Graft with Titanium Reinforced dPTFE Membrane and Implant Placement
This case involved a 36 year old Asian female who presented with chief complaint of pain of the left posterior mandible. Clinical and radiographic evaluation revealed a fistulous tract associated with the mandibular left first molar (Figure 1), along with radiographic evidence of periapical pathology including lack of buccal plate (Figure 2). Post extraction treatment options for this patient included do nothing, conventional bridgework, removable prosthesis, as well as an implant supported crown which was the option that this patient elected to pursue. Extraction of tooth #3 was accomplished with full flap buccal reflection revealing the extent of buccal plate loss and existing granulation tissue (Figures 3,4). After vigorous curettage and debridement of the residual socket as well as site preparation including intramarrow penetrations, a bone graft consisting of mineralized allograft including cortical and cancellous particles (MinerOss), was placed into the socket along with fixation of a Cytoplast titanium reinforced dPTFE membrane (Figure 5,6).
The dPTFE membrane was secured with 2 Profix screws on residual buccal bone, and the lingual membrane segment was placed into the previously created lingual pouch (subperiosteal) (Figure 7). Next, soft tissue closure was accomplished with a combination of PTFE suture and 4-0 Vicryl suture (Figure 8). At the two month mark, there was some inflammation and erythematous tissue present at the crestal buccal line angle of the dPTFE membrane. This membrane was then cut at the crestal facial line angle leaving in tact the fixated buccal segment (Figure 9).
CBCT revealed excellent bone incorporation at 6 months (Figure 10). Full flap buccal reflection was performed at the 6 month mark with membrane removal (Figure 11). Excellent bone graft incorporation was found (Figure 12) as was indicated from Figure 10. A 5.8 mm diameter BioHorizons tapered internal root form implant was placed into D2 quality bone in a Nonsubmerged mode (Figures 13,14). The Osstell reading upon insertion was 80 (Figure 15). Soft tissue closure was accomplished with 4-0Vicrol and PTFE suture (Figure 16). Excellent keratinized gingiva was found at the 3 month healing point (Figure 17). Finally, (Figure 18,19) show 6 months post prosthetic completion with excellent soft tissue interface.