Socket Grafting with Free Gingival Grafts followed by Implant Placement via the use of Osseodensification Burs
This is a 36 year old male that presented to the office with problematic teeth numbers 8 and 9 (Figures 1, 2). A relatively thick gingival phenotype is present along with periapical pathology of both teeth. Root canal treatment along with post and core crowns had been done a number of years prior. Treatment plan involved ultimately placing 2 root form implants in a delayed mode after extraction and bone grafting.
Phase 1 treatment involved flapless extraction of teeth numbers 8, 9 (Figure 3). At that same time two 8mm diameter circular free gingival grafts were harvested from the right hemi maxilla for closure of the proposed socket grafts (Figure 4, 5).
In addition, LPRF membranes were placed in a subperiosteal pouch created on the facial aspect of both extraction sites (Figure 6). Next, the sockets were grafted with mineralized allograft (MinerOss) along with LPRF membranes and exudate (Figure 7).
Finally, the free gingival grafts were sutured into position with 6-0 Nylon (Figure 8) and an Essix retainer was placed (Figure 9).
Six months of healing time had elapsed although typically only 4 months would be needed for this type of case. Clinical and radiographic evaluation revealed excellent soft tissue healing and bone graft incorporation (Figures 10, 11).
Osteotomies were then created using the Versah osseodensification burs (Figures 12, 13). This allowed for precision circular osteotomies to be made along with outstanding insertion torque values of approximately 60 and 65 Ncm respectively for each site (Figures 13, 14).
Two BioHorizon tapered internal Laser Lok implants 3.8 mm diameter x 12 mm length were placed (Figure 15). Finally, primary closure was obtained with rotational flaps and an Essix retainer was positioned (Figures 15, 16). In approximately 10 weeks these implants will have adequate integration for restoration.
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