4-Step Grafting

A 42-year-old woman (ZC) has lost the lower left 1st molar crown for a month (Fig.1).  She has history of the temporomandibular joint disease (clicking).  Let her take multiple mouth rest during implant placement.  She will travel abroad in 10 days.  Give her detailed postop instruction, especially how to handle an immediate provisional.  Since the superior border of the Inferior Alveolar Canal is indistinct (Fig.1), the initial osteotomy depth in the septum is 10 mm after Metronidazole application.  If there is more bone height after taking the 1st intraop PA, extend the osteotomy to 11.5 mm (Fig.2). 

After implant placement, cut collagen plug into long strips and place them in the apical and lateral aspect of the sockets (Fig.3 pink).  With a healing screw placed (Fig.4 blue), place allograft/Osteogen in the inner portion of the sockets (Fig.4 red).  After choosing a cemented abutment (Fig.5 blue), place the 2nd batch of bone graft over the plateau of the implant (purple).  Before or after placement of an immediate provisional (Fig.6 white), insert the 2nd round of collagen plug (strip) to close soft tissue gap (yellow).

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Xin Wei, DDS, PhD, MS 1st edition 05/04/2016, last revision 05/09/2016