Biologics

When the patient returns for #15 comp, the bone resorption and swelling at #19 are worse than those 3 years ago (Fig.1,2).  After debridement, the mesial socket is large, while the septum is thin, irregular and with undercut (Fig.3).  It seems difficult to obtain primary stability for an immediate implant.  Vanilla bone and cortical bone hydrated with GEM21 S are placed for socket preservation (Fig.4,5), followed by 12x12 mm BioXclude and 4/0 PGA.  In fact the bone height is limited for an immediate implant (Fig.6 (5x10 mm)).  There is not enough bone in the septum for primary stability (Fig.7 (cross section of 3D image; L: lingual)).  The socket heals 16 days postop (Fig.8).  It appears that the granulation tissue is covered by a thin layer of granulation tissue (Fig.9 *), while the membrane remains in place (M).  In fact the bone graft remains in the soft tissue zone as well as the hard tissue one (Fig.10).  In spite of no apparent loss of bone graft (Fig.4,10), the graft seems to shrink in height 3.5 months postop (Fig.11), while the crest decreases (compare Fig.1 and 11).  The keratinized gingiva is wide, but the alveolus reduces in width (Fig.12).    The buccal crestal bone is lost 3.5 months postop (Fig.13).

Return to Lower Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table) No Deviation GEM21S 30 13 开场白 SP 手术 牙周敷料
Xin Wei, DDS, PhD, MS 1st edition 07/13/2020, last revision 03/15/2021