62 year old male reported last year with discomfort on the maxillary left molar region. PA x-ray showed some lesions and because we take a cone beam on everyone, we were able to see massive bone loss around all three roots that extended up into and around the sinus floor. Patient chose to have a bone graft and a future implant and his surgery was done right after the first of the year.
Under IV sedation, the tooth was removed and all of the infection was as well. The socket was granted with 1.5 cc of sticky bone and because of the size of the defect and the amount of time I wanted it to heal, I chose to do a two layer membrane sandwich technique.
First, I layered a 20 × 30 collagen membrane and draped it from the buccal across to the palatal walls. Then I placed a 12 x 30 cytoplast PTFE membrane and secured both membranes with sutures. I wanted to leave the cytoplast for six weeks due to the size of the defect and graft, so I used both PTFE and glycolon sutures. The postoperative PA showed excellent bone fill that was dense.
Patient returned at six weeks and the PTFE membrane and sutures were removed and he was healing as expected.
At four months, patient returned and records were made for the implant process. Records showed good bone fill and good bone height, the implant was planned on exocad software and a guide was fabricated.
Today, we placed the implant, scanned for the final restoration, just like teaches us to do, and I placed a Neodent healing abutment.
Couple things about this case, I chose to do a tissue punch because the width of the ridge and the amount of attached tissue present. When we use the PTFE membrane for socket preservation, we ultimately grow nice, thick attached tissue, and this is a perfect example of that. I probably only do one or two tissue punches a year.
Notice in the final pictures, the amount of attached tissue is greater around the implant that it is around the natural teeth. Bone is obviously important for implants, but attached tissue will determine how long they last and how healthy they stay.
