Quite possibly the biggest implant practice builder is the tooth borne fixed bridge. Like all things in dentistry they fail over time. However, they typcially have catastrophic failure in my experience.
This lovely lady was in for a recent recall visit with no pain or complaints. But upon evaluation we noticed a fistula ‘bubble’ above tooth #13. So we took a PA xray and you can see for yourself below.
Unfortunately #13 and #15 both exihibited signs of infection that pretty much rendered the teeth hopeless (unless you are really into heroic dentistry).
Treatment Plan
The treatment plan for this case is to remove #13 and #15. We anticipate the presence of a buccal defect with #13 and significant granulation tissue with site #15 with loss of buccal plate. So the area is planned for guided bone regeneration with resorbably collagen membrane and allograft bone mixed with PRF.
Second phase is placement of implant in site #13 and #15 for fixed implant bridge. Ideally I would like to place an implant in site #14 so that we can have individual restorations, but the the sinus location would require an additional external sinus lift.
Our Lucky Day
First we removed the teeth and cleaned out the granulation tissue with a combination of hand curretting (which always seems to tire out my hands/fingers) and surgical round bur on surgical handpiece. I happened to notice I was able to visualize the sinus membrane at the medial wall of socket #15 (see blue arrow below) with the membrane intact.
Using a currette I was able to gently tease the membrane without tearing it. I now had access to place bone and do a sinus lift. The challenge was delivering bone to the site would not be easy through this small window.
Novabone Compule To The Rescue
While my preferred bone graft of choice is Mineross Blend mixed with PRF. The delivery of particulate bone for internal sinus lifts is not ideal. So instead, for internal sinus lifts I choose to use Novabone Dental Putty in a cartridge delivery.
The cartridge delivery tip allows me to reach difficult areas and also provides pressure to help displace the membrane safely.
So in this case we were able to deliver .5cc of Novbone to the sinus through a small window opening on the medial wall of site #15 extractions socket in addition to the socket and lateral grafting done in site #13 and #15.
This will now allow us to have an alternative site in the event #15 site does not maintain the bone and/or be able to place 3 implants to have individual teeth.
The Right Tools
Surgical dentistry is difficult to plan even with all the best technology. A regret I have in my early days of my surgical journey was not having all the right tools and materials readily available.
Partly was me being frugal (aka cheap) and partly was due to me simply not being aware of different techniques available. Over time I learned more and became more enlightened to the value of having things readily available. This has led to increase confidence and flexibility to handle things as they pop up.
The Sales Pitch
There’s a reason I wasn’t aware of different techniques early in my career. That’s because most, if not all, of the CE I was taking was beings sponsored or being taught by organizations that were funded or highly influenced by single dental companies.
It’s this reason I have always worked hard to be fair and open about products used in practice and the pros/cons of various products.
Since founding 3D Dentists in 2013 – we have not taken a single penny from any company to feature their products in our educational offerings. Of course, we do get material support from our partners, but we purposely don’t accept any monies. This allows us to present an open learning platform to share our best practices and speak our minds.
I invite you to attend a 3D Dentists lecture, seminar, or workshop and experience the difference yourself. I promise that you will learn, laugh, and be ready to implement to grow your practice.
