Guided Surgery is the Way to Go Part 1

Panoramic x-ray with pre-sized ball bearing to determine degree of magnification, missing crown #10, bony radioleucencies #10,11 & several other teeth.

This 74 year old patient presented asymptomatic asking for apicoectomies on #10,11 after just losing the crown #10. The past medical history is significant for elevated cholesterol, takes Lipitor and (ASA)Acetylsalicylic acid. I explained to the patient that the remaining root #10 was fractured and was the reason the crown fell off. #11, no buccal bone due to a large periapical radioleucency with probing of the infection track to #10.

The patient expressed wishes for implant replacement and it was presented as a restorative option. Several other areas of pathology noted on panorex, and are assymptomatic the patient wanted to address the upper anterior first.

Teeth #10,11 were both extracted necessitating (GTR) Guided tissue regeneration with inclusive of a slowly resorbing membrane in conjunction with the extractions. The thin dehisced buccal plate of the anterior maxilla was maximally grafted as a result of moderate-severe buccal atrophy from pathology.

Essix retainer is an excellent temporary prosthesis that helps to relieve external pressure on delicate healing tissues and allows access for thorough hygiene of the surgical site

Missing teeth #10 11 shows less radiodense bone with adequate alveolar bone for implants

Temporary radiopaque restoration in place shows relationship to alveolar bone for esthetic emergence,work-up

3 months after extraction CBCT of Upper anterior showing missing teeth and boney healing and clinically healed soft tissue. Atrohpy of buccal alveolar width necessitating buccal bone grafting at the time of the implants.