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Misc. Grafting
Procedures...the
following images are very graphical
In order to
make implant restorations look natural, we have to know prior to surgery where the future
replacement tooth needs to be, in order to satisfy esthetic as well as functional
requirements. This sometimes forces us to employ grafting techniques of one form or
another, especially when there is not sufficient bone available (due to resorption) to
place the implant properly. Below is an example, where an implant was placed and a
grafting procedure done at the same time in order to satisfy ???.
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In the pre-operative picture above on the left you can see that this patient is missing a
central incisor. Clinically there appears to be just a minor defect, hinting a
straightforward placement of the implant. The image on the right shows the initial
incision.. |
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Above to the left we see the bony ridge after the tissues are reflected somewhat. From
this angle the ridge seems to be adequate. However, when we place an indicator pin (used
to gauge the angulation after the initial pilot hole is drilled) and shift the angle so
that we look directly onto the incisal edges of the teeth, we see that the bone ridge is
very thin (arrow). |
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Once the implant is inserted into the bone it has threads exposed, as you can see on the
left image above (arrow). Sometimes we have to take this into account in order to place
the implant in the proper position. If we placed it a little more to the inside (where
there is plenty of bone) the future esthetics and the implant’s biomechanical loading
characteristics would have been compromised. The exposed threads are covered with some Autogenous Bone (collected from the bone drills) and the
graft site is then covered with a membrane (white). |
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Above on the left an right are clinical images at 3-month post-op. Notice the exceptional
healing of the tissues.
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Above to the left you can see the implant during the Uncovery
Procedure, during which the membrane is removed and a healing collar is placed. Here
you can see the membrane still in place (arrow). Above to the right you can see the
implant with the healing collar in place and the membrane removed. Notice that the threads
are now covered (arrow) with a bony substance (still very immature bone, which will mature
in the future). |
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Above to the left is an image showing the tissues re-sutured around the healing collar.
Prior to actually placing the healing collar, an impression was taken for a temporary
crown, which was fixed to the implant at the time of suture removal, ten days later. To
the right is a clinical image of the site ten days after the uncovery. At this point the
sutures and the healing collar were removed and the temporary crown was placed. |
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The
picture to the left shows the soft tissue condition after the temporary (acrylic) crown
had been in place for about eight weeks. At this time the tissues were mature enough for a
final impression to be taken and a permanent porcelain crown to be made. To the left you
can see the final porcelain crown in place. Notice how we achieved even gum architecture
around the implant, blending in fairly well with that of the natural teeth. |
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