I walk on my tongue over broken glass to get folks to contribute clinical content – Canadians that is and nadda. I meet a friend from Estonia in Hamburg whom I know from a long standing relationship on an online discussion forum and voila – do the math – “This one is especially for Ken following our discussion at poster stands in Hamburg :-)” This elderly lady was referred to me by another dentist for surgical treatment only. Original plan included placing two implants in both sides of maxilla; bone augmentation PRN”. BY Dimitri Ruzanov of Estonia – he gits share and care.
1st surgery a) autogenous bone harvest from linea obliqua externa mandibulae dextra; as I needed bone for both block and sinus I went for a larger piece straight ahead b) recipient site: ONE VERTICAL INCISION and tunnelling. Referral said the day before yesterday that one implant would be sufficient. So I figured out I didn’t need much bone for alveolar reconstruction, so i chopped a smaller bone plate off the big block for that. A small plate of bone was fixed AT A DISTANCE from the alveolar crest and voids filled with particulate bone. Sinus lifting procedure followed by filling the sinus with autogenous bone chips. It always amazes me how much elasticity is there in the oral mucosa – just think of it: I went with tunnel all the way to the palate and behind the tuberosity to provide for tension release – and then there were plenty of room for sinus access and bone block management and fixation with two screws. Healing time – 3 months Healing was uneventful
2nd surgery small crestal-palatal incision, fixation screws removed, implant placed and covered with VIP-CTF harvested from underneath palatal flap. I would not do this normally, however, in this case you can see a dehiscence over one of the screws (it did nothing harmful, however it indicates that soft tissue volume is not optimal) Healing time – 3 months. Healing was uneventful
3rd surgery micro flap and sulcus-former attachment – Final healing at two months. Patient received final restorative last summer. I have not seen her since that time – this summer she’s gonna come to see me for a check-up, so there will be update 🙂
Kind regards,
Dmitri
