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CBCT Scan Reveals Previous Unsuccessful Bone Graft

This post was prepared in collaboration with Carestream

On an experimental basis, we have asked a limited number of companies to provide us with practical “How To” answers to clinical questions. We were prompted to conduct this experiment when dental team members told us that they visit company websites and consult company representatives for practical clinical information. We look forward to receiving your feedback on this experiment.

Case Overview

Fig 1

Fig 1

A healthy male patient presented at my office seeking an implant to replace the maxillary left central incisor (# 9).His general dentist had extracted the tooth and performed a socket bone graft and the patient felt more comfortable having a specialist place the implant. The patient was eager to begin treatment and was confident he had enough bone. Indeed, the initial clinical exam also gave me the impression of plenty of bone (Fig. 1).

 

 

Fig 2

Fig 2

Although it initially appeared that there was adequate ridge width, a computed tomography (CT) image (Fig. 2) revealed that the ridge was deficient; it was resorbed and too palatal. A cone beam computed tomography (CBCT) image captured with the CS 9300 confirmed that the previous socket bone graft was unsuccessful, leading to vertical and horizontal bone deficiency (Fig. 3).

The extracted tooth crown had been bonded to the adjacent teeth by the general dentist. Also, the bonded crown had a portion of the root included, making it too long.

Treatment

The defect was exposed (Fig. 4) and the site grafted with autograft harvested from the site with an AMC bur (Fig. 5). The area was then augmented with BioOss (Fig. 6) and the site was covered with Ossix Plus collagen membrane (Fig. 7). A post-op cone beam CT scan was taken to confirm the success of the graft (Fig. 8). The graft healed very well and the patient was pleased with the results. So pleased, in fact, that he posted a rave review on the practice Facebook page.

One comment

  1. CBCT scans provide an interesting snap-shot perspective indeed, but the clinician needs all manner of perspective, experience and continuing education to judge its output/results. For instance, the notion that a post-op CBCT showed ‘the graft was a success’, really needs to be validated in time. Whether the synthetic/particulate material stays in position or is converted to bone or resorbed is best known with an open inspection/biopsy/or serial CBCT scan, logically over 1-10+ year timeframe. Under-represented in our day is the importance of accuracy in all forms of communication, let alone a manufacturer’s case testimony that promotes the many benefits of great technology. In the hands of less experienced person, this case with an implant in position might still hold a disappointing esthetic surprise. Yet, 21st century materials and methods are at our disposal to achieve the very best of patient results over their lifetime. I know I practice at a much higher level incorporating CBCT into my general practice setting every day and would strongly recommend one acquaint themselves with this technology.

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