Bone For Dental Implants: Case Study


I have a 50 year old female patient who came in about 6 months ago with a numbness under her nose for over a month. She was seeing another dentist at the time who suspected that the bite was off and was adjusting that. However the numbness was getting worse. An x-ray of the area revealed root can therapy on the 2 central incisors and the upper left lateral incisor. Significant history revealed that the patient had a bicycle accident as a teenager and the root canals were done over 30 years ago.

I referred her to my surgeon who took a CT scan which revealed the extent of the infection. A flipper was fabricated and the teeth were extracted. After an normal period of healing the surgeon went back and did bone grafting to the area. After a total of 4 months study models were taken and the area examined. There may be enough bone for implants (the plan is to put 2 in, 1 in the right central molar area and one in the left lateral area with a fixed bridge fabricated). However, from a cosmetic standpoint there is a shortage of bone to make the teeth of normal size and shape.

The patient is dismayed that this could not be accomplished at the first surgery. In fact, it is not that uncommon to require additional bone grafting after extraction of infected teeth. She may in fact require multiple bone grafts (more than just one additional).

If there is any good news on this, the materials and techniques continue to improve. Twenty years ago these materials to accomplish this were not available and bone had to be harvested from other parts of the body to get enough bone to support a dental implant. This is still necessary in extreme cases, but I prefer keeping other body parts intact!