Dentaltown February 2020 - 70
Case
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70
FEBRUARY 2020 // dentaltown.com
A 52-year-old patient presented missing his left
central and lateral maxillary incisors, wanting implants
to replace those missing teeth and a fixed prosthetic
approach. The patient indicated that the teeth had been
extracted eight years ago, and clinical examination noted
a deficient facial aspect of the ridge at the extraction
sites and healthy soft tissue (Fig. 1, p. 69).
A cross-sectional CBCT view of the edentulous
space confirmed inadequate width of the ridge in
the facial-palatal dimension to house implants at
the adjacent sites (Fig. 2, p. 69). The patient was told
this and that it would be necessary to augment the
site with an osseous graft. Because insufficient bone
would not permit simultaneous implant placement
at the time of grafting, a healing period of four to six
months would be needed between graft placement and
implants placement, followed by another four to six
months to allow the implants to osseointegrate before
any restoration could be placed on the implants. The
patient agreed to this plan.
The patient presented for Phase 1 of treatment: ridge
augmentation by lateral grafting. After review of the
written consent, the patient signed the consent form.
Blood was drawn from the patient's left antecubital fossa
to fill four glass tubes (Becton, Dickinson and Co.) to
be used to prepare the most current 2018 variations of
the original platelet-rich plasma, or PRP. Two tubes
were placed into a PRP centrifuge (MedEquip Dental
Supplies) and spun for three minutes at 3,500 rpm. The
short centrifuging time does not allow the blood in the
tube to fully clot, but "pre-clots" the blood.
While the blood was being centrifuged, local
anesthetic was administered for local infiltration at the
maxillary facial edentulous area and at the posterior
buccal right, with addition to an IAN block in the lower
right. Two tubes were placed in a separate centrifuge
for 12 minutes at 1,500rpm.
With a #15 scalpel, we created a vertical releasing
incision between the right canine and lateral incisors and
also between the left first and second premolars. These
were connected by a facial sulcular incision medial to the
vertical releasing incisions and a midcrestal incision at
the edentulous area. A full-thickness flap was elevated,
extending past the mucogingival junction to expose
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Dentaltown February 2020
Table of Contents for the Digital Edition of Dentaltown February 2020
Dentaltown February 2020 - Intro
Dentaltown February 2020 - Cover1
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Dentaltown February 2020 - Cover3
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