Pre-treatemnt photograph of the mandibular area dentiton. All four incisors had been endodontically treated and were failing. The left lateral incisor had a draining fistula.
The site has been prepared for the fabrication of the provisional (see more detail of the technique under the blog archives "Provisional Cosmetic Bridge"). The whitish surface on the gingiva is due to brief application of Superoxyl (37% Hydrogen peroxide) which allows for adequate hemostasis while provisional material sets without staining.
A wire was suspended between the abutment teeth for the provisional bridge. 2mm Connect fiber (Kerr) was wrapped over the top of the abutments and coated with a flowable composite Zenith Luxaflow)The incisors have been reduced to the gingival level to allow for the creation of the proper form of the provisional. The roots of the incisors were removed at the time of implant placement in the areas of the lateral incisors.
At approximately 6 months later, the alveolar ridge collapsed more than expected. The titanium endosseous implants are discernible in the positions of the lateral incisors.
The base of the alveolar ridge is only 0.6mm thick between the areas where the implants were placed. The buccal frenum is noted by pulling the lower lip down and away.
A diode laser (Odyssey by Ivoclar) was used to cut the frenum, reducing the muscle pull on the future graft site for ridge augmentation.
The modified provisional with pink composite (Cosmodent) added on the gingival to simulate gingival tissue. A combination of medium and light pink were used with addition blue and red composite tints (Kerr Kolor Plus).
The modified provisional in place prior to attempting bone ridge augmentation. The laser incision will heal uneventfully and will release some of the muscle pull on the graft site.
Pre-treatemnt photograph of the mandibular area dentiton. All four incisors had been endodontically treated and were failing. The left lateral incisor had a draining fistula.
The site has been prepared for the fabrication of the provisional (see more detail of the technique under the blog archives "Provisional Cosmetic Bridge"). The whitish surface on the gingiva is due to brief application of Superoxyl (37% Hydrogen peroxide) which allows for adequate hemostasis while provisional material sets without staining.
A wire was suspended between the abutment teeth for the provisional bridge. 2mm Connect fiber (Kerr) was wrapped over the top of the abutments and coated with a flowable composite Zenith Luxaflow)The incisors have been reduced to the gingival level to allow for the creation of the proper form of the provisional. The roots of the incisors were removed at the time of implant placement in the areas of the lateral incisors.
At approximately 6 months later, the alveolar ridge collapsed more than expected. The titanium endosseous implants are discernible in the positions of the lateral incisors.
The base of the alveolar ridge is only 0.6mm thick between the areas where the implants were placed. The buccal frenum is noted by pulling the lower lip down and away.
A diode laser (Odyssey by Ivoclar) was used to cut the frenum, reducing the muscle pull on the future graft site for ridge augmentation.
The modified provisional with pink composite (Cosmodent) added on the gingival to simulate gingival tissue. A combination of medium and light pink were used with addition blue and red composite tints (Kerr Kolor Plus).
The modified provisional in place prior to attempting bone ridge augmentation. The laser incision will heal uneventfully and will release some of the muscle pull on the graft site. 
3 comments:
Rhys,
Great to hear from you. I think this will be a great site and I look forward to posting some cases.
The provisional bridge looks great and I have utilized this technique since you revealed it to me.
My question on this case is "why didn't the extraction sites get grafted at the time of implant placement?" As you know, it is much, much easier(and less costly) to practice ridge preservation than it is to try and rebuild ridges. Alos, did this patient have an amalgam tatoo below #24? If that is a esthetic concern, it can be removed with any soft tissue laser including your diode. I can post one of these cases in the future if you want to see one.
Good to hear from you Jay,
The extraction site didn't get grafted because I didn't do this implant placement. The periodontist that did the placement was sure that the implants would be enough to support the ridge. This is one of the reasons I'm now placing my own implants. Today I am using a combination of bone replacement materials from Alvelogro (888) 898-2583 (Flow PEP-Gen P-15 and Pepgen Particulates and suturing resorbable collagen tape over the site). The amalagam tatto hasn't been an aesthetic issue but I'll give a try at elimination with a diode.
I've followed the same path as you with placing my own implants, especially in critical esthetic situations. Got tired of scrambling at restoration time to achieve the desired result. I also like using the Pepgen materials to maintain a ridge but usually mix it with demineralized bone if I'm grafting a socket for a future implant placement. The Pepgen can get so hard that it is difficult to pilot through at implant placement.
Jay
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