Connective tissue grafting

Today's procedure is a 4 tooth CT graft using native tissue, emdogain and a coronally repositioned flap. Continuous sling sutures for the graft, continuous and interrupted sling for the curtain and finally a modified mattress suture for curtain/graft stabilization. Will post, post op photos as the case progresses.

PAOO - Wilcko

I haven't taken Wilcko course, but this is the idea, referred by Leone and Vaughn, some of Seattle top Orthodontists. Enjoy! Sorry for picture quality...

Immediate implant temporization in the maxillary anterior can provide a psychological boost for a patient when they are going to be losing on of their front teeth. If conditions are favorable for immediate extraction, placement and temporization than it is a predictable procedure that can lend itself to excellent long term results. Final result shown at bottom following restoration.

An Older Case - But good example of what regen can do

In this case, it was one where I realized the primary stability really has alot more to do with what you engage, than how much you engage. Studies show that obtaining primary stability is an important factor in implant success. In this case over 75% of the threads we exposed at time of placement and we waited 5 months prior to loading this site, however it has since been in function for five years. I will update with post restoration photos shortly. for this to be done successfully you need to do an extremely good job of debriding the extraction socket of all soft tissue. Will post the restored PA in the near future.

PAOO - Wilcko

I don't claim to do Wilcko procedures as I have never attended their courses, but I have been competing PAOO procedures for several local orthodontists. These procedures have been described as upregulating the osteogenic response via surgical injury and then providing a substrate and proper forces to allow tooth movement to occur quickly and with a superior bone profile following treatment. In this case I completed the PAOO bilaterally and this particular ortho group (both are geniuses) elected to couple the tooth movement to invisalign tray movement on the order of 4-5 days as opposed to 2 weeks.

Flapless One Stage Implant Placement

In cases where I have removed a tooth and developed the site, I almost always prefer to the place the implant in a flapless (removing only a small out of tissue with a tissue trephine, don't do transgingival where you prep through the tissue) one stage (healing abutment placed immediately) procedure. Here is an example: it is 10 minutes from patient seating to dismissal and legitimately painless.

Extraction, Immediate Placement, Temporization

This is what I call the emergency implant. Can be used in most cases in tooth protected sites from tooth #4 - #13. I always prefer a screw retained temporary as it eliminates potential cement overflow, but additionally is my check for an ideally placed implant. ALWAYS leave the temps out of occlusion and the implant needs to be primarily stabilized at time of placement to attempt this, although I don't think it is hard to achieve either of those two things. I have not had a failure utilizing this technique out of about 70 or so cases. Just in case people are wondering this site was grafted with a dynamatrix bone putty, however no membrane was used.