Ramsey Amin DDS
I don’t have complications too often but this is one worth sharing. I did a very large block bone graft in the front of the mouth for dental implants. The bone graft was both vertical and horizontal and gained a lot of volume. The block bone graft was held in by screws which will be removed later. This will yield plenty of bone for two front teeth implants.
Her temporary Essix bridge inadvertently put some pressure on the gums after the surgery. You never want pressure on top of a newly placed bone graft ! This happened due to a slight tear of clear retaining part of the Essix bridge on the palate. Regardless, it dug into the gum a bit and exposed the newly healing bone. Now the bone is showing. You can see how I had to really adjust the Essix temporary to clear all of the bone that was added.
I will describe how I closed this open wound using the patient’s own blood platelets-L PRF. (Leukocyte rich platelet rich fibrin)
(PLEASE NOTE THAT THIS PATIENT IS NOT COMPLETE — ONE TOOTH WAS EXTRACTED SO THE GAP IS NOW A TWO TOOTH GAP. I PURPOSELY OVER BULKED AND OVER BUILT BONE SO THERE IS EXTRA TO WORK WITH RATHER THAN NOT ENOUGH. THIS WILL LOOK GREAT ONCE THE IMPLANTS AND TEMPORARIES ARE DONE TO SHAPE THE GUMS. THIS IS A VERY LARGE GRAFT BECAUSE IT IS BUILDING BONE VERTICALLY AND HORIZONTALLY)
The proper thing here is not to try to reclose the open wound with stitches. That will often make it worse. Usually a noncritical, more basic bone socket graft may fill in on its own. This one was not doing that even though it started off pretty small! You can see the progression over about 7 weeks that it took to close this hole. At first it was not really present, then they got a bit larger> then it shrank down to where pink gum is covering the bone again.
I am always there for my patients. I will do what it takes to correct this. This can happen with block bone graft or GBR membrane techniques….I do both.
What I did was remove a very slight bit of surface bone and drew blood from her right arm. With her own blood draw from the arm, special cells in the bloodstream called platelets are concentrated to make a type of gel/membrane call L PRF. I placed the L PRF on the open wound and stitched a web over it to hold in. Over the course of about 2-3 weeks I saw her back 2 times to repeat the blood draw and add more L PRF under the webbing of special Prolene stitches.
The bone graft exposure closed! Complication solved. It is still a bit immature in this last picture but there is pink gum fully covering the bone which is a great sign! Often I get messages from people worldwide with bone exposed that lost their entire bone graft and had to start all over again. This is a very efficient, natural way to close a wound but it does not miraculously close bone grafts that were done with poor technique.
L-PRF and PRP (platelet rich plasma) outside of dentistry heal up wounds that are taking too long such as people with diabetes have open sores.
Your comments and questions are welcome.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry