Hi everyone, I have an interesting case I want to discuss and get your thoughts.
I'm 35, based in London, fit, healthy, and doing my best to maintain impeccable hygiene.
We had to extract the left lateral incisor due to an infection that went unnoticed for too long. We've done a socket preservation and the site has healed. I'm about 6 months post-extraction at the time of writing.
The bone has resorbed and there is a horizontal defect. The bone width is between 2 and 3.5 mm at best. Vertically it's fine, with no defect.
Ideally, I'd want to have a post-immediate implant with GBR and gum graft in one session. The other alternative is to have the GBR, let it heal for 3-4 months then place the implant.
I have 4 treatment plans so far, 3 from London and one from Budapest from a world-renowned doctor who invented the Sausage Technique
London 1 said he would try to do a one-step procedure, with GBR, implant, and gum graft but it would depend on what he sees during surgery and if the odds are not favorable he would opt for the delayed solution. It would take around 3-4 hours plus sedation.
London 2 said he could do the implant with his eyes closed (he rectified after and said of course it's involved and so on) with a 97% success chance, 1:15 hours, with xenograft material and no sedation but with no gum graft. He said a graft would be hard to maintain, and high odds of failure so there's no reason for it. This would be the most convenient option for me but I'm concerned about the long-term durability of such an implant and the soft tissue architecture therefore I'd like to get your thoughts on this. He did say there will some some recession.
London 3 said there is no way he can even attempt a one-step surgery and he would do a block graft followed by the other steps. Under no way I'm going to have a block graft in this day and age for that area so it's out of the question however he did raise some good points about London 2's option with a one-step procedure and the xenograft. He was concerned about the success odds, the durability of the implant, and the risk of my bone fracturing during the procedure because of the narrow width.
Budapest said 2 steps, first GBR, then the implant. However, it would be virtually impossible for me to travel 4-6 times and stay 7-14 days on some occasions.
I have at least 2 other opinions lined up for next week from some reputable doctors in London but it seems there's more consensus for a 2 step procedure vs a single-step procedure. For me, it would be ideal if I could get it done in one procedure because it's been a long process and I'd like to finalize it but I have to weigh in the success rate, the long-term survival rate, and the most predictable strategy backed with data not just convenience.
I will update the thread once I get the other opinions but any thoughts that can help me make a more informed decision would be appreciated.
Many thanks.
Tudor.
I'm 35, based in London, fit, healthy, and doing my best to maintain impeccable hygiene.
We had to extract the left lateral incisor due to an infection that went unnoticed for too long. We've done a socket preservation and the site has healed. I'm about 6 months post-extraction at the time of writing.
The bone has resorbed and there is a horizontal defect. The bone width is between 2 and 3.5 mm at best. Vertically it's fine, with no defect.
Ideally, I'd want to have a post-immediate implant with GBR and gum graft in one session. The other alternative is to have the GBR, let it heal for 3-4 months then place the implant.
I have 4 treatment plans so far, 3 from London and one from Budapest from a world-renowned doctor who invented the Sausage Technique
London 1 said he would try to do a one-step procedure, with GBR, implant, and gum graft but it would depend on what he sees during surgery and if the odds are not favorable he would opt for the delayed solution. It would take around 3-4 hours plus sedation.
London 2 said he could do the implant with his eyes closed (he rectified after and said of course it's involved and so on) with a 97% success chance, 1:15 hours, with xenograft material and no sedation but with no gum graft. He said a graft would be hard to maintain, and high odds of failure so there's no reason for it. This would be the most convenient option for me but I'm concerned about the long-term durability of such an implant and the soft tissue architecture therefore I'd like to get your thoughts on this. He did say there will some some recession.
London 3 said there is no way he can even attempt a one-step surgery and he would do a block graft followed by the other steps. Under no way I'm going to have a block graft in this day and age for that area so it's out of the question however he did raise some good points about London 2's option with a one-step procedure and the xenograft. He was concerned about the success odds, the durability of the implant, and the risk of my bone fracturing during the procedure because of the narrow width.
Budapest said 2 steps, first GBR, then the implant. However, it would be virtually impossible for me to travel 4-6 times and stay 7-14 days on some occasions.
I have at least 2 other opinions lined up for next week from some reputable doctors in London but it seems there's more consensus for a 2 step procedure vs a single-step procedure. For me, it would be ideal if I could get it done in one procedure because it's been a long process and I'd like to finalize it but I have to weigh in the success rate, the long-term survival rate, and the most predictable strategy backed with data not just convenience.
I will update the thread once I get the other opinions but any thoughts that can help me make a more informed decision would be appreciated.
Many thanks.
Tudor.