From: Terry Pannkuk
To: ROOTS
Sent: Thursday, July 30, 2009 12:56 AM
Subject: [roots] More Tales from the Gray Side

This attractive young woman had a split maxillary molar with the buccal plate completely blown out.
In March I extracted and grafted the buccal sockets only leaving a nice clot to form in the palatal.
Gary Carr got into a contentous argument with me when I presented it on TDOChat claiming it was poor
treatment. I sutured a Biomend membrane to keep the Puros and followed up the healing which occured
nicely validated at one month.  At this point I was skating on thin ice at TDO finding ways to present
alternative opposing options to every Carr manifesto I could find.  It was great fun but I knew my days
were numbered.

This patient came back for the implant placement today.  The procedure went very smoothly, ideal torque
at 35 Ncm, tapped the sinus with osteotomes and placed a 5.0 x 10 mm NBC replace select straight with
a 3mm healing cap.  It seems she should have a nice esthetic emergence profile when the final
restoration is placed and I was happy with the resultant buccal wall contour considering the blow out.
- Terry





Great job! How would Gary have treated this? - Dan Shalkey

I don't know.....he just didn't like the way I did it.  My suspicion is that he would have extracted
the tooth then grafted later if necessary which in my view was automatically going to be necessary
because the young woman had a wide smile, was pretty, young, and probably didn't want some wanker
performing onlay block grafts and slicing and dicing her ramus up later after she complained about
the concave food trap and exposed threads. :):):)

Attached is a healed socket on a patient I checked today.  The woman is a little older.  It's a
mandibular molar with a slight crater defect that I didn't graft. There was no reason.  It was a smaller defect,
the bone is better quality and the esthetics are not the same priority.  With a long buccal shelf,
is the buccal wall likely to collapse?

Each patient should get a custom, thoughtful, treatment plan based on their specific situation and expectations.

Right?  I graft very consevatively and rarely, but I'm not afraid to when it seems necessary.

On the patient with the extraction site healing I checked today, would anyone have grafted that case?
Why? ....for the insurance code and money? :):):) - Terry



I would not even suture it. Is that a collagen sponge in the socket? It is still a graft ;-) - Dmitri

Nope, collagen sponge isn't a graft, its gone in 2 weeks replaced by a natural clot - Terry

Terry which graft material, membrane and suture did you use? - Dr Sanjay Jamdade