Live Surgery - Removal of Mesh and Placement of Implants

This is the second stage of the regeneration of a ridge in vertical and horizontal dimensions. The first stage of this treatment was presented as a live surgery during the SEPA Global Online Bone Regeneration Summit 2021. This is the live surgery of the second stage of the treatment.

In this second live surgery, Dr. Jay Malmquist and the assisting surgeon, Dr. Michael Malmquist, remove the previously placed titanium mesh in the anterior maxillary region. This mesh was placed to help regenerating an anterior maxilla of a patient, suffering from a trauma caused by a car accident. The female patient has a history of trauma and failed implants and subsequently significant bone loss in the anterior region of teeth #12, 11, 21, 22 (US # 7, 8, 9, 10). Before starting the second surgery, Dr. Malmquist reviews the first surgery and evaluates the bone gain achieved by using a rhBMP2 protein in combination with a titanium mesh. This approach helped to reconstruct the missing bone in two dimensions, vertically and horizontally. Following a healing period of 6 months, Dr. Malmquist now removes the mesh and starts the reconstruction of the missing teeth.

After accessing the site carefully and exposing the mesh as much as possible, Dr. Malmquist removes the mesh and assess the bone that was able to grow using biomaterials and BMP proteins. He prepares the osteotomies for two implants, using a surgical guide. The guide guides the pilot drills, the final preparation of the osteotomies is done free-hand in order to adjust the drilling procedure, if required. He places two implants and verifies the Implant Stability Quotient (ISQ) as the implants are placed completely in newly gained bone. He closes the implants with cover screws and closes the flap on top. 
While closing the flap, Dr. Malmquist explains his approach to wound closure.

During the whole surgery, Dres. Malmquist will explain every step of the procedure and discuss their approach and experience in complex cases like the presented one.

The final and third part of this treatment will follow later and will be made available here as well.