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Oral Surgery/Tooth Extraction/Dental Implant

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Question
CT Scan Screen Shot
CT Scan Screen Shot  

Implant Location?
Implant Location?  
I suffered a trauma to the face at the end of last march that spilt my #8 tooth to the root. It was removed about a week later and left to heal for an implant. I went in for my first consultation with an oral surgeon about 10 months later ( I realize this is most likely too long of a wait- It was due to scheduling issues). The screen shots attached are from a CT scan that was taken at that visit.

I have a few questions regarding the images:

- In the first image what is the channel of missing bone that seems to be almost behind the #9? Would this affect an implant to replace the #8? The oral surgeon suggested a bone graft before a scan was even administered ( just based on the trauma sustained to the site), he then confirmed this after viewing the scan but was apprehensive on whether or not it was necessary- only ideal.  

- The second picture is where I would assume my #8 was prior to extraction and where I would assume the implant would be placed ( or at least very close to that area).

So to recap my questions- What is the channel of bone that seems to be missing? It almost looks like a tooth was removed from there but the location does not match where my #8 was originally, it was a perfectly normal tooth that was inline with the rest of my smile. What would be a recommended course of action for a dental implant? Is it almost certain I have insufficient bone for an implant?

Additional Details:
-19 yr old male in otherwise good health
-Smoker; trying desperately to quit ( especially in anticipation of this procedure)

Ps: I would like to apologize in advance for any "dumb" questions, I have virtually no knowledge of medicine or dentistry. I would also like to apologize if the attached images provide insufficient information- I can attach more if required as I have the entire scan on my computer.          

Thanks in advance for your time,
Neil from Calgary, AB

Answer
Neil, Thank you for your questions. The channel of bone behind the tooth is the incisive foramen or anterior palatal foramen. This is a channel in the bone where a nerve runs that gives you feeling to the top teeth and anterior palatal soft tissue. In my opinion, I would bone graft the site because you have lost bone on the outside and you will get a less than ideal esthetic result without grafting the area before placing an implant. I hope I have answered all your questions. Remember, the only dumb questions are the ones not asked.

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon

Expertise

Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at www.eosdds.com

Experience

Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

Organizations
American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Publications
Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

Education/Credentials
S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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