Dr Fabrizio Colombo

GBR, simultaneous implant placement and soft tissue augmentation in esthetic zone

Dr. Fabrizio Colombo

Milan, Italy

Case courtesy of Dr. Colombo

Patient: 22 years old, male, no systemic diseases, no oral pathologies or dental problems (patient previously treated with orthodontic treatment).

Clinical situation: agenesis of 1.2 with moderate loss of buccal convex architecture.

Surgical solution: placement of a NobelReplace® CC PMC implant 3.5x11.5 mm. Bone regeneration using Nobel Biocare creos™ xenogain "S" gr. 0.5 and Nobel Biocare resorbable membrane creos™ xenoprotect 25x30 fixed by pins. Soft tissue augmentation using creos™ mucogain.

Restorative solution - Provisional: Acrylic screw-retained temporary crown. Final: individual crown on implant.

Surgery date: November 5, 2018.

Total treatment time: 24 months.

Tooth position: Upper right lateral incison, 1.2.

 

 

 

Case courtesy of Dr. Fabrizio Colombo.

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Case courtesy of Dr. Colombo

Initial clinical solution

Young patient, no gummy smile; slight asimmetry exposing slightly more the right side of the oral cavity (left).

Agenesis of the upper right lateral incisor provisionally treated using a Maryland bridge (top right).

Occlusal view of the Maryland bridge (bottom right).

Case courtesy of Dr. Colombo

Initial clinical solution

Lack of the typical vestibular convex architecture in the area of 12 (lateral view) (left).

Lack of the typical vestibular convex architecture in the area of 12 (controlateral view) (right).

Case courtesy of Dr. Colombo

Initial clinical solution

Interdental space wider than ideal one (frontal view) (left).

Interdental space wider than ideal one (occlusal view) (right).

Case courtesy of Dr. Colombo

Treatment planning

Endoral x-ray of the area to be treated (left).

CBCT showing a moderate lack of buccal bone (right). 

Case courtesy of Dr. Colombo

Surgical procedure

Initial clinical picture (left).

Opening of a full-thickness trapezoidal flap (right).

Case courtesy of Dr. Colombo

Surgical procedure

Implant placement of a NobelReplace® CC PMC 3.5x11.5 mm (left).

Vestibular fenestration in the apical area of the implant (right).

Case courtesy of Dr. Colombo

Surgical procedure

Execution of osteopromotive holes and placement of a Nobel Biocare creos™ resorbable membrane creos™ xenoprotect on the palatal site using a pin (left).

Hydratation of the particulate bovine bone (creos™ xenogain "S") using normal saline solution and patient's blood (right).

Case courtesy of Dr. Colombo

Surgical procedure

Placement of the particulate bone graft on the defect and fenestration (left).

Placement of the membrane fixed with pins (right).

Case courtesy of Dr. Colombo

Surgical procedure

Detail of the membrane in situ (occlusal view) (left).

Closure of the flap by primary intention using PTFE suture (center).

Post-operative endoral x-ray (right).

Case courtesy of Dr. Colombo

Surgical procedure

Suture removal after 15 days healing (left).

Loss of the correct shape of the parabola of 11 due to the crestal repositioning of the upper lip frenulum (right).

Case courtesy of Dr. Colombo

Surgical procedure

Healing 2 months after surgery (left).

Reopening (center).

Improving gingival thickness by using creos™ mucogain (right).

Case courtesy of Dr. Colombo

Surgical procedure

Soft tissue handling: free gingival graft to prevent recurrence of a crestal frenulum insertion.

Immediately post-op clinical picture.

Case courtesy of Dr. Colombo

Restorative procedure

Temporary impression taking (left).

Healing after 10 days (right).

Case courtesy of Dr. Colombo

Restorative procedure

Acrylic screw-retained provisional crown (left).

Insertion of an acrylic screw-retained temporary crown after suture removal (10 days after the surgery) (right).

Case courtesy of Dr. Colombo

Restorative procedure

Shaping 1.3 and 2.3 using direct composite restoration.

Case courtesy of Dr. Colombo

Restorative procedure

Soft tissue conditioning by means of the temporary crown.

Case courtesy of Dr. Colombo

Restorative procedure

Healing 2 months after surgery.

Case courtesy of Dr. Colombo

Outcome

Final screw-retained metal-ceramic crown (frontal view) (left).

Final screw-retained metal-ceramic crown (lateral view) (right).

Case courtesy of Dr. Colombo

Outcome

Healing 2 months after surgery.

 

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