Central incisor with tissue reconstruction with the Nobel Biocare N1™ concept
Dr. Oded Bahat, Dr. Ion Zabalegui, Dr. Eva Berroeta, Mr. Javier Pérez
Spain
Implant placement in the anterior zone with ridge augmentation.
Patient: 38 years, female
Clinical situation: healed site in esthetic zone. Compromised ridge vertically and horizontally
Surgical solution: implant placement with GBR
Restorative solution: single implant supported restoration
Surgery date: Bilbao, April 27, 2019
Total treatment time: 1 year 2 months
Tooth position: 11 (FDI), 8 USA
Initial clinical solution
Baseline: Ridge atrophy with bone and volume deficiency.
Healed site before the surgery (left).
Large bone and soft tissue defect (right).
Treatment planning
CBCT scan.
Narrow long ridge. Prominent incisal foramen. Buccal concavity. Ridge flared to the facial.
Treatment planning
Surgical pre-planning.
Try-in surgical guide (left).
Marking of advanced flap (right).
Surgical procedure
Occlusal view of the narrow ridge (left).
Check of implant position (right).
Surgical procedure
Check of depth of osteotomy with depth marking on the OsseoDirector™ instrument.
Surgical procedure
OsseoShaper™ instrument* at low speed (50 rpm) without irrigation (left)
OsseoShaper™ instrument* with bone chips (center).
Osteotomy created by the instrumenon (right).
* In this clinical case the pre-launch version of the OsseoShaper™ instrument has been used: the “CS Soft Bone Gizmo”. Black markings on the shaft and a 0.5 mm longer tip on the instrument are introduced on the final design of the OsseoShaper™ instrument.
Surgical procedure
Implant* of the Nobel Biocare N1™ concept is placed at osteotomy (left).
Implant insertion torque to 55 Ncm (center).
Occlusal view of implant in place (right).
* In this clinical case the pre-launch version of the Nobel Biocare N1™ implant has been used: the “CS Tiger Ultra Implant”. A flat platform is introduced on the final design of the Nobel Biocare N1™ implant.
Surgical procedure
Reconstructed hard tissue site with bone augmentation and L-PRF.
Fenestration and fracture of buccal plate (left).
Allograft and autogenous bone graft placed (center).
Placement of L-PRF membrane (right).
Outcome
Radiograph illustrating immediate post-placement position.
Immediate post-op radiograph (left).
Immediate post-op CBCT illustrating implant position and facial reconstruction (right).
Outcome
5 days post-op (left).
1 year post-op facial view (right).
Outcome
1 year post-op occlusal view.
Outcome
36 months post-op.
Outcome
36 months post-op facial view.
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