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Dr. Ferdinando D'Avenia

Immediate implant placement in a site with severe buccal dehiscence

Dr. Ferdinando D'Avenia

Italy

“creos™ xenogain is a user-friendly bone grafting material: hydration, manipulation and positioning is simplified by its wettability coupled with a smart syringe packaging that really makes things easy.”

Case courtesy of Dr. D'Avenia

Patient: male, 60 years old

Clinical situation: chronic periodontitis. Tooth # 25 with porcelain fused to metal crown and metal post and core. Vertical root fracture occurred two months earlier. 10 mm “U” shaped buccal dehiscence.

Surgical solution: Immediate implant placement (NobelParallel™ CC RP 4.3 x 13 mm) in combination with a GBR procedure (using creos™ xenogain and creos™ xenoprotect).

Restorative solution: NobelProcera® Zirconia Abutment

Surgery date: May 9, 2016 (GBR)

Total treatment time: 7 months

 

 

 

Case courtesy of Dr. Ferdinando D'Avenia.

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Case courtesy of Dr. D'Avenia

Initial clinical situation

Initial situation: pre-operative CBCT images (left).

Clinical pre-surgical situation (right).

Case courtesy of Dr. D'Avenia

Surgical procedure

After atraumatic tooth extraction, the granulation tissue is completely removed. The osteotomy is prosthetically driven, in order to provide a second premolar screw retained restoration with an occlusal screw access hole. In order to satisfy this criteria, the implant is more favorably housed in predominantly native bone, mesio-lingually to the center of the defect (left).

The implant (NobelParallel™ CC RP 4.3 x 13 mm) is placed with 20 Ncm insertion torque, with buccal threads exposed to the defect area (without bone contact) (right).

Case courtesy of Dr. D'Avenia

Surgical procedure

Placement of creos™ xenoprotect inside the extraction socket to protect creos™ xenogain from exposure to the soft tissue through dehiscence (left).

Hydration of creos™ xenogain with venous blood (right).

Case courtesy of Dr. D'Avenia

Surgical procedure

Placement of creos™ xenogain into the bony defect. The implant is covered with a 3 mm healing abutment (Ø 3.6 mm) (left).

Healing after 8 days with slight membrane exposure (right).

Case courtesy of Dr. D'Avenia

Surgical procedure

Post-operative CBCT showing sufficient bone augmentation of the buccal wall dehiscence (left).

120 day follow-up: during the final impression visit, the healing abutment is changed. A wider diameter allows a better management of the final restoration emergency profile (right).

Case courtesy of Dr. D'Avenia

Restorative procedure

CBCT after healing.

Case courtesy of Dr. D'Avenia

Outcome

Final restoration.

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