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Patient: 69 years old, male, no systemic diseases, no oral pathology or dental problems.
Clinical situation: presence of a damaged upper left first premolar.
Surgical solution: extraction of 24, simultaneous placement of a NobelReplace PMC 4.3x11.5 and filling of the buccal gap using creos™ xenogain.
Restorative solution: Provisional: immediate loading using a screwed acrylic crown (temporary abutment engaging). Final: screwed zirconia crown.
Surgery date: November 22, 2018.
Total treatment time: 7 months.
Tooth position: upper left first premolar.
Case courtesy of Dr. Fabrizio Colombo, DDS.
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Initial clinical situation
Front view (left) and Buccal view (right).
Detail of the typical buccal convex architecture in the area of 24. Frontal view (left).
Detail of the typical buccal convex architecture in the area of 24. Occlusal view (center).
Pre-operative X-ray (right).
Loss of the palatal wall of the crown on 24 (left).
Vertical fracture on 24 (right).
Detail of 24 after extraction; presence of two vestibular roots and an accidental fracture of the buccal bone plate (left).
Leveling and cleaning of the buccal wall (right).
Detail of the implant site preparation in the alveolus palatal region. The interradicular septum has become the new buccal cortical bone around the implant (left).
NobelReplace® PMC 4.3 x 11.5 mm insertion (35 N/cm) (right).
Occlusal detail of the implant placement (left).
The socket is filled using creos™ xenogain 0,5 g small granules (right).
Insertion of the graft in the buccal socket (left).
View of the biomaterial placed (center).
Temporary protection of the graft with fibrin sponge (right).
Impression phase (left)
X-ray taken during the impression phase (right).
Detail of the impression (Impregum 3M ESPE) (left).
Temporary screwed crown a few days after surgical phase (center).
Temporary crown X-ray (right).
Final clinical situation of the gingival tunnel (occlusal view). Detail of the buccal convex architecture (7 months after implant placement) (left).
Final zirconia screwed crown (occlusal view) (right).
Final ceramic screwed crown (lateral view, 7 months after implant placement) (left).
Final ceramic screwed crown (frontal view). Detail of the buccal convex architecture (7 months after implant placement) (right).
CBCT 7 months after the implant placement.
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