GBR, simultaneous implant placement and soft tissue augmentation in esthetic zone
Dr. Fabrizio Colombo
Milan, Italy
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.
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).
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).
Initial clinical solution
Interdental space wider than ideal one (frontal view) (left).
Interdental space wider than ideal one (occlusal view) (right).
Treatment planning
Endoral x-ray of the area to be treated (left).
CBCT showing a moderate lack of buccal bone (right).
Surgical procedure
Initial clinical picture (left).
Opening of a full-thickness trapezoidal flap (right).
Surgical procedure
Implant placement of a NobelReplace® CC PMC 3.5x11.5 mm (left).
Vestibular fenestration in the apical area of the implant (right).
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).
Surgical procedure
Placement of the particulate bone graft on the defect and fenestration (left).
Placement of the membrane fixed with pins (right).
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).
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).
Surgical procedure
Healing 2 months after surgery (left).
Reopening (center).
Improving gingival thickness by using creos™ mucogain (right).
Surgical procedure
Soft tissue handling: free gingival graft to prevent recurrence of a crestal frenulum insertion.
Immediately post-op clinical picture.
Restorative procedure
Temporary impression taking (left).
Healing after 10 days (right).
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).
Restorative procedure
Shaping 1.3 and 2.3 using direct composite restoration.
Restorative procedure
Soft tissue conditioning by means of the temporary crown.
Restorative procedure
Healing 2 months after surgery.
Outcome
Final screw-retained metal-ceramic crown (frontal view) (left).
Final screw-retained metal-ceramic crown (lateral view) (right).
Outcome
Healing 2 months after surgery.
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NobelReplace® Conical ConnectionProven performance, enhanced esthetics.
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creos™ xenoprotectA membrane with outstanding handling that facilitates bone gain.
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creos™ xenogain3 methods of application to meet all your bone grafting needs.
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creos™ mucogainUnique oriented porous structure designed for guided soft tissue regeneration.
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