Dr Fabrizio Colombo

Immediate loading of post extractive single tooth in esthetic zone with simultaneous GBR

Dr. Fabrizio Colombo, DDS

Milan, Italy

Case courtesy of Dr. Colombo

Patient: 69 year 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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Case courtesy of Dr. Colombo

Initial clinical situation

Front view (left) and Buccal view (right).

Case courtesy of Dr. Colombo

Initial clinical situation

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).

Case courtesy of Dr. Colombo

Surgical procedure

Loss of the palatal wall of the crown on 24 (left).

Vertical fracture on 24 (right).

Case courtesy of Dr. Colombo

Surgical procedure

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).

Case courtesy of Dr. Colombo

Surgical procedure

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® CC 4.3 x 11.5 mm insertion (35 Ncm) (right).

Case courtesy of Dr. Colombo

Surgical procedure

Occlusal detail of the implant placement (left).

The socket is filled using creos™ xenogain 0.5 g small granules (right).

Case courtesy of Dr. Colombo

Surgical procedure

Insertion of the graft in the buccal socket (left).

View of the biomaterial placed (center).

Temporary protection of the graft with fibrin sponge (right).

Case courtesy of Dr. Colombo

Surgical procedure

Impression phase (left)

X-ray taken during the impression phase (right).

Case courtesy of Dr. Colombo

Restorative procedure

Detail of the impression (Impregum 3M ESPE) (left).

Temporary screwed crown a few days after surgical phase (center). 

Temporary crown X-ray (right).

Case courtesy of Dr. Colombo

Outcome

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). 

Case courtesy of Dr. Colombo

Outcome

Final ceramic screwed crown (lateral view, 7 months after implant placement).

Case courtesy of Dr. Colombo

Outcome

CBCT 7 months after the implant placement.

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