Buccal bone augmentation during immediate implant placement

Case courtesy of Dr. Bastian Wessing.

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Initial clinical situation

Pre-operative situation: single X-ray after three months of endodontic treatment after trauma (left).

In the facial view, tooth 11 (FDI) appears discolored with persistent pain and mobility grade II (Miller) (right).

Surgical procedure

Extraction of hopeless tooth 11 (FDI), with intact buccal bone (left).

Pilot-drill with a lab side drilling guide and extension drill into the alveolar-palatal bone (right).

Surgical procedure

Immediate implant placement using a NobelActive® 4.3 × 13 mm implant (left).

Optimized implant placement: slightly palatal without compression or even contact with the buccal bone (right). 

Surgical procedure

Augmentation of the buccal gap with creos™ xenogain (small granules) to reduce bucco-palatal resorption of the alveolar ridge volume (left).

Occlusal view after gap augmentation (right).

Surgical procedure

Panoramic radiograph after implant placement.

Restorative procedure

Screw-retained provisional titanium abutment after opaque application (left).

Facial view of a chairside provisional for immediate restoration (right).

Restorative procedure

Occlusal view of the emergence profile after two months healing time (left).

Impression with an impression coping in an open-tray technique (right).

Restorative procedure

Veneered zirconia NobelProcera® ASC Abutment for a screw-retained single implant crown (left).

Side view of the finalized NobelProcera® ASC Abutment with the Omnigrip™ screwdriver on the master cast (right).

Outcome

Occlusal view of the final restoration after three months' treatment time. Note the slight bucco-palatal resorption of the alveolar ridge (left).

Facial view of the final restoration (right).

Outcome

Facial view of the final restoration.