Concepts et produits - indication matrix

Initial situation – Treatment plan: Replace the adhesive upper left central incisor bridge with a dental implant

Advanced bone loss after traumatic tooth loss more than 10 years ago

CBCT: Advanced bone loss after traumatic tooth loss more than 10 years ago

Patient used to have a diastema in the area which she no longer wanted to be recreated. Treatment plan: implant for UL1 and a veneer for the UR1 to match the space analysis and achieve acceptable and symmetrical aesthetic outcome

Three-sided full thickness flap and cleaning the surgical area from the granulation tissue

Three-sided full thickness flap and cleaning the surgical area from the granulation tissue

Shaping and preparing the uni-cortical maxgraft® block using straight hand-piece under copious irrigation to fit the surgical field and to ensure good adaptation

Shaping and preparing the uni-cortical maxgraft® block using straight hand-piece under copious irrigation to fit the surgical field and to ensure good adaptation

Stabilisation of the bone block with two 10 mm fixation screws placed oblique. Sharp edges of the block were polished to avoid defeasance in the soft tissue healing

Stabilisation of the bone block with two 10 mm fixation screws placed oblique. Sharp edges of the block were polished to avoid defeasance in the soft tissue healing

Layer of maxgraft® cancellous particles used to fill any gaps and to allow smooth contour medially and distally and covering with Jason® membrane

Layer of maxgraft® cancellous particles used to fill any gaps and to allow smooth contour medially and distally and covering with Jason® membrane

Soft tissue adjustment - frenulum adjustment and muco-periosteal release to achieve full closure under no tension to allow the flap margins to heal with primary intension

Soft tissue adjustment - frenulum adjustment and muco-periosteal release to achieve full closure under no tension to allow the flap margins to heal with primary intension

Flap closure using 5/0 monofilaments Prolene sutures

Flap closure using 5/0 monofilaments Prolene sutures

Six months healing period was allowed - healthy soft tissue contour, satisfactory convexity

Six months healing period was allowed - healthy soft tissue contour, satisfactory convexity

Post op CBCT shows well integrated and remodelled bone block with sufficient augmentation

Post op CBCT shows well integrated and remodelled bone block with sufficient augmentation

Osteotomy prepared revealing a well integrated and nourished bone block. Prostheticly driven implant placement (Straumann Roxolid BLT - RC 4.1x 10 mm) - using a pre-fabricated surgical guide of the approved wax up

Osteotomy prepared revealing a well integrated and nourished bone block

Implant is placed 3 mm away from the cementoenamel junction. Good primary stability was achieved with a torque of 35 Nom at placement and good block integration

4.5 mm diameter x 4 mm height healing abutment

GBR at the time of the implant placement - added cerabone® 0.5 cc small particles to increase the convexity and insure stability of the soft tissue. Jason® membrane stabilised with titanium pins and sutured palatally

GBR at the time of the implant placement - added cerabone® 0.5 cc small particles to increase the convexity and insure stability of the soft tissue. Jason® membrane stabilised with titanium pins and sutured palatally

Exposure of the UL1 implant and fitting a chair side temporary crown

Exposure of the UL1 implant and fitting a chair side temporary crown

Final implant impression with Straumann RC customised impression pick up with an open tray for final screw retained implant crown on UL1 and Porcelain veneer on UR1

Final implant impression with Straumann RC customised impression pick up with an open tray for final screw retained implant crown on UL1 and Porcelain veneer on UR1

Final fit of final screw retained implant crown with CAD/CAM Ti abutment on UL1 and Porcelain veneer on UR1. Lab work was provided by Ceramist Guglielmo Parziale - Napoli - Italy

5 years clinical review – stable outcome

5 y post op CBCT - Axial view at the coronal 2mm level

5 y post op CBCT - Coronal view showing the upper left central incisor implant

5 y post OP CBCT -Sagittal view