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,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
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