- The patient is a 56 year-old, active and healthy man. He does not smoke, takes no medications and has no allergies. He had a loose anterior bridge from 11 to 22.
- Since his profession requires speaking in public, the appearance of his anterior teeth has a strong impact on his self-confidence.
- Slightly inflamed gum with no abscess
- Clinical examination revealed vestibular bone loss at tooth 11 and a decayed root, but no bone loss at tooth 22.
- Two treatment options were considered:
1. Extraction, period of healing, re-entry for implantation and simultaneous GBR, healing, gingivoplasty and final
2. Immediate extraction and implantation with simultaneous GBR and provisional crown restoration.
- The 2nd option was chosen to provide the shortest overall treatment time.
Implant placement 1
- Removal of the bridge showed a vertical radicular fracture in tooth 11 and extensive decay in tooth 22
- Tooth 22 was extracted atraumatically (using Benex® Extraction system) and 11 with a very fine elevator
- A gingival flap was elevated for access to the bone defect at tooth 11
Implant placement 2
- At tooth 11, a flap was elevated for access to augment the buccal aspect of the alveolar ridge
- Buccal bone at tooth 22 was intact so the gingivae was left intact
- A surgical guide was used to identify the ideal axes for the implants and the best emergence level.
Implant placement 3
- Two Roxolid® Bone Level Tapered Implants (Ø 4.1mm RC, SLActive® 14mm) were placed with insertion torques greater than 50Ncm
- Both implants were placed more palatally, leaving gaps between the implant and buccal bony walls
- Anchorage was achieved apically, hence the choice of length and underpreparation of the socket.
Implant placement 4
- Autologous bone fragments were collected to fill the deficient sockets at sites 11 and 22.
- At site 11, an osteogingival graft from the maxillary tuberosity was harvested and fixed with an osteosynthesis screw engaging the cortical bone of the palate.
- Straight Straumann Screw-retained Abutments ( SRA, height 2.5mm ) were placed onto the implants, before flap closure with 5.0 monofilament
- Abutment level impression for fabrication of the provisional prosthesis
- Protective caps temporarily covered the SRAs during labwork.
- 6 hours post-surgery
- Protective caps were removed without any anesthesia and temporary bridgework was screwed onto the SRAs
Post-operative X-ray – immediate
- Radiographic examination performed post-surgically with temporary restoration in-situ
Post-operative results – 1 week
- Successful initial healing phase after 1 week ( these image )
- Healthy looking gingiva and the patient reported no symptoms
Post-operative results – 2 months
- Follow-up consultation after 2 months also revealed good healing results of implant with bone and gingivae.
Testimonial from the surgeon
- The restoration was successful due to several state-of-the-art technologies and techniques:
1. The design of the Straumann® Bone Level Tapered Implants provided good primary stability in compromised recipient bone conditions.
2. The retrieval and reuse of bone fragments using the Straumann ® Bone Level Tapered implant drills.
3. The use of the maxillary tuberosity osteogingival tissue graft technique.
- With this, we were able to provide our patient fixed teeth in a single day. The temporary bridge had no occlusal contact and only served to enable the patient to speak and smile. Once osseointegration was completed and the graft has been consolidated, the final bridge can be planned.
About the author
Dr Sepehr Zarrine
DDS, Dr. med dent
- Exclusive private implantology practice
- Speaker ITI France
- European Master in Dental Implantology, Surgery, Prosthetics, Bone grafts (Frankfurt, Germany)
- University diploma in surgical maxillofacial rehabilitation (Medicine, Paris VII)