Initial situation

60-year-old patient presented with failing post crown and cracked root at the upper left central incisor area (UL1). Tooth was extracted gently with minimal trauma to the labial plate. Eight weeks following extraction, patient presented at his implant placement surgery with signs of gum recession and labial bone loss (Fig 1).

Surgical procedure

Buccal mucoperiosteal flap was elevated and early healing socket at the upper left central incisor was found. Granulation tissue was removed and Straumann 4.1 x 14mm Roxolid SLA BLT implant was placed within the prosthetic envelope, following the correct four-dimensional placement. Primary stability was achieved recording 25Ncm torque and a 4.5. x 4mm healing abutment was placed (Figs 2-5). 4mm labial threads were exposed due to the labial bone dehiscence. The implant threads were covered with autogenous bone chips harvested using bone scraper from adjacent area (Fig 6).

Jason membrane and Cerabone were used to create labial convexity at the UL1 area. (Figs 7-15).

Flap was closed following a transmucosal approach and a temporary fixed adhesive Rochette was placed. (Figs 16-17).

Twelve-week healing time was allowed before removal of the healing abutment and fixture level impression was taken to build a lab-made screw retained temporary crown to work on the prosthetic soft tissue sculpture of the peri-implant soft tissue, aiming to create a customised emergence profile. (Figs 18-23).

Ten weeks afterwards, final impression was taken and final screw retained crown was made by the lab. Final crown was fitted using 35Ncm achieving satisfactory pink and white aesthetics. (Figs 24-27).

One year post op, a CBCT was taken to check the peri-implant bone volume showing very good peri-implant bone stability (Figs 28a and 28b).

Hassan Maghaireh

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