Case study 1

Patient presents with the Chief Complaint:

“I need an implant because I lost my tooth.”

Intraoral examination

Generalized gingival erythema, with localized bleeding on probing. Probing depths ranging between 1-3mm, no furcation involvement, no mobility present. Mucogingival deformities and conditions around edentulous areas #9.

intraoral examination

intraoral examination

Step by step Treatment

1Determine the 3D implant position and evaluate the amount of bone that needs to be augmented.

3D implant position

The stent identifies the amount of bone augmentation needed for future implant placement in a prosthetic driven position.

identifying the amount of bone augmentation needed

A 3D model was printed and a CBCT was exposed in order to evaluate the ridge morphology.

evaluation 3D model

evaluation CBCT

2Bone grafting procedure

Local anesthesia was achieved, using an anesthetic that will supplement the vasoconstriction in the area.

Basic steps of the procedure were followed: gingival flap elevation - full thickness, decortication - in order to increase the blood supply for the grafted area, adapting the Titanium Mesh, adding the hydrated bone graft and the membrane. The Ti Mesh will support the space, fixated by some screws in the apical portion, and assure a better stability of the regenerated bone. After the area was grafted, partial thickness of the buccal flap was prepared, releasing the periosteal attachment in order to achieve primary closure.

bone grafting 1

bone grafting 2

bone grafting 3

bone grafting 4

bone grafting 5

Horizontal mattress and simple interrupted sutures were used to approximate the flaps and achieve closure of the flaps.

bone grafting 6

3GBR evaluation - 6 months after

After the 6 months healing period, the clinical and radiographic parameters were evaluated ith the prothetic stent in place. At this stage of the treatment, it is critical to assess the need of further bone grafting prior or simultaneous with implant placement.

GBR evaluation

3D models

CBCT

4Membrane removal and Implant placement

After local anesthesia was achieved, the Ti Mesh was removed and the evaluation of the bone achieved in order to place the implant #9 area. It is critical to respect the vertical, horizontal and buccal-lingual dimensions and to use the sirgical stent for an accurate 3D position.

membrane removal

implant placement

implant CBCT

5Post-operative instructions

Periodontal instructions are given to the patient: use of ice-packs, sleep with the head slightly tilted in order to avoid the blood accumulation in the area of the procedure; use Peridex, soft diet and avoid eating on the side with the procedure; no brusing or flossing in the area until the follow-up period.

Healing at 6 month follow up

The implant is ready to receive a final implant-supported FPD.

final implant

Direct comparison BEFORE and AFTER

before

after

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