From missing buccal bone to successful regeneration and implant placement

regeneration and implant placement

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Dr M. Leventis DDS, MSc, PhD.


Patient profile: 63-year old male patient. Non-smoker. The patient presented with a non-restorable upper right central incisor. Tooth mobility was grade 3, there was marked soft tissue recession, a periodontal abscess, and displacement of the tooth due to severe bone loss (Pics 1-3).

According to protocol (Fairbairn and Leventis 2015) the tooth was “atraumatically” extracted without raising a flap and the site was thoroughly debrided (Pic 4). 

After extraction, a severe buccal hard and soft tissue defect was evident (Pic 5). The site was left to heal spontaneously under secondary intention. 

After 6 weeks, the area was covered by newly-formed soft tissues (Pic 6).  A site-specific, papilla-sparing, full-thickness flap was raised, revealing a large 3-wall bony defect. The buccal bone was completely missing.  A 3.75×11.5 implant was placed in the optimal position (Pics 7,8). 

The area was subsequently grafted with 0.5cc self-hardening ß-Tricalcium Phosphate/Calcium Sulfate – EthOss® (Pic 9). 

After 12 weeks, the implant was exposed and a healing abutment placed. A screw retained implant crown was fitted (Pic 10). 

At 10 months follow-up, the architecture and volume of the ridge had been successfully restored and the area buccally was covered by thick regenerated keratinized soft tissues (Pics 11,12). A CBCT showed that the buccal bone was successfully regenerated (Pic 13). 

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