Case report
This patient initially presented 1 year after having lower molar extraction and site bone graft. The diagnostics revealed excellent bony height however mild to moderate deficiency of tissue at the top of the ridge. The treatment plan included 3-D computer assisted planning, implant placement with surgical guide, tissue augmentation using guided bone regeneration technique at time of implant placement, and restoration with custom abutment and crown. The outcome was a functional and aesthetic restoration with proper contours and tissue support.
Treatment
1. Diagnostics were obtained: CBCT and optical scan for 3-D planning
2. Surgical guide fabricated from 3-D work up using 3-D printing
3. Selected dental implant was placed using the guide. The buccal bone, as diagnosed during work up, was thin.
4. Guided bone regeneration was done using combination of allogeneic and xenogeneic bone particulates and resorbable membrane.
5. Following 4 months of healing, the implant was uncovered and healing abutment placed.
6. Implant level impressions were obtained and custom abutment and crown were fabricated and placed.
Success factors
1. The diagnostic work up began with the end in mind.
2. 3-D digital work flow for diagnostics and planning
3. A proper surgical guide allowed accurate placement of the implant.
4. Site development with bone grafting. This allowed proper tissue topography and emergence.
