Guided Implant Placement with Buccal Exposure and Graft – clinical case

Dott. Alexandre Minis, France

Case description:
The 55 years old female patient has a lack of prior medical history and is a non-smoker.
There is a fracture under the crown of #12 with infection and vestibular fistula for which a temporary extraction with a valplast for 3 months is performed.
On the control CBCT, low bone volume and evidence of a radiolucent vestibular image initially suggesting fenestration linked to the fistula present before the extraction, or, of the bone being formed.

Surgical dental history:
The surgery is performed using a surgical guide, designed on 3Shape Implant Studio, dentition supported guide 3D printed on a Phrozen Shuffle printer.

The CBCT reveals that due to the vary narrow bone volume a very precise mesio-distal and vestibular-palatinal axis a high degree of precision will be required during implant placement.
The performing of a vestibular flap after drilling in order to analyze the clear radio image. No tissue punch was used in this case because the flap was already planned.
The fenestration was filled with B-TCP and covered with a collagen membrane then closure of the site. The 1,5mm subcrestal placement of an EL 3.5 * 11 implant with satisfactory primary stability (35 N) and a healing abutment.

Next Steps:
the absence of a provisional during the first 30 days, then an “Esthetic” valplast without any support on our abutment that the patient will wear as little as possible.
It will be reviewed at 3 months for the final crown.