Menai Bridge, United Kingdom
Clinical case description:
An elderly man presented with a catastrophic vertical root fracture on a root filled post crowned canine which had been in function with no problems for 20 years. The tooth was atraumatically extracted and socket left to heal for 8 weeks. A CBCT scan at 6 weeks confirmed the absence of a buccal plate, and a potentially difficult placement due to a horizontal and vertical defect. The patient had a medium tissue biotype, and was a low aesthetic risk in terms of smile line, according to the ITI SAC Classification.
An option of an advanced bone block grafting procedure had been discussed with the patient and he was consented for a human donor block, but would rather not have it if possible. He wanted to keep surgery to a minimum, as well as the time to be able to restore and load the tooth back to function.
It was decided to attempt a large augmentation, and a narrow diameter tissue level implant was placed, with a regular neck prosthetic platform at a deeper than normal position, and slightly more palatal. Autogenous bone chips were harvested around the area, and a GBR procedure was performed, using the Bio-oss pen to collect the patient’s own blood, and then the area grafted and covered with a bio-guide membrane, as a double layer technique. A closure screw was placed and the implant completely submerged, with a periosteal release achieving a tension free primary wound closure.
A second stage procedure was performed 3 months later, moving keratinised palatal tissue over to the buccal aspect, and placing a bevelled healing cap. A tissue level open tray impression was taken and the crown fitted two weeks later, with a screw retained palatal access hole, for retrievability. The crown was placed into right side group function, with the adjacent upper right first premolar. The patient was instructed on daily oral hygiene measures to use super-floss circumferentially around the implant crown.