42
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CERECDOCTORS.COM
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QUARTER 3
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2014
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BOLTCHI
abort the immediate implant placement
procedure and choose the early implant
placement treatment option after
allowing for six to eight weeks of soft-
tissue healing. The extraction socket
was debrided and several PRF plugs
(Fig. 12) were placed into the socket,
held in place by a 5.0 Plain Gut crestal
mattress suture (Fig. 13). A pre-fabri-
cated Essix retainer was then inserted
as a temporary restoration.
The second surgical procedure was
performed after an uneventful healing
periodof eightweeks to allowfor complete
soft-tissue healing of the extraction site #8
(Figs. 14-15). A full-thickness bucco-lingual
mucoperiosteal flap was elevated in sites
#5-#12 without any vertical releasing inci-
sions (Fig. 16) revealing a three-wall, well-
contained extraction site defect of #8 with
complete loss of the buccal osseous plate
(Figs. 16-17). Osseous crown lengthening
consisting of osteoplasty and ostectomy
was then performed to position the buccal
osseous crest of the remaining maxillary
anterior teeth 3mmapical to the cemento-
enamel junctions (Fig. 18).
The previously fabricated Optiguide
was then utilized for the guided implant
osteotomy preparation in site #8, and a
4.6 mm x 12 mm tapered bone level
implant was placed in site #8 in the
restoratively correct and pre-planned
position (Figs. 19-20). In addition, care
was taken to place the implant to the
correct restorativedepthof 3mmto4mm
apical to the future facial restorative
margin (Fig. 22).
The implant achieved excellent
primary stability, was placed well within
the confines of the three-wall extraction
site defect, and revealed a significant
buccal dehiscence defect (Figs. 21-22).
An internal cover screw healing
cap were placed onto the implant and
Fig. 14: Facial view after 8 weeks of
healing
Fig. 15: Occlusal view after 8 weeks of
healing
Fig. 16: Facial view after full thickness
flap reflection
Fig. 17: Occlusal view of defect site #8
Fig. 18: Facial view after osseous crown
lengthening
Fig. 19: Semi-guided implant
placement
Fig. 20: Verification of implant
position
Fig. 21: Occlusal view of implant
placement
Fig. 22: Facial view of implant
placement
Fig. 23: First layer of bone grafting
with MinerOss/PRF bone graft
Fig. 24: Second layer of bone grafting
with Bio-Oss/PRF bone graft
Fig. 25: Double layer of CopiOs
Pericardiummembrane over
bone grafts
Fig. 26: PRF membranes placed over
CopiOs Pericardiummembranes
Fig. 27: Suturing for tension-free closure
Fig. 28: Immediate postoperative
radiograph of implant #8
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