58770 Testori IIP1 e.qxp
13.6.2007
14:18 Uhr
Seite 1
3.2a Clinical concept in the non-aesthetic region
Remark: The non-aesthetic region is considered the lateral-posterior area.
Background information
Dr. Tiziano Testori and Dr. Matteo Capelli:
“Immediate post-extraction implants represent a valid approach for optimizing
the surgical procedures, the timing and the management of the aesthetic issues
after tooth extraction in the anterior area.
Implants were thought to preserve bony buccal plates from resorption. However,
recent studies1,2 and our clinical experience underline that buccal bone resorption takes place despite the placement of an implant immediately after tooth
removal. Bone augmentation procedures are often required at the time of
implantation since the goal is to preserve the buccal plate and to reduce bone
resorption over time. Furthermore, an aesthetic score is needed to evaluate the
outcome3.”
Case A Implant bone distance > 3 mm
Case B Implant bone distance < 3 mm
Fig. 7a Fresh extraction socket.
Fig. 7b Fresh extraction socket.
Fig. 11a Occlusal view of the healed site.
Limited bone resorption can be noted buccally.
Fig. 11b Occlusal view of the healed site.
There is a slight mucosal screw exposure at
the level of the implant.
Fig. 8a Implant placed and intra-gap-grafting with Bio-Oss® granules (0.25 –
1 mm).
Fig. 8b Implant placed, intra-gap and external grafting with Bio-Oss® granules
(0.25 – 1 mm) .
Fig. 12a Occlusal view of the final prosthesis.
Fig. 12b Pick-up impression coping in position. Note the amount of buccal bone beside the first molar implant.
Fig. 9a Application of an immediate healing abutment, and placement of a BioGide® membrane (not shown).
Fig. 9b Placement of a Bio-Gide® membrane
in a double layer and a pedicled palatal
graft is used in addition to cover the membrane. To obtain a better soft tissue profile
on the palatal side, the thick tissue has been
split and rotated towards the vestibule.
Fig. 13a Radiographic image with the final
prosthesis. Note the graft stability after
2 years of healing.
Fig. 13b Radiographic view with temporary
abutments. Note the graft stability after 6
months of healing.
Fig. 10a Radiographic view at the time of
implantation: Implant positioned with
healing abutment. Note the mesio-distal
intra-gap bone graft.
Fig. 10b Radiographic view with cover
screw at the time of implantation. Note
the bone graft around the post extraction
implant.
2. Aims of the therapy
> Maintenance of buccal and palatal bone volume after tooth extraction by placing
Bio-Oss® granules into the residual gap and overbuilding the buccal wall by 20%.
3. Surgical procedure
3.1 Clinical problem: Considerable bone resorption after tooth extraction
Fig. 2 Immediate implant placement without any bone augmentation procedure.
Fig. 1 Extraction of first and second molars.
Fig. 4 Peri-implant soft tissue healing after
6 months. Note the considerable buccal
bone resorption.
Fig. 5 Radiographic view at time point of
crown delivery 6 months after implantation.
Fig. 3 Implants in position (one stage procedure).
Fig. 6 Clinical picture at time point of
crown delivery 6 months after implantation.
3.2 Clinical concept according to Dr. Tiziano Testori and Dr. Matteo Capelli
3.2a Non-aesthetic region (see page 3 + 4)
Implant planning
3.2b Aesthetic region (see page 5)
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3
Fig. 14b Occlusal view of the final prosthesis.
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page 5