Successful implant placement and horizontal augmentation for bilateral congenitally missing maxillary incisors
A 30 year-old male patient was referred to me with bilateral congenitally missing lateral incisors in the maxilla. The referring general dentist had previously made a resin bonded bridge which was successful for a few years but had frequent debondings. Clinical examination revealed lack of ridge contour but the CBCT revealed existence of adequate width for placement of narrow diameter implants with additional bone grafting and contour augmentation. The existing bone anatomy precluded placement of implants for screw-retained restorations without a pre-surgical lateral ridge augmentation procedure. The patient accepted a treatment plan for placement of 2 narrow diameter implants and simultaneous bone grafting and contour augmentation followed by restoration with zirconia cement-retained crowns.
My treatment goals were to preserve the existing soft-tissue architecture, especially the interdental papilla, mesial and distal to the lateral incisors, improve the facial contour at the lateral incisor sites by bone grafting with a low substitution biomaterial, and harmonize esthetics and function with optimal implant-supported restorations.
Single stage implant placement with bilateral papilla-sparing incision design and simultaneous contour augmentation using a mixture of Geistlich Bio-Oss® autologous bone chips and Geistlich Bio-Gide®.
Keys to Success
- Bilateral papilla-sparing incision design
- Implant placement with simultaneous contour augmentation procedure
- Use of a low substitution deproteinized bovine bone material with a rapidly vascularizing membrane
- Single stage procedure to support soft-tissue volume and contour
- Appropriate provisional restorations to sculpt the soft-tissues