Esthetic Zone • Ridge Augmentation • Implant Placement • Bone Graft

A healthy 18 year old male patient presents as ASA 1. He had a history of trauma at age 8 years old with the loss of both teeth #’s 8 & 9. Orthodontic treatment was carried out followed by a permanently cemented PFM bridge when he was a young teenager. As the patient grew older he no longer was satisfied with the esthetic result. Autogenous bone grafting and implant supported restorations were considered and chosen as the best course for long-term treatment.

The ridge measured approximately 2.5mm in width. The ridge was increased in width via autogenous block grafting to approximately 10mm surgically, five months prior to implant placement. A soft tissue graft was also considered. Autogenous bone grafting is regarded as the “gold standard” (Wheeler,1996/Khoury,2007/Toscano, 2010). The osteogenic and osteoinductive potential is exceptional with excellent long-term stability. Intra-oral bone is the preferred genotype and it was used in this case.

I. PRE-OPERATIVE

Fig 1: Preoperative edentulous sites #8 & #9

Fig 2: CBCT (white arrows) shows ridge width of approximately 2-3mm. Pre-planning shows ideal implant positions in green.

II. RIDGE AUGMENTATION

Fig 3: On reflection of soft tissue see resorbed osseous ridge width of only 2.5mm.

Fig 4: Autogenous Block Graft with ridge width increase to 10mm. After 4-5 months of bone healing, the implant planning and placement phase will begin.

Fig 5: Ridge width increase observed during healing phase follow up visit

Fig 6: At 5 months after autogenous bone grafting, The screws were removed. The
osteogenic potential of the patients own bone is powerful and predictable. Once
implants are placed, bone stability increases as the implants signal “functionality”
to the bone similar to that of a natural tooth. If implant placement is delayed, bone
loss can occur again.

III. IMPLANT

Fig 8: Post surgical radiograph (x-ray). Implants have been placed in bone with cover screws.

Fig 7: CAD/CAM design phase. Note the preoperative ridge width compared to
the augmented bone (separated by white line)

ONE YEAR LATER…

Fig 9: One year after the initiation of treatment, block graft and implants placement
phase completed. Comparative ridge contour before and after treatment is
demonstrated. The positive esthetic impact on lip support is dramatic.

Fig 10: Three months after implant placements, healing abutments are removed as part of a routine follow up visit shortly before the impression phase. Peri-implant soft tissue as well as bone health is checked under the surgical microscope.