flapless placement with connective tissue augmentation
DESCRIPTION
External resorption and periodontal bone loss set this patient up for considerable gingival recession. To minimize additional recession a flapless approach was chosen with connective tissue grafting. This case shows that the 7 degree rotation-block was needed to adjust the initial implant axis.TRANSCRIPT
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Categories ; Anterior, Flapless, grafting, Nobel Biocare
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Hopeless lateral incisor, external resorbtion
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Bone loss secondary to periodontal breakdown and resorption 3 ,month post
extraction
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Working cast
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Desired Bucco –lingual axis for screw retained crown
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Too far lingual
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This would be too far buccal
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Narrow Diameter Buccal wing in desired Mesio- Distal position
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Ortho Acrylic connection of the wings to the vacuform carrier
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Crossbar removal
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Retention rails exposed
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Surgical guide with 0 degree ( green) rotation-block
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X-ray is correctly exposed, but predetermined axis is incorrect
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Yellow rotation-block , 3 degrees, with drill guide ; needs more correction
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Red rotation-block, 7 degree with drill guide ; angulation is now good.
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Tissue punch, we’ll used the connective tissue plug to augment the buccal
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Drill set at 7 mm, although planned implant will be 10. Drill at a safe short
distance, then check.
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Confirmed correctness of angulation, now prepared to full depth
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2.0 at 10 mm
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2.8 at 10 mm
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3.0 at 7 mm, stepped back preparation for tapered Nobel Active implant. Note
that we added on addition 3 MM (red) Flexistop to get the stepped back
preparation
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Guided tap
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Confirm integrity of bone walls
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Nobel Active 10 x 3.5
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Guided placement
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Implant placed
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Remove epithelium from connective tissue plug. No additional surgical site
needed as we use the punched out connective tissue
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Small pouch created
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Did not get the CT in place
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Resorbable suture trough graft allows us now to pull the graft in place
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CT graft in place
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Buccal contour augmented
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Final placement with bonded natural tooth pontic