Central-Lateral Dilemma Part 2

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Posted on By Maurice Salama In Failures

Patient presents from a referring doctor very concerned with the poor esthetic result with 2 implants placed for the maxillary left central and lateral incisors. Black Triangle has formed. Notice also crestal bone loss around the implants on PA film. Patient wishes a better esthetic result? Photos #4 and #6 showcase restorative options attempted. Thoughts on surgical intervention displayed here? Dr. Salama

Frenectomy performed with CO2 laser and both implant abutments removed and tissue allowed to grow over the top
Lateral view after prosthesis removal and healing

Frontal view after prosthesis removal and healing
Flap reflection


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18 Comments

Suturing the grafts into place

Sutures of graft with PTFE
Tension Free Closure


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Hi Mo!

Wonderful approach!
My question is: Are you gonna introduce the implants in two stages? I mean, First the 2.2 and then the 2.1 or Are you gonna leave submerged the 2.1?

Thank you in advance!

best

Emilio


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6 weeks healing

6 weeks healing
6 weeks occlusal view


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Before & After 1st surgical phase CTG & Tuberosity Ridge Augmentation.

Before surgical intervention
After with Essix Transitional appliance in place


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Least risk and best reward! Fantastic! You went back to your paper for placing the healing abutments to tent the tissue. I just used the same technique a few weeks ago. Beautiful results, surgery and CTG harvest my compliments Dr. Salama


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2nd Stage uncovering Sx with additional grafting and implant exposure of #10 ONLY. Roll on #10 and Tuberosity Ridge Augmentation over #9.

2nd Stage uncovering
Additional Grafting


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2nd Stage uncovering Sx with additional grafting and implant exposure of #10 ONLY. Roll on #10 and Tuberosity Ridge Augmentation over #9.

sutures occlusal
sutures labial view


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10 days evaluation with new Cantilever provisional to begin tissue sculpting phase.

10 Days
10 Days


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Updates

Preop
4 weeks with new cantilever provisional


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updates

preop defect after abutments removed
after 2nd Stage healing


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Nice Maurice! Dr. Seibert taught us well the value of soft tissue. Great result!


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Thanks Mark. True that. Mo


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Fantastic treatment planning and - we can already say - result. The power of soft tissue and skilled hands!
Interestingly, on pre op x-ray it looks like bone resorption around implants, clinically peri implant bone looks better.
Thank you for sharing this very important case management!
Best regards
Snjezana


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Thanks Snjezana....we learn together. Regards Maurice


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That's amazing result Mo! Great demonstration to the power of soft tissue. I too was surprised by the photo of the initial implant uncovering, was expecting more bone loss around the implants.
Krafty


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Thanks Anthony...often the 2D PA is inadequate and can fool us somewhat.


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Wow, this is simply an amazing result!!!! This really showcases the power of connective tissue. Great case. Regards, Naheed


Reply

Thank you Naheed


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