"SVG" Surgical Veneer Grafting 6 years followup

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Posted on By Maurice Salama In Implants

Patient presented almost 7 years ago (just before PET became a routine therapeutic alternative) with maxillary incisors hopeless and in need of extraction & replacement. SVG was a directive at that time with internal AND external socket grafting with BOTH bone and soft tissue. We followed this case now and have 6 yrs post CBCT for comparison.
Thoughts, concepts, ideas welcome. regards Dr. Salama

Implant Placement in Laterla incisors
Failing maxillary incisors

Atraumatic extractions
ACDM added for tissue thickness

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Healing and tissue conditioning.

Final tissue shape
Tissue levels at temp stage


Lab phase Zirconium bridge

Lab Zr bridge
Lab prosthetics


Finals at insertion visit

Final at insertion
Final occlusal view


Tissue Thickness measurements in "Tissue Zone"

Tissue measurements
tissue thickness 2.5mm


6 yrs post

6 yrs
lateral view of restoration


Follow up CBCT

PA 7 yrs
axial CBCT


Before and After occlusal view.

Before Extraction
After treatment


The time has thought us that if PET not applicable, we should overbuild the site. This is what we see in your`s and Howie`s cases.
Bone gives the basis for the soft tissue and soft tissue protects the bone.
6 years result is very stabile - both clinical and CBCT.
Admirable tissue management: central papilla not touched,
healing abutments instead of primary closure (reduces the need for coronal flap advancement), small diameter implants.
Congratulations for beautiful result and thank you for sharing and inspiring!

Best regards



Thanks Snjezana. Precisely my thoughts, we NEED so much more grafting when we do NOT utilize PET to maintain and compensate for natural remodeling. Great to see you in NYC and look forward to your presentation in Florida!!! regards Maurice



Just spectacular - Is patient in night guard and did you consider RST?




Richard; Should of, could of performed PET here!!! Little curious about a full SVG approach so did not perform SRT here.....regards Mo


Maurice, great result, thanks for sharing. What type of Graft you prefer for this kind of space maintenance . Allo, xeno, synthetic, Auto or combination of one or two.

Depending on the case situation, If it's handled wisely, Both the procedures will give almost same results but at this point of time Since we can avoid all these extra surgical steps and graft materials in PET, I always opt for the later. Best regards.


Ashok; Yes, low turnover materials are preferred but always a RISK of spontaneous exfoliation of graft material. Yes, today think PET for sure. Much less grafting and more predictable outcome IMHO. thanks Dr. S


CBCT 6+ yrs post op bone thickness measurments

#10 CBCT


Beautiful case and inspiring documentation !! True that PET would be standard here now, but one cannot argue with the success and stability of this result. Truly perfection on each step. Inspirational work!!
Thanks for sharing Dr salama !!


Thanks Ehab...but when I consider the vast amount of overbuild surgical approaches required to offset the resorption, I do think PET makes so much more sense just technically more demanding when we first implement it. regards Dr. S


Would you consider placing 4 narrow platform implants?


You could place 4 narrow diameter implants but at a potential cost esthetically. I have done both ways, it really depends on lipline and patient esthetic demands and tissue type?
High scallop with hip lipline....this way is best. Dr. Salama

4 implants
lab model


4 implant solution?? Same case as above. Dr. Salama

Final tissue shape Thick Flat
Low Lipline


Two implants would be my "weapon of choice". I would "sink" the two centrals or graft the sockets. Anyway you do a great job, either with two or four implants, because you know when to place them. But as a general rule, it cannot apply, because few people can understand the drawbacks of placing too many implants.



I would agree...thanks Dr. Salama