Soft tissue management around implant with SCTG and slim healing abutment
A 27-year-old female patient, in good general systemic health, presented to the dental practice with:
- Missing dental element in the position 35# FDI. The tooth was extracted 5 years before due to an orthodontic treatment
- Vestibular deficit in correspondence to the missing element
A NobelReplace® CC NP implant was placed to substitute the missing tooth with an implant fixed prosthesis. The vestibular volume deficit was instead compensated by augmenting the soft tissues with a Sub-epithelial Connective Tissue Graft (SCTG), harvested from the maxillary tuberosity, punched into a slim healing abutment. The slim healing abutment was substituted with a normal size healing abutment once the soft tissue healing was completed. The definitive prosthetics made of a universal abutment in Titanium and an Emax crown was delivered 12 weeks post augmentation procedure.
At 3 years follow up, marginal bone stability, good hygiene and soft tissue stability were observed.
Progress & Completion
Questions
Ask a questionWhat was the step between the removal of the second healing abutment and the impression ?
Could you please detail the steps after the second healing abutment ? I see you removed the abutment and in the photo name “final impression for the zirconia crown” we see the tissue morphology is different than when the healing abutment was removed. How did the tissue heal in such an anatomic shape ?
Could you please detail the steps after the second healing abutment ? I see you removed the abutment and in the photo name “final impression for the zirconia crown” we see the tissue morphology is different than when the healing abutment was removed. How did the tissue heal in such an anatomic shape ?
Thank you for your question!
8 weeks with slim healing abutment
4 weeks with narror healing abutment
4 weeks with temporary crown
Could you take the slim healing abut easily without any incision? Also, what about the excessive pressure and blanching when you put the regular healing screw? For my limited experience, even though it came lose followed by unscrewing completed, it came out only after some incisions with a microblade. I believe thick and firm connective tissue around the neck does contribute this phenomenon.
Please share your experience on it. Thanks for the fantastic case presentation.
Due to the loss of buccal bony volume, was the implant placed more lingual than ideal? Was guided surgery utilized?
From the CBCT it seems there was no loss of the buccal bone volume but the soft tissue only. Hence, the doctor was able to place the implant in the perfect 3-D position.
Thank you for your question! This position is correct, but with out guide-protocol.
MY QUESTION IS FOCUSED ON THE USE OF LYOPHILIZED BONE GRAFTING VS CONNECTIVE TISSUE.
GOOD MORNING, DR PAVEL. MY QUESTION IS WHY, INSTEAD OF USING CONNECTIVE TISSUE, DID YOU NOT USE FREEZE-DRIED LYOPHILIZED BONE GRAFT IN THE BONE DEFECT? CONGRATS ON YOUR INTRODUCTION.
GOOD MORNING, DR PAVEL. MY QUESTION IS WHY, INSTEAD OF USING CONNECTIVE TISSUE, DID YOU NOT USE FREEZE-DRIED LYOPHILIZED BONE GRAFT IN THE BONE DEFECT? CONGRATS ON YOUR INTRODUCTION.
Thank you for the presentation. I womder why the crown is so radiolucent on the 3y follow-up X-ray. You wrote that it’s zirconia
In reply to Thank you for the presentation. I womder why the crown is so radiolucent on the 3y follow-up X-ray. You wrote that it’s zirconia by more moremore
Thank you for your question! You right, it is Emax restoration. There was an error in the description.
In reply to Thank you for the presentation. I womder why the crown is so radiolucent on the 3y follow-up X-ray. You wrote that it’s zirconia by more moremore
Thank you for your comments! We now corrected the description!