Page 20 - Dental Practice South Asia 18-6

multidisciplinary section

in the months following grafting.
Five months after the graft healed, I
obtained the volume of bone necessary to be
able to place the implant in the anterior
edentulous area (Figures 17 to 20).

Second step
In this second step the planned goal was to
insert an endosseous implant in the regener-
ated ridge and restore the volume of kera- FIG 13: Etching of the front teeth FIG 14: Final bonding of the mock-up
tinized mucosa in the vestibular area around
the implant itself, recreating an adequate
vestibular gingival profile in harmony with
the gingival profile of the neighboring teeth.
Also, in this phase the fundamental pre-
rogative was to create a second provisional
with an appropriate emergence profile in
order to further stabilize the soft tissues by
conditioning them permanently.
FIG 15: Initial scan and use of CEREC software for the FIG 16: Design of 2.1
My procedure was as follows: creation of the first provisional

1) Impression using an intra-oral scanner 4) Customization matrix "FIBROGIDE" the healing phase, it should not be oversized
The most important aspect during this Fibro-Gide is a collagen matrix of porcine to avoid flap contractions and/or excessive
first scan is the creation of the so-called origin, porous, resorbable and volumetrically volumes after healing. Since it is a particular-
"Gingival Mask", i.e. the copying of stable, designed specifically for the regenera- ly resistant matrix, I find it dangerous to
previously conditioned soft tissues. Such a tion of soft tissues in order to avoid autolo- shape it with a scalpel blade. I suggest rather,
scan will guide us during the design phase of gous sampling of connective tissue. Such a the use of a zirconia cutter at low revolutions:
the emergence profile of the temporary matrix promotes angiogenesis, formation of in this way, it will avoid overheating and
tooth. A correct emergence profile is new connective tissue and the stability of the denaturing the collagen by maintaining the
certainly the key to success and will allow us collagen network in submerged healing. In unaltered structural characteristics (Figures
to predictably obtain a correct conditioning an aesthetic case like this, however, it is cus- 26 to 30b).
of the tissues around the cervical third tomized and adapted to the receiving site.
of the crown screwed to the implant. Being very stable and keeping its volume in 5) Placement of the personalized collagen
The maxillary master model must be digital-
ly cut in the center of the edentulous
area 2.1 using the “Sectioning” tool
(Figure 21).
2) Flap design
The incision must not involve the coronal
part of the papillae: the involvement of the
bone crest, in fact, would inevitably
lead to the loss of 1-1.5 mm of bone impair-
ing the final aesthetics. Therefore, an intra- FIG 17: Gingival and prosthetic aesthetic result of the FIG 18: Bone regeneration of the fractured alveolus
sulcular vestibular incision was made by cre- first phase
ating a small mucous pocket involving partial
thickness of the soft tissues at the buccal por-
tion of the edentulous area (Figures 22 to 24).

3) Implant positioning
The implant was centrally positioned with a
palatal inclination in order to prevent the
access hole of the screw from contacting the
incisal edge of the provisional or, even worse,
on its vestibular surface (Figure 25).
FIG 19: CBCT after healing after 5 months FIG 20: Preliminary conditioning of soft tissues

20 Dental Practice // November-December 2022 // Vol 18 No 6