Implant placement in the aesthetic zone following an autogenous bone graft from an intraoral site: a case study

In the front of the mouth, the treatment of such a bony defect carries the risk of a poor aesthetic outcome. High patient expectations, combined with the difficulty of recreating a large mass of viable bone in which a dental implant will be biomechanically stable is a real challenge. PURPOSE OF TREATMENT: The intention of this treatment was to replace the patient's chronically infected upper right incisor with a dental implant that was both biomechanically and aesthetically stable for the long term.

Four months after extraction of the upper right central incisor, under local anaesthetic, a bone block was harvested from the right retromolar area of the patient's mandible and grafted into the defect. This was secured with a single bone screw. Small deficiencies between the block and the host site were filled in using bovine derived particulate bone (Bio Oss, Geistlich Biomaterials, Wolhuser, Germany). A resorbable porcine derived membrane (Bio-Gide, Geistlich Biomaterials, Wolhuser, Germany), held in position by two bone tacks (Frios, Friadent, Mannheim, Germany), was used to stabilse the graft. Following close clinical and radiographic monitoring of graft maturation, the bone screw was removed at three months and one week later the implant placed. A bone level impression was taken at surgery, and the implant left submerged for four months before exposure and abutment connection. After a further period of two months to facilitate soft tissue contouring the definitive crown was cemented.

The implant tooth has been in trouble free function for eighteen months. In that period, the marginal bone levels and gingival margin around the implant have remained stable and aesthetically satisfactory.