BIOBRIEF
Successful Implant Placement and Horizontal Augmentation for Bilateral Congenitally Missing Maxillary Incisors
THE SITUATION
A 30-year-old male patient was referred to me with bilateral congenitally missing lateral incisors in the maxilla. The referring general dentist had previously made a resin-bonded bridge which was successful for a few years but had frequent debondings. Clinical examination revealed lack of ridge contour but the CBCT revealed existence of adequate width for placement of narrow-diameter implants with additional bone grafting and contour augmentation. The existing bone anatomy precluded placement of implants for screw-retained restorations without a pre-surgical lateral ridge augmentation procedure. The patient accepted a treatment plan for placement of two narrow-diameter implants and simultaneous bone grafting and contour augmentation followed by restoration with zirconia cement-retained crowns.
THE RISK PROFILE
| Low Risk | Medium Risk | High Risk | |
|---|---|---|---|
| Patient’s health | Intact immune system | Light smoker | Impaired immune system |
| Patient’s esthetic requirements | Low | Medium | High |
| Height of smile line | Low | Medium | High |
| Gingival biotype | Thick – “low scalloped” | Medium – “medium scalloped” | Thin – “high scalloped” |
| Shape of dental crowns | Rectangular | Triangular | |
| Infection at implant sight | None | Chronic | Acute |
| Bone height at adjacent tooth site | ≤ 5 mm from contact point | 5.5 – 6.5 mm from contact point | ≥ 7 mm from contact point |
| Restorative status of adjacent tooth | Intact | Compromised | |
| Width of tooth gap | 1 tooth (≥ 7 mm) | 1 tooth (≤ 7 mm) | 2 teeth or more |
| Soft-tissue anatomy | Intact | Compromised | |
| Bone anatomy of the alveolar ridge | No defect | Horizontal defect | Vertical defect |
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download pdfTHE APPROACH
My treatment goals were to preserve the existing soft-tissue architecture, especially the interdental papilla, mesial and distal to the lateral incisors, improve the facial contour at the lateral incisor sites by bone grafting with a low substitution biomaterial, and harmonize esthetics and function with optimal implant-supported restorations.
“The patient had failed resin-bonded bridges with deficient contours for bilateral congenitally missing lateral incisors.”
THE OUTCOME
Single-stage implant placement with bilateral papilla-sparing incision design and simultaneous contour augmentation using a mixture of Geistlich Bio-Oss® autologous bone chips and Geistlich Bio-Gide®.
Dr. Avinash Bidra
Dr. Bidra is a Board Certified Maxillofacial Prosthodontist and Director of the Prosthodontics Residency Program at UCONN School of Dental Medicine. He has extensive surgical experience and maintains a part-time private practice restricted to Implant Surgery and Prosthodontics in Meriden, CT. He has lectured at national and international meetings, as well as published extensively in international scientific journals. He has invented prosthetic components and is a co-inventor of a new implant design.