Phenotype Conversion Using Geistlich Fibro-Gide® for Immediate Implants in the Esthetic Zone
A healthy non-smoking 50-year-old female patient who desires a single tooth solution to replace a non-restorable tooth, #12. A root fracture at the level of the palatal post was diagnosed in a root canaled tooth. Maintaining esthetics of the adjacent teeth is important as they are also restored with single full coverage porcelain crowns. Lastly, treatment time reduction and a minimally invasive surgical technique are desired by the patient for reduced downtime and post-operative morbidity.
THE RISK PROFILE
|Intact immune system
|Impaired immune system
|Patient’s esthetic requirements
|Height of smile line
|Thick – “low scalloped”
|Medium – “medium scalloped”
|Thin – “high scalloped”
|Shape of dental crowns
|Infection at implant sight
|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
|Width of tooth gap
|1 tooth (≥ 7 mm)
|1 tooth (≤ 7 mm)
|2 teeth or more
|Bone anatomy of the alveolar ridge
Facial Bone Wall Phenotype: High Risk (<1mm)
Esthetic Risk Profile (ERP) = Medium (summary of above)
A minimally invasive surgical removal of tooth #12 with maintenance of the buccal plate and leaving a 3mm buccal gap. The implant will be placed one mm below the level of the intact buccal plate with an anatomically correct surgical guide template to provide for a screw-retained solution. The gap will be filled with Geistlich Bio-Oss Collagen® to maintain the bone buccal to the implant, and a palate free approach utilizing Geistlich Fibro-Gide® for soft tissue thickening to accomplish “phenotype conversion.” The long-term surgical goal is >2-3mm thickness of both hard and soft tissue buccal to the implant.
Minimally invasive surgery for buccal wall maintenance, virtually planning the buccal gap and implant width, using a xenograft in the buccal gap with phenotype conversion using a volume stable collagen matrix in conjuction with immediate contour management, allows for the best chance for papillae fill interproximally and maintenance of the mid-buccal gingival margin long-term.
Virtual planning the implant width for a screw-retained prosthesis based on an intact buccal wall after extraction to allow for a buccal gap of >2mm to be grafted are important keys for esthetic success.”Dr. Robert A. Levine
The importance of the ‘one-two punch’ of ROUTINE phenotype-conversion using Geistlich Fibro-Gide® in conjunction with bone grafting the >2mm buccal gap with Geistlich Bio-Oss Collagen® provides excellent buccal convex tissue maintenance long-term.”Dr. Robert A. Levine
Dr. Robert A. Levine
Robert A. Levine DDS is a board-certified periodontist at the Pennsylvania Center for Dental Implants and Periodontics in Philadelphia. He is a Fellow of the International Team for Dental Implantology (ITI), College of Physicians in Philadelphia, International Society of Periodontal Plastic Surgeons and the Academy of Osseointegration. He has post-graduate periodontology and implantology teaching appointments at Temple University in Philadelphia, UNC in Chapel Hill and UIC in Chicago and has over 80 scientific publications.