Immediate loading in the maxillary anterior region using VARO Guide

Patient information / Treatment plan Patient information: 48 years old, Female Treatment plan: 1. Hard & soft tissue augmentation on the labial side of #11 2. Implant placement using VARO Guide and immediate loading

Pre-operative observation In the Pre-OP clinical pictures and panoramic view, there is labial gingival deficiency on #11.

Lingual incision was made and thick soft tissue from palatal area was rolled to augment the soft tissue.

Labial bone deficiency was observed.

An impression was made with a Pre-Guide, in which a light-curing resin and impression material was filled, then was light-cured in the mouth and removed. Then CBCT was taken with the Pre-Guide in the mouth.

The Pre-Guide library was merged in the CT image.

Implant positioning was performed in the program(VARO Plan). Labial bone was very thin and needed bone graft.

Drilling was performed with point drill through the VARO Guide hole.

Drilling was performed with 2.2 initial drill through the VARO Guide hole.

The final drill for a ф4.0x10mm IS-III fixture was used through the hole with 1,200rpm.

The short cortical tap was used for pre-tapping in the coronal cortical bone for passive maximum contact between the cortical bone and implant for immediate loading.

IS-III Active ф4.0x10mm was placed. The initial torque was 40N/cm that allowed Anytime loading. The fixture was placed in the same position as planned.

A temporary abutment for immediate loading(facial view)

Periapical radiograph shows proper direction of implant.

Bone graft was performed using DM bone.

A temporary crown was made on the abutment and bone graft was done.

Suture was done with the restoration.

S/O after 2 weeks of implant placement

Final prosthesis was delivered after 1 month. (Facial view)

Final prosthesis was delivered after 1 month. (Periapical radiograph)

F/U after 1.5 month, #11 maintains a convex contour at labial aspect without loss of papilla.

Periapical radiograph after 1.5 month