Implant therapy for lower mandibular incisors: Immediate implant placement and GBR

Introduction

This case presents replacement of failing mandibular incisors with extraction, immediate implant placement with GBR and growth factors. The procedures are detailed step by step with practical advice.

Failing lower incisors due to recurrent decay and root fracture.

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Buccal bone was noted to be thin and presented with concavity

Thin buccal bone and concavity

Neobiotech IS-II active fixture being placed (3.5 x 13 mm)

Fixture being removed from its convenient carrier

Lingual placement of implants

Excellent primary stability is achieved with the design of IS-II active fixtures

Peri-apical radiograph immediately after fixture placement

Preparation of collagen membrane

Growth factor enriched cortical allograft

Growth factor enriched allograft to cover defects around implant and buccal wall

Periosteal release is needed in order to achieve tension free primary closure

Placement of bone graft material

Collagen membrane in place to cover the graft completely

Tension free primary closure of the surgical area

Essix retainer made using existing bridge

Essix retainer in place as provisional

Complete healing of soft tissue after 3 wee

Uncovery of implants at 3 months show excellent ridge thickness and quality of bone

Placement of healing abutments

Healing of soft tissue after uncovery

Open tray impression technique

Cement retained 4 unit bridge

Final radiograph

Permanent restoration insertion