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Reverse Planning for Esthetic GBR

Situation

In anterior cases, where we cant place the implant immediately post extraction, we have to increase the soft tissue first and then do the GBR, in order to decrease complications and get stability in long term.

Reverse strategy has two steps, the first one is soft tissue augmentation.

The second is the implant placement and bone augmentation. Means that even final objective is the bone regeneration you have to begin with soft tissue regeneration in order to decrease complications.


Patient Information

Women patient 32 years old, with a chronic periapical lesion the reason was a car accident when she was 12 years old.

 

First Procedure

Extraction central left incisor, and CTG with Plasma Rich in growth factors.



The suturing of the connective tissue draft with a horizontal mattress technique in order to increase the biotype thickness.



Placement of plasma rich in growth factors in the socket.



The suturing of the connective tissue draft with a horizontal mattress technique in palatal area.



Second procedure

4 months later.



Previous Cone Beam



IS-II Implant placement



A3 Titanium membrane placement



Auto bone with ACM, CTi membrane and PRGF fibrin membranes



4 months later




Take the impression during the implant uncover in order to avoid several reconnections and bone lost.



Uncover implant, membrane removal, impression and placement of shapeable abutment with 30 Nm torque and cemented provisional crown.



2 months later



Abutment impression





Impression of the shapeable abutment, 2 months later and final restoration with a Zirconium crown stratified with feldespatic material.



Final crowns were placed



Post follow up 6 months



Post-operative Observation



































































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