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