Page 19 - GP Fall 2019

Figure 8. Healed grafted site with temporary
removed.
Figure 12. Implant placement with immediate Figure 17. Temp at time of impression for final
temporization. Note implant is placed almost restoration.
entirely in grafted bone.
placement of an implant is thought to spare
the disruption in the blood supply and
preserve crestal bone.

To preserve and support the surrounding
gingiva a stock abutment was modified
with flowable composite to provide an Figure 18. Abutment at time of impression.
ovate shape to manage the healing gingival Excellent gingival response due to accuracy of
Figure 9. Radiograph of healed grafted surgical site. A stock abutment was placed fit of temp, with papillary contours maintained.
site before implant placement. and a coping of flowable composite had
been prepared in advance to fit intimately
papillae and buccal gingiva while sealing with the abutment and the extraction space. The patient returned in six months, where
the socket further, affording additional (Figures 10,11,12) This was picked up with the gingival cuff around the abutment was
protection to the extraction site. a block of composite (Revotek LC- GC ideal (Figures 17, 18). A final impression
America) (Figure 13), and the voids filled was taken and an appropriate PFM crown
After five months, the graft had completely
incorporated into the host bone and implant
placement with immediate temporization
was planned (Figures 8, 9). Since the
keratinized gingiva and the bone was so
voluminous, a ‘flap-less’ surgery was
performed, resulting in little bleeding or
post-operative pain (Figure 10). Because a
Figure 13. Coping being picked up by block Figure 19. Final restoration buccal view.
composite, with many voids.
with more flowable composite (Figures 14,
15). The temporary crown was built 1 mm out
of occlusion to minimize masticatory stress
and remove all lateral forces (Figure 16).

Figure 10. Implant placement with stock Figure 20. Final restoration. Note #5 has had new
abutment with ‘flap-less’ technique. crown made together with #4 due to distal decay.
significant portion of the blood supply to cemented (Figures 19, 20). The abutment
the crestal bone comes from the periosteum was never removed after initial placement,
directly over it, a ‘flap-less’ surgical minimizing bone loss due to biologic width
Figure 14. Voids filled Figure 15. Voids filled in
in with flowable with flowable composite
composite. occlusal view.

Figure 21. Radiograph of implant at
placement of final crown.
Figure 16. Temp in mouth day of stage 1
Figure 11. Fabrication of coping on stock abut- surgery, at least 1mm out of occlusion.
ment prior to placement of abutment into mouth. Note absence of blood or suture. www.nysagd.org l Fall 2019 l GP 19