Implant Treatment in the Aesthetic Zone

Aim: In this case, the treatment of a 41-year-old woman who suffered a traumatic loss of her maxillary incisors is described. Due to the loss of alveolar and gingival contour, two patientspecific allogenos milled bone blocks had to be transplanted. Materials and methods: Introduction A female patient, aged 41, was referred to our clinic for implant therapy after traumatic loss of her central incisors. Due to severe alveolar bone loss in the implant site, allogenous bone blocks had to be transplanted to fill the defect in the maxillary anterior region. Treatment Performed Therapy was performed in several stages. Stage 1. The patient was referred with an "flipper" as a replacement for her maxillary incisors. A cone beam tomography was necessary to evaluate the maxillary defect. Stage 2. patient customized allogenic bone blocks were grafted to the anterior maxilla for horizontal ridge augmentation. Stage 3. Six months after bone grafting, removal of bone fixation screws and guided placement of two implant in the lateral incisor region. Stage 4. Six months after implant placement, a second stage exposure and augmentation procedure and placement of two gingivaformers. Stage 5. two weeks later, provisional abutments with a custom Zirconia core based on a CAD- CAM Abutment were inserted and a provesional bridge was placed. Stage 6. One month later, final Zirconia abutments with a custom were inserted and a final bridge of Ceramic fused to Zirconia was placed. Discussion: Missing maxillary incisor sites often show horizontal as well as vertical atrophy, with inadequate conditions for implant placement. Therefore bone and soft tissue grafting is often necessary to develop the optimal site for implant placement. To select the appropriate surgical procedure for site development, a wax-up or even a provisional prosthesis can be helpful to assess the amount of bone and soft tissue deficiency. In this case patient customized allogenic bone blocks were used for two-stage alveolar ridge augmentation. Based on CT/CBCT scans, the bone blocks were virtually designed and in second stage milled from processed cancellous bone blocks originating from living human donors. Implants were placed six months after bone grafting surgery using a SMOP surgical guide, based on the initial augmentation planning in order to achieve correct three dimensional implant positioning. Conclusion: A surgical plan based on the prosthetic design and desires of the patient should be established after the evaluation of the existing hard and soft tissue. The planned implant procedure steps should be discussed with the patient regarding treatment time and treatment costs. Keywords: Implant treatment, aesthetic zone, SMOP, allogenous bone block, CAD-CAM abutment, zirconia abutment