Use of bovine bone mineral, titanium mesh, and a cross-linked collagen membrane in single implant site development at a maxillary central incisor tooth site: a 3-year follow-up case report

Purpose: It can be extremely challenging to replace a hopeless tooth in the maxillary central incisor area with an implant restoration, especially when the bony housing of the tooth is severely damaged. This condition is frequently found in teeth that have been severely traumatized in childhood. To avoid their extraction, these teeth might have been exposed to multiple compromised treatments and repeated traumatic injuries. When skeletal changes cease and implant therapy becomes an option, the surgeon may often find only remnants of the socket walls. This imposes difficulty when regenerating the missing tissues required for long-term functional and esthetic implant restoration. This article describes the unique anatomical, biological, and surgical considerations in the treatment of such a case. Materials and methods: In the reconstruction of a safe bony housing around the implant, obliteration of the incisive canal was followed by the use of bovine bone mineral (BBM) and titanium mesh (Ti-mesh) layered with a crosslinked collagen membrane. The soft tissue was augmented with a xenogeneic soft tissue matrix and further enhanced by a novel technique, the 'radial cuts technique.' Results: Functional and esthetic implant restoration was successfully achieved. Follow-up of the patient took place for 2 years post-implant loading and 3 years post-ridge augmentation, after which the stability of the implant and surrounding tissue was demonstrated. Conclusion: Enhanced functional and esthetic results may be achieved when BBM and Ti-mesh layered with a soft collagen membrane are utilized as augmentation materials in the esthetic zone. The key factors for success in this case were combining the advantages of the different materials with a carefully considered sequence of procedures.