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Categories ; Anterior, Flapless, grafting, Nobel Biocare

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Hopeless lateral incisor, external resorbtion

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Bone loss secondary to periodontal breakdown and resorption 3 ,month post

extraction

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Working cast

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Desired Bucco –lingual axis for screw retained crown

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Too far lingual

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This would be too far buccal

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Narrow Diameter Buccal wing in desired Mesio- Distal position

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Ortho Acrylic connection of the wings to the vacuform carrier

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Crossbar removal

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Retention rails exposed

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Surgical guide with 0 degree ( green) rotation-block

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X-ray is correctly exposed, but predetermined axis is incorrect

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Yellow rotation-block , 3 degrees, with drill guide ; needs more correction

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Red rotation-block, 7 degree with drill guide ; angulation is now good.

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Tissue punch, we’ll used the connective tissue plug to augment the buccal

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Drill set at 7 mm, although planned implant will be 10. Drill at a safe short

distance, then check.

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Confirmed correctness of angulation, now prepared to full depth

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2.0 at 10 mm

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2.8 at 10 mm

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3.0 at 7 mm, stepped back preparation for tapered Nobel Active implant. Note

that we added on addition 3 MM (red) Flexistop to get the stepped back

preparation

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Guided tap

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Confirm integrity of bone walls

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Nobel Active 10 x 3.5

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Guided placement

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Implant placed

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Remove epithelium from connective tissue plug. No additional surgical site

needed as we use the punched out connective tissue

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Small pouch created

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Did not get the CT in place

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Resorbable suture trough graft allows us now to pull the graft in place

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CT graft in place

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Buccal contour augmented

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Final placement with bonded natural tooth pontic