Dr. Erick Mota

Clinical Situation:

The patient presented with a hopeless maxillary central and lateral incisor indicated for extraction in the aesthetic zone. Both teeth were compromised by apical lesion and internal resorption, resulting in loss of the labial/buccal bone wall. The clinical situation was challenging due to the compromised labial wall of the socket, which increased the risk of post-extraction contour collapse and soft tissue recession.

Given the high esthetic demands of the anterior maxilla, the treatment objective was not only tooth replacement, but also preservation of the existing tissue architecture. Particular attention was given to maintaining the facial ridge contour, supporting the soft tissue profile, and creating favorable conditions for a natural emergence profile.

An immediate implant placement protocol was therefore selected to reduce treatment time, preserve the peri-implant tissues, and support a predictable aesthetic outcome due to limited space availability, the decision was made to place an implant in the central incisor position and perform alveolar ridge preservation of the lateral incisor socket using a slow-resorbing material. In this case, cerabone^® +HyA was used for socket grafting, while NOVAMag^® SHIELD was utilized for simultaneous labial wall reconstruction.

Key Challenges:

• Immediate replacement in the esthetic zone
• Reconstruction of the deficient labial wall
• Preservation of soft tissue contours
• Long-term volume stability

Surgical Approach:
Following atraumatic tooth extraction of the central and lateral incisors, immediate implant placement was performed with primary stability achieved in the native apical bone in the central incisor site, while the lateral incisor socket underwent alveolar preservation with cerabone. To support the peri-implant contour:

• NOVAMag^® SHIELD was adapted for simultaneous labial wall reconstruction.
• cerabone^® +HyA was used for socket grafting and volume augmentation.

Clinical Outcome:

Healing progressed uneventfully with reconstruction of labial/buccal wall, excellent maintenance of the facial contour, and peri-implant soft tissues.

Highlights:

✓ Stable hard and soft tissue healing
✓ Complete reconstruction of labial wall of the central incisor
✓ Natural emergence profile around the implant restoration
✓ Harmonious integration within the surrounding dentition

The combination of NOVAMag^® SHIELD and cerabone^® +HyA enabled predictable regeneration and aesthetic tissue preservation, supporting a successful immediate implant outcome in a challenging anterior maxillary case.