• Case Of The Month: close-up of a dental implant site showing pink gingiva, a metallic abutment between two front teeth, with a dark backdrop and high-contrast visuals.
Alejandro Lanis
Dr. Alejandro Lanis
Chile

CASE OF THE MONTH     |   02/2026

Delayed Implant Placement with NOVAMag® SHIELD and cerabone®

Dr. Alejandro Lanis

In this clinical case, a patient presented with a severely compromised upper right central incisor (tooth 1.1), characterized by significant probing depth, advanced bone loss and complete resorption of the buccal bone wall as confirmed by pre-operative CBCT. The tomographic images confirm an oblicual root fracture. The specific clinical situation suggested the planning of an atraumatic extraction followed by a ridge preservation and delayed implant placement in the anterior zone.

A ridge preservation was performed following tooth extraction using a fully resorbable, magnesium-based NOVAMag® SHIELD, contoured into an L-shape and positioned between the soft tissue and residual buccal bone without additional fixation to support the buccal wall defect. NOVAMag® SHIELD, was positioned to coronally cover the extraction socket and positioned beneath the palatal mucosa, adjacent to the palatal bone wall, being stabilized and secured with sutures, while intentionally leaving parts of it exposed.  NOVAMag® SHIELD, delivered mechanical reinforcement and space maintenance, which is crucial during the critical early healing phase, while its gradual degradation eliminated the need for a secondary removal surgery, thereby reducing invasiveness. The site was augmented with cerabone® particles, which provided a stable, osteoconductive scaffold for new bone formation.

Clinical assessments and CBCT imaging at 4-months post-OP demonstrated successful graft integration. An AI-assisted segmentation confirming substantial volume gain, facilitating a prosthetically driven digital implant planning.

Re-entry at 4 months revealed well-integrated particles and vascularized hard tissue, allowing for a guided implant osteotomy and placement (s-CAIS). To enhance peri-implant soft tissue volume and thickness, a modified roll flap combined with a connective tissue graft was perfomed during this stage. Soft tissue conditioning was accomplished using provisional CAD/CAM restorations. After the obtetion of the desired emergence profile, definitive CAD/CAM restorations were designed to maintain the emergence profile, enhance aesthetics and recover function. The final prosthetic rehabilitation included a screw-retained hybrid zirconia implant-supported crown on tooth 1.1 and a cemented tooth-supported zirconia crown on the adjacent tooth 2.1.

Final clinical and radiographic evaluation at 4 months post restorations delivery confirmed stable peri-implant bone levels, excellent soft tissue integration, and satisfying aesthetic outcome. This approach, combining NOVAMag® SHIELD with cerabone®, provided a predictable and minimally invasive solution for reliable long-term implant success in the aesthetic zone.

Initial clinical situation.
CBCT pre-Operative. Note the apical and peri-root lesion.
Probing depth on tooth 1.1. Tooth 2.1 was prepared for a provisional crown with a splinted mesial cantilever.
Debridement following tooth extraction.
Try in of NOVAMag® SHIELD.
Application of cerabone® particles for ridge preservation.
NOVAMag® SHIELD was placed under the periosteum, extended over the ridge crest, tucked beneath the palatal flap, and left partially exposed to heal by secondary intention.
Frontal view after bone augmentation and provisional placement.
Clinical Control after 2 months.
Clinical Control: 2 months post guided bone regeneration - occlusal view.
Prosthetically driven soft tissue conditioning using the provisional tooth supported splinted crowns.
CBCT 4 months post ridge preservation.
AI-assisted segmentation 4 months post-ridge preservation: Occlusal view.
AI-assisted segmentation 4 months post-ridge preservation: Frontal view.
AI-Segmented CBCT overlay – Regenerated area visualization and digital implant planning.
Digital implant planning.
Tangential and Sagittal views of planned implant position and its relation with the renenerated site.
3D-Rendered view of the regenerated site.
Re-entry procedure after 4 months.
Re-entry: Modified roll- flap technique. Tissue marking.
Re-entry: Modified roll- flap technique. De-epitelization of the marked punch.
Soft tissue augmentation based on palatal connective tissue graft.
Final implant positioning. The rolled pedicle has been secured. Connective tissue graft was inserted by a tunnel approach and fixated with sutures.
Wound closure post-implant placement. Provisional restoration in place.
Control X-Ray following implantation.
Suture removal 14 days post-implant placement.
After 3 months, a scan body was placed for digital impression.
Provisional CAD CAM restorations were placed for prosthetically driven soft tissue conditioning.
Provisional restoration: Lateral view.
Emergence profile after 4 weeks of soft tissue conditioning: Occlusal view.
Definitive restoration in place.
4-months follow up radiographic analysis.
Clinical Result: 4 months post-restorations delivery.

The „Case Of The Month“ highlights every month a clinical case, which distinguished itself by the clinical results or the treatment concept in combination with the applied botiss biomaterials. The selection of the case is based on content relevance and quality of the documentation.

cerabone®NOVAMag® SHIELDSocket management

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