Dr. Georgios Emmanouilidis

In this clinical case, a patient presented with an edentulous site in the anterior maxilla in the region of tooth 12, associated with a pronounced horizontal ridge deficiency and an unfavorable soft tissue contour. The tooth was previously extracted and the patient was undergoing orthodontic treatment with clear aligners to improve the space distribution. Clinical and CBCT examination confirmed insufficient ridge width at site 12, indicating the need for horizontal ridge augmentation prior to implant placement.

Following flap elevation, the extent of the horizontal bone deficiency at site 12 was clinically confirmed. Guided bone regeneration (GBR) was performed using cerabone^® granules to reconstruct the deficient ridge contour. The grafted area was covered with a Jason^® membrane, which was stabilized over the augmentation site. In addition to the hard tissue augmentation, mucoderm^® was placed to increase the soft tissue volume and support reconstruction of the ridge contour.

After a healing period of 8 months and completion of the orthodontic treatment, clinical examination demonstrated favorable soft tissue healing and an improved ridge contour at site 12. CBCT assessment showed increased ridge dimensions, providing suitable conditions for subsequent implant placement.

A bone level implant was subsequently placed at site 12 using a prosthetically driven, digitally guided approach. Following implant insertion, the soft tissues were adapted around the implant, and a healing abutment was placed to further support the peri-implant soft tissue maturation.

After 4 months, removal of the healing abutment revealed a well-developed peri-implant soft tissue architecture. The treatment was completed with a definitive implant-supported screw retainer restoration at site 12, along with a three-unit e.max bridge on the left side and two e.max veneers on the sites 11 and 13.

At the 3-month follow-up, the clinical situation demonstrated stable peri-implant soft tissue conditions and papilla growth, further improving contour of site 12, indicating maintenance of the hard- and soft-tissue augmentation achieved during the reconstruction treatment.