Immediate Implant Placement with Buccal Wall Reconstruction Using NOVAMag® SHIELD and cerabone® +HyA

CLINICAL CASE

Immediate Implant Placement with Buccal Wall Reconstruction Using NOVAMag^® SHIELD and cerabone^® +HyA

Dr. Tolga Genç

A 60-year-old female patient presented with pain and swelling associated with the maxillary right central incisor 11. Her medical history revealed that the tooth had undergone root canal treatment and apicoectomy approximately 20 years earlier. Two weeks before presentation, the tooth had sustained trauma during intubation under general anesthesia.

Clinical examination revealed tooth mobility and the presence of a fistula, while radiographic assessment demonstrated a buccal bone dehiscence with a radiolucent lesion, resulting in severe facial bone deficiency. Maintaining the ridge contour therefore represented a major challenge for immediate implant placement.

Treatment objectives:

Immediate implant placement
Reconstruction of the deficient buccal wall
Preservation of the ridge contour
Minimally invasive approach with open healing

Surgical Procedure

A treatment plan was established for guided immediate implant placement following tooth extraction.

After atraumatic extraction and thorough socket debridement, the extent of the buccal dehiscence became fully apparent. A static surgical guide was used to achieve prosthetically driven implant positioning with adequate primary stability.

A subperiosteal tunnel was then prepared between the buccal dehiscence and the overlying soft tissue. NOVAMag^® SHIELD was individually contoured and inserted into this space, reconstructing the missing buccal wall and creating a stable regenerative compartment.

The space between the implant and the NOVAMag^® SHIELD was augmented with cerabone^® +HyA. The socket entrance was subsequently sealed with an autogenous palatal connective soft tissue graft, which was stabilized using sutures to support open healing.

Surgical workflow

Atraumatic tooth extraction
Guided immediate implant placement
Preparation of a subperiosteal tunnel
Placement of NOVAMag^® SHIELD
Augmentation with cerabone^® +HyA
Socket sealed with an autogenous palatal soft tissue graft and stabilized with sutures

Healing & Outcome

The soft tissue graft healed uneventfully, and the sutures were removed after 2 weeks. A 3-month healing period was allowed before re-entry.

At re-entry, a healing abutment was placed. Clinical evaluation revealed excellent regeneration of the buccal bone, successful reconstruction of the facial contour, and healthy peri-implant soft tissue architecture with a favorable emergence profile, allowing progression to the prosthetic phase.

Postoperative radiographic evaluation demonstrated maintenance of the facial bone contour around the implant. As expected, NOVAMag^® SHIELD was no longer radiographically visible due to its physiological degradation process and replacement by newly formed tissue.

Clinical outcome