Dr. Xavier Uriarte 

The patient attends after a failed GBR due to early infection of the regenerated site. The graft needed to be removed and the site was cleaned with CHX through a small pocket. After healing of the soft tissues, the new treatment plan is GBR with simultaneous implant placement.
A complex case for many reasons: Anterior sector, high aesthetic expectation, previously intervened site, periosteal scar and patient management.
At reopening, a 1 mm wide remnant of the first GBR is visible and the tent screw and pin tacks are removed during flap release. After osseodensification, an implant is placed accompanied by a Sausage Technique with cerabone® plus mixed with mandibular autograft and Jason® membrane.
After 4 months healing time for osseointegration the connection surgery combined with a connective tissue graft from the tuberosity is performed and a provisional crown is fixed. Some spaces are closed with resin composite fillings  to improve contours and the gingival contour is managed until an aesthetic soft tissue architecture is achieved.
Direct customized impression technique and further design in Exocad is performed. Finally, a final fixed prothesis with a screw-retained crown in monolithic Zircona with stratified vestibular cutback in feldspathic ceramic is installed.