Socket rebuilding for immediate implant placement

1. Initial situation: extended combined perio-endo lesion 11, buccal wall missing

2. Initial x-ray examination 11: missing buccal wall plus vertical defect to the apex

3. Extraction of the multi-fractured tooth 11

4. Extraction of the multi-fractured tooth 11

5. Periodontal probes to demonstrate the extension of the missing buccal bony wall

6. Placement of 4,2 mm ASTRA Profile next to the palatal wall, see the buccal deficiency

7. Inserting a defect related, folded Soft Cortical Lamina®

8. Soft Cortical Lamina® before insertion with indirect tunnel opening to help unfolding the inserted Lamina® on top of the defect borders

9. Cutting the Soft Cortical Lamina® according to a paper template matching the deficient bony wall

10. ASTRA Profile with cover screw to allow bone grafting of mp3® between implant and replaced buccal wall (Soft Cortical Lamina®)

11. Additional grafting of a thin autogenous connective tissue

12. Replacing the cover screw by an adequate healing abutment to support the new bony wall and the connective tissue

13. X-ray after 4 months post-op at impression taking

14. CBTC 6 months after prostho-delivering to demonstrate the new bony buccal wall

15. 1 week post-op with provisional in place to condition the soft tissue profile

16. Final situation 6 months after ceramic restoration of the upper front #13-#23 (full ceramic: #12, implant #11, #21 ceramic veneers: #13, #22, #23)