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Opposite to teeth, whose surrounding bone receives plenty of blood support from the periodontal ligament, the implant have no ligament and no surrounding blood circulation. Thus the buccal wall blood support comes only from the periosteum and the transeptal blood vessels.
Providing the buccal bone wall with a good thickness allows the internal bone blood vessels to supply nutrients to the buccal bone.
bone cavity ICX-Templant internal hexagon bone level dental implant
protecting the buccal bone wall
Bone graft autologous bone Bio-Oss buccal wall
with bone graft and membrane

The width of the buccal wall of a dental implant is becoming more and more important for its long term durability.
Placing the dental implant with 1,5 to 2 milimeters away from the buccal wall provides the bone wall with enough blood supply.
 
  • Diagnosis:
The X-ray shows two edentulous spaces on a 60 year-old man, non-smoker. Thick biotype.
occlusal view, upper jawPanoramic diagnostic X-ray implant surgeryocclusal view, lower jaw
Lateral right view, pre-operatory dental implant surgeryFront view, preo-operatory dental implant surgeryLateral left view, pre-operatory dental implant surgery

Preoperatory diagnostic measures. Control of the soft tissue quantity and quality

pre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgery

pre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgerypre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgery

pre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgerypre-operatory soft tissue vertical lateral bone resorption reduced attached gingiva height, dental implant surgery
as well as a2D X-ray measurement with 5″ diameter balls.
Panoramic diagnostic X-ray measurement balls dental implant surgery
  • Implant placement surgery
Regular split flap with only one vertical discharge mesial of the spot. 
The 3,75×12,5″ ICX-Templant (internal hexagon) dental implant is placed 1mm under the bone level. This allows some typical crestal bone resorption while still keeping the internal cone properties of the implant. Notice the concavity of the buccal wall under the ridge level.
 
bone cavity ICX-Templant internal hexagon bone level dental implant
Bio-Oss and Bio-Guide GBR material protecting the buccal bone wall. This increases the initial volume and adds extra hard tissue substance to the buccal wall.
Bone graft autologous bone Bio-Oss buccal wallBio-Guide collagen membrane bone graft autologous bone Bio-Oss dental implant
Panoramic post-operatory X-ray, after placing two 3,75×12,5″ ICX-Templant internal hexagon dental implants.
Panoramic post-operatory X-ray 3,75x12,5" ICX-Templant implants
Suture of the flap with 4/0 Prolene.
Suture 4/0 prolene
healing sequence after 2 weeks,
Healing phase 2 weeks implant surgery
and after and 9 weeks
soft tissue implant surgery lateral volume increase

soft tissue implant surgery lateral volume increase

  • Implant exposure surgery 
after 8 weeks a partial thickness displacement flap is moved buccally, with the incision beginning well on the lingual side, The keratinized tissue is displaced buccally. 6″ Healing abutment over the 3,75×12,5″ ICX-Templant (internal hexagon)
 
Implant exposure surgery. Buccally displacement flap increase attached gingiva buccal wallImplant exposure surgery. Buccally displacement flap increase attached gingiva buccal wallImplant exposure surgery. Buccally displacement flap increase attached gingiva buccal wall
3 weeks after the exposure surgery, with the healing abutment.
 
Implant exposure surgery. Buccally displacement flap increase attached gingiva buccal wall
  • Prosthetical phase

Impression transfer for a closed tray.

Implant exposure surgery. Buccally displacement flap increase attached gingiva buccal wall impression abutment
 
3,75×12,5″ ICX-Templant (internal hexagon) abutment on cast lab model showing the platform switch, with the corresponding crown
 
Cast model platform swtiching abutmet ICX-Templant 3,75" analogCast model platform swtiching ICX-Templant 3,75" analog
Cast model platform swtiching abutment ICX-Templant 3,75" analog crownCast model platform swtiching abutment ICX-Templatnt 3,75" analog
Soft tissue 6 weeks after the implant exposure surgery. 6″ healing abutment.
 
Soft tissue implant exposure surgery healing abutment ICX-Templant 3,75"Soft tissue implant exposure surgery healing abutment ICX-Templant 3,75"
3,75×12,5″ ICX-Templant (internal hexagon) abutment emerging. Screwed at 30Ncm torque.
Soft tissue implant exposure surgery healing abutment ICX-Templant 3,75"
  • Crown insertion
Metal-ceramic crown placed on the 3,75×12,5″ ICX-Templant (internal hexagon) abutment. Notice the metal line at the gum level, due to slight gingival retraction
Soft tissue implant exposure surgery crown abutment ICX-Templant 3,75"
Soft tissue 12 weeks after the implant exposure surgery, 6 weeks after crown placement.
Soft tissue implant exposure surgery healing crown abutment ICX-Templant 3,75"Soft tissue implant exposure surgery healing crown abutment ICX-Templant 3,75"Soft tissue implant exposure surgery healing crown abutment ICX-Templant 3,75"