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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.

3,75x12,5" ICX-Templant internal hexagon under bone-level concavity buccal bone wallBio-Oss Bio-Guide GBR material buccal bone wall

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.

  • 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-operatoryFront view, preo-operatoryLateral left view, pre-operatory dental implant surgery
 
 
Preoperatory diagnostic measures. Control of the soft tissue quantity and quality
lateral right, invagination soft tissue attached gingivaocclusal right showing invagination soft tissue, mirror view

as well as a2D X-ray measurement with 5″ balls.
 
Panoramic diagnostic X-ray measurement balls dental implant surgery
  • Implant placement surgery

Regular split flap with two vertical discharges mesial and distal of the spot. Bone condensing carried out to finally place a 3,75×12,5″ ICX-Templant (internal hexagon) insertion after bone spreading.
The 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.

Bio-Oss Bio-Guide GBR buccal bone wall3,75x12,53,75x12,5" ICX-Templant internal hexagon under bone-level concavity buccal bone wall
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.
 
 
Panoramic post-operatory X-ray 3,75x12,5" ICX-Templant implants
Panoramic post-operatory X-ray, after placing two 3,75×12,5″ ICX-Templant internal hexagon dental implants.
 
 
Suture with 4/0 Prolene.
 
4/0 suture wund4/0 suture wund
 
and healing sequence after 2, 5 and 9 weeks
2 weeks, implant surgery wund healing

9 weeks, implant exposure  surgery wund healed, lateral right view40 days, implant surgery wund healing, occlusal mirror view9 weeks, implant surgery wund healed, occlusal mirror view

 

  • Implant exposure surgery after 9 weeks

a regular exposure surgery, with a minimal incision from the palatinal side, and the tissue buccally displaced. Healing abutment over a 3,75×12,5″ ICX-Templant (internal hexagon)

implant exposure surgery, tissue buccally displaced. Healing abutment 3,75x12,5" ICX-Templant (internal hexagon)implant exposure surgery, tissue buccally displaced healing abutment 3,75x12,5" ICX-Templant (internal hexagon)

3 weeks after the exposure surgery, with the healing abutment.

3 week inplant exposure surgery healing abutment over the 3,75x12,5" ICX-Templant (internal hexagon)3 week implant exposure surgery healing abutment 3,75x12,5" ICX-Templant (internal hexagon)
  • Prosthetical phase

Impression transfer for a closed tray.

 
Impression transfer abutment 3 week 3,75x12,5" ICX-Templant (internal hexagon)
3,75×12,5″ ICX-Templant (internal hexagon) abutment on cast lab modell showing the platform switch, with the corresponding crown
 
3,75x12,5" ICX-Templant (internal hexagon) abutment cast lab modell platform switch3,75x12,5" ICX-Templant (internal hexagon) abutment crown3,75x12,5" ICX-Templant (internal hexagon) abutment cast lab modell platform switch, crown
 
3,75×12,5″ ICX-Templant (internal hexagon) abutment emerging. Screwed at 30Ncm torque.

3,75x12,5" ICX-Templant (internal hexagon) abutment 3,75x12,5" ICX-Templant (internal hexagon) abutment occlusal mirror view
  • 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
 
Metal-ceramic crown implant 3,75x12,5" ICX-Templant (internal hexagon) abutment. metal line gum level  gingival retractionICX-Templant (internal hexagon) abutment. metal line gum level  gingival retraction
 
 
7 weeks after insertion. The metal-ceramic crown placed on the 3,75×12,5″ ICX-Templant (internal hexagon) abutment. Notice that the metal line at the gum level has dissapeared, due to gingival re-growth
 
ICX-Templant (internal hexagon) abutment. metal line gum level  gingival retractionICX-Templant (internal hexagon) abutment. metal line gum level  gingival retraction
 
occlusal mirror view of the final result
3,75x12,5" ICX-Templant internal hexagon3,75x12,5" ICX-Templant internal hexagon ceramic crown