Dr. Alejandro Lanis

In this clinical case, a patient presented with a severely compromised upper right central incisor (tooth 1.1), characterized by significant probing depth, advanced bone loss and complete resorption of the buccal bone wall as confirmed by pre-operative CBCT. The tomographic images confirm an oblicual root fracture. The specific clinical situation suggested the planning of an atraumatic extraction followed by a ridge preservation and delayed implant placement in the anterior zone.

A ridge preservation was performed following tooth extraction using a fully resorbable, magnesium-based NOVAMag^® SHIELD, contoured into an L-shape and positioned between the soft tissue and residual buccal bone without additional fixation to support the buccal wall defect. NOVAMag^® SHIELD, was positioned to coronally cover the extraction socket and positioned beneath the palatal mucosa, adjacent to the palatal bone wall, being stabilized and secured with sutures, while intentionally leaving parts of it exposed. NOVAMag^® SHIELD, delivered mechanical reinforcement and space maintenance, which is crucial during the critical early healing phase, while its gradual degradation eliminated the need for a secondary removal surgery, thereby reducing invasiveness. The site was augmented with cerabone^® particles, which provided a stable, osteoconductive scaffold for new bone formation.

Clinical assessments and CBCT imaging at 4-months post-OP demonstrated successful graft integration. An AI-assisted segmentation confirming substantial volume gain, facilitating a prosthetically driven digital implant planning.

Re-entry at 4 months revealed well-integrated particles and vascularized hard tissue, allowing for a guided implant osteotomy and placement (s-CAIS). To enhance peri-implant soft tissue volume and thickness, a modified roll flap combined with a connective tissue graft was perfomed during this stage. Soft tissue conditioning was accomplished using provisional CAD/CAM restorations. After the obtetion of the desired emergence profile, definitive CAD/CAM restorations were designed to maintain the emergence profile, enhance aesthetics and recover function. The final prosthetic rehabilitation included a screw-retained hybrid zirconia implant-supported crown on tooth 1.1 and a cemented tooth-supported zirconia crown on the adjacent tooth 2.1.

Final clinical and radiographic evaluation at 4 months post restorations delivery confirmed stable peri-implant bone levels, excellent soft tissue integration, and satisfying aesthetic outcome. This approach, combining NOVAMag^® SHIELD with cerabone^®, provided a predictable and minimally invasive solution for reliable long-term implant success in the aesthetic zone.