logo 17 • CAMLOG Partner Magazine • March 2018 15 Fig. 12: Drilling template in thermoforming process with prefabricated sleeve with positioning and axial direction aligned with the original tooth. Fig. 18: Occlusal view of the inserted implant with very well regenerated vestibular ridge contour. Fig. 21: Palatal pedicle connective tissue graft for soft tissue augmentation. Fig. 13: Orthopantomogram with drilling template before removal of osteosynthesis screws and implantation. Fig. 19: Frontal view with paracrestal implant shoulder at maximum vertical bone regeneration. Fig. 14: Frontal view with clinical findings after four months of healing of the block grafts. Fig. 20: Orthopantomogram for radiological evaluation after implantation 11. occlusal view (Fig. 15) already showed clinically a physiological alveolar ridge transversal, which gave rise to the hope of corresponding bone regeneration. The surgical field was opened using a mucosal split flap to allow the possibility of simultaneous soft tissue augmentation after implantation. After preparation of the two-layer vestibular flap, bone regeneration of the previous defect could be easily assessed (Fig. 16). The bone blocks were fully integrated and showed both excellent transverse regeneration as well as maximum vertical regeneration. After removing the osteosynthesis screws, template guided pilot drilling was performed (Fig. 17). Extension of the drilling shaft up to the diameter of final form drilling was performed freehand. After completion of the bony preparation, the drilling shaft is to be probed for an intact bony boundary on all sides with a blunt button probe in the form of bone mapping. This rules out perforations to the nasal floor and a possible need for subsequent augmentation – especially vestibular – can be determined. Subsequent augmentation was not necessary in this case. The manually inserted implant (CAMLOG® SCREW-LINE) was surrounded in the occlusal view by a sufficiently dimensioned and well perfused vestibular bone wall. The curvature of the jaw arch was also completely restored (Fig. 18). The frontal view shows the crestal bone profile and the paracrestal implant shoulder position as well as the positioning of the implant in mesiodistal direction while maintaining the anatomical minimum distances to the adjacent teeth (1.5 to 2 mm), so that the subsequent formation of papillae could be ensured with sufficient nutrition of the interdental bone (Fig. 19). In this case, a 4.3 mm wide and 13 mm long CAMLOG® SCREW-LINE implant was inserted and radiologically documented after surgery (Fig. 20). In order to increase the volume of the periimplant gingiva, simultaneous soft tissue augmentation with a palatal pedicle connective tissue graft had already been performed with the placement of the implant. For this purpose, the paramarginal palatal, subepithelial prepared tissue was driven into the tooth gap over the anterior pedicle pole (Fig. 21) and fixed with the previously prepared periosteum of the split flap with an absorbable suture. This CASE STUDY
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