Clinical case · Severe buccal recession

Dr. Minas Leventis

An everyday site made difficult: after extraction of a tooth with a small cyst there was no bone and no soft tissue on the buccal side. Treated without membranes or soft-tissue grafting, using the Cervico tools and an osteoinductive synthetic biomaterial.

The minimally invasive protocol

1. 

   STEP 01

   Simple extraction and enucleation of the cyst. No bone or soft tissue buccally. The site is left to heal by secondary intention so new hard and soft tissue regenerate spontaneously.

2. 

   STEP 02

   Clinical and radiographic view eight weeks after extraction.

3. 

   STEP 03

   The Cervico Guide evaluates the site intraorally. The cylindrical tab measures the prosthetic space and then serves as the stent for the initial trephination.

4. 

   STEP 04

   Site-specific full-thickness flap; 3.75 × 11.5 mm implant placed 1 mm subcrestal with high initial stability. The depth gauge reads depth and tissue thickness, targeting 4 mm from platform to future margin.

5. 

   STEP 05

   Essential Mold: the PEEK abutment goes into the chosen well, flowable composite is injected around it and light-cured. Elsodent Purefill Bio+ was used.

6. 

   STEP 06

   The custom healing abutment fitted and torqued. Its shape will generate the anatomical components of the transmucosal complex.

7. 

   STEP 07

   The area grafted with 0.3 cc of fully resorbable silicate b-TCP (Powerbone Putty). No membranes, no soft-tissue graft. Prosthetic canal sealed with SilverPlug.

8. 

   STEP 08

   Sutured with PTFE 5-0. Three months post-op: the proper emergence profile is in place and the patient returns to the referring dentist for prosthetics.

Materials: Keystone Paltop Dynamic implant · Cervico Guide and Essential Mold · Elsodent Purefill Bio+ flowable composite · Powerbone Putty b-TCP · SilverPlug · PTFE 5-0
Credit: Case and images: Dr. Minas Leventis. Full case as published by the clinician; patient details are not disclosed.