One abutment one time.

Categories ; Posterior, Flapless, Grafting, Immediate load, Nobel Biocare

Preoperative situation

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External resorbtion

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An overextended impression records a large amount of information.

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Drawing of the roots and estimated mesio-distal implant trajectory

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Transferring the bone sounding information to the cast. The pinhole indicates the implant shoulder.

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Bucco-lingual setup leaving minimal buccal thickness for the abutment, but implant in the middle of the bone

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Screw retained bucco-lingual, but would give bone fenestration

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The best position considering bone and restorative materials

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Mesio-Distal position is set

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The premolar is removed from a new cast, leaving the outline of the gingival contours

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Model surgery is performed

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The cast osteotomy

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Working backwards, using the guided implant carrier from Nobel Active

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The analog is glued with a composite into the cast

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The analog is placed in the same position as the future implant

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Permanent zirconia abutment is premade

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CAD/CAM zirconia abutment, provisional and coping for final crown are all premade

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Screw access of provisional trough buccal

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Selected trajectory is good, use green rotation block.

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Premolar extracted

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Osteotomy created.

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Guided bone tap

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Final osteotomy

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Nobel Active 13 x 4.3

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Implant placed as planned

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Guided bonemill .

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Permanent abutment in place for try-inn.

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Provisional in place for try-inn, exactly as planned. No adjustments were made

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Provisional is cemented extra orally to prevent cement sepsis

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Buccal is grafted with non resorbing bone substitute ( bio-oss)

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Permanent abutment with pre-cemented provisional are seated

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One abutment, one time

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Immediately post extraction and implant placement

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