Failed Anterior Ridge

Case Study 11

CASE DESCRIPTION:

The patient presented with a failed anterior bridge in the aesthetic zone, accompanied by a severely atrophic and thin residual ridge, as well as significant periapical pathology around the retained roots of the lateral incisors. This combination of structural deficiency and infection created a highly challenging clinical scenario, requiring a staged and biologically driven approach to rebuild both hard and soft tissue foundations prior to implant placement.

Following a comprehensive clinical and radiographic assessment, Dr. Nik developed a meticulous treatment plan focused on predictable bone regeneration and long-term aesthetic success. The initial phase involved the careful extraction of the retained roots, ensuring minimal trauma to the already compromised ridge. This was immediately followed by a horizontal ridge augmentation using the Sausage Technique, designed to restore adequate bone volume for future implant placement.

Autogenous bone particles were harvested from the external oblique line, providing a highly osteogenic grafting material. These were combined with a xenograft (MinerOss X) in a 60/40 ratio to enhance volume stability and support long-term regeneration. The graft was then carefully contained using a Mem-Lok Pliable collagen membrane, which was precisely adapted and stabilised with periosteal sutures both buccally and deep palatally. This ensured effective immobilisation of the graft and created an optimal environment for vascularisation and bone formation.

To maintain aesthetics and function during the healing phase, a provisional bridge was securely fixed to the canines. This interim solution allowed the patient to preserve confidence and oral function while the regenerative process progressed over several months.

After an uneventful healing period of nine months, significant bone regeneration had been achieved, restoring the ridge to a volume suitable for implant placement. Dr. Nik then proceeded with the surgical phase, performing a combination of full- and split-thickness flap techniques to allow precise access and tissue management. Two Conelog Progressive implants from BioHorizons were placed in ideal prosthetically driven positions, ensuring optimal support for the future restoration.

Recognising the importance of soft tissue aesthetics in the anterior region, Dr. Nik simultaneously performed a subepithelial connective tissue graft harvested from the palate. Using a platform-based suturing technique, the graft was positioned to vertically augment the crestal soft tissue, improving tissue thickness and contour. The flap was then carefully repositioned and primarily closed to promote undisturbed healing and integration of the graft.

With successful healing of both hard and soft tissues now achieved, the next phase of treatment will involve implant exposure and the placement of a provisional screw-retained bridge after approximately three months. This stage will allow for further soft tissue conditioning and refinement of the emergence profile prior to the final restoration.

This case highlights Dr. Nik’s advanced expertise in staged bone regeneration, precise implant placement, and sophisticated soft tissue management in the aesthetic zone. His structured and detail-oriented approach ensures predictable outcomes in even the most complex cases, making him a trusted referral partner and an excellent mentor for clinicians seeking to elevate their skills in advanced implant and restorative dentistry.

Failure of upper anterior bridge
Atrophic residual ridge with large periapical defects
Autogenous bone particles and xenograft
Periosteal sutures for membrane fixation
Primary closure
Bone regeneration after 9 months
Placement of 2 dental implants
Subepithelial Connective Tissue Graft for vertical augmentation of the crestal soft issue.
Primary closure.