Replacement of a missing maxillary central incisor with an Astra Tech® implant, following a horizontal ridge augmentation, using a sympheseal mandibular onlay graft: a case report

Background: An 18 year old female patient presented for implant placement at the site of a congenitally missing right maxillary central incisor. The clinical examination revealed an insufficient bucco-lingual width of the edentulous ridge, requiring a horizontal bone augmentation procedure prior to implant placement. Methods: An autogenous bone block graft was harvested from mandibular symphysis, fixed on buccal aspect of edentulous crest with titanium miniscrews, covered first by autogenous bone chips and xenograft particles, and second with a resorbable barrier membrane. Four months later, an Astra Tech® implant was placed in the grafted site, surrounded by a thick buccal bony wall, demonstrating excellent primary stability and guaranteeing a better esthetic outcome. Impressions for prosthetic work were taken and final restoration cemented 3 months following implant placement. Di scussion: Autogenous bone block grafting is regarded as a predictable procedure, especially in horizontal bone augmentation from intra-oral sites. Many requirements have to be respected however in order to achieve this purpose. In addition, timing of implant placement with autogenous block grafts is a subject of controversy. Finally, implant placement in anterior maxilla has to meet guidelines proposed in the literature to avoid esthetic shortcomings. Conclusion: This case report describes the successful replacement of an anterior missing tooth with an Astra® implant after a bucco-lingual augmentation of the edentulous ridge.