L-Shape technique with Geistlich Bio-Oss® Collagen

BioBrief - GBR around implants

The Situation

The patient presented to the clinic with a discolored and mobile tooth 11, which had a history of trauma. Despite undergoing root canal treatment, the tooth had developed a horizontal fracture in the apical third of the root and suffered from recurrent infections. The patient was experiencing discomfort and was unhappy with the tooth’s appearance. His goal was to have tooth 11 removed and replaced with a fixed, long-term solution. 

The Approach

Tooth Extraction and Bone Preservation

To achieve the patient’s desired outcome, the treatment plan involved careful extraction of tooth 11 while preserving the surrounding alveolar bone. An early implant was placed at the site along with guided bone regeneration (GBR) using Geistlich Bio-Oss® Collagen xenograft. The graft was shaped into an “L-Shape” and protected with a Geistlich Bio-Gide® collagen membrane.

Soft Tissue Management and Provisional Restoration

To enhance the peri-implant soft tissue, a connective tissue graft was added during the healing phase to increase soft tissue volume at site 11. A provisional restoration was placed to guide the emergence profile, ensuring a natural-looking outcome.

Definitive Reconstruction and Long-Term Stability

The final step involved delivering a definitive reconstruction that provided both functional stability and esthetic harmony.

The Outcome

The treatment successfully provided the patient with a stable and esthetic fixed solution. The implant demonstrated excellent marginal bone stability, due to precise placement combined with the GBR procedure. The peri-implant soft tissue remained healthy and well-integrated, with sufficient volume achieved through soft-tissue augmentation. The final restoration met the patient’s esthetic expectations and functioned seamlessly in occlusion.

Keys to Success

• Careful tooth extraction with minimum damage to the alveolar socket walls
• Proper prosthetically driven implant placement using a surgical guide
• Simultaneous guided bone regeneration with a stable bone substitute (Geistlich Bio-Oss® Collagen) covered by a well-stabilized bilayer collagen membrane (Geistlich Bio-Gide®)
• Soft tissue augmentation using an autogenous connective tissue graft (not shown)
• Development of an adequate emergence profile that mimics a natural tooth
• Fabrication of a ceramic implant restoration that blends with the adjacent dentition and is screw-retained whenever possible