Immediate placement

At the beginning of treatment the patient was 48 years old and in good general health. For decades the patient had suffered from a severe, aggressive, generalised periodontitis (type III B) (fig 1), which could be healed completely prior to implant restoration (PerioHealing Concept; fig 2).

Treatment planning

At first the diseased anterior mandible was healed in a regenerative and biological manner and without bone replacement materials, by employing enamel matrix proteins (Straumann Emdogain) for ‘socket preservation’ prior to immediate implantation at 32 and 42 (fig 2). From the digital volume tomogram (DVT) it could already be presumed preoperatively that simultaneous augmentation to provide a less invasive procedure could be dispensed with by precise implantation at soft tissue level, and that a four-unit fully functional composite metal ceramic (CMC) bridge could be inserted without difficulties due to the more stable implant material (Roxolid).

Surgical procedure

Following periodontal healing (fig 3), teeth 32 and 42 were extracted in toto from the healthy tissue without fracturing, in particular of the buccal lamellae. The clinical and radiological examination employing combined depth gauges showed a four-unit anterior bridge to be possible under these conditions with appropriate implementation (figs 4–6). There was also no need for simultaneous bone augmentation (osteogenic jumping distance).