Following the healing period, during which soft tissue is allowed to heal, implant surgery is performed. Special attention is paid to correct prosthetic positioning of the implant in all three dimensions with good primary stability.

The crater-like defect exposing a part of the buccal implant surface is covered with locally harvested autogenous bone chips in order to promote bone re-formation in the region of the defect as quickly as possible.

The bone volume is further optimised by local augmentation using Geistlich Bio-Oss^® granules. The low substitution rate of Geistlich Bio‑Oss^® helps to maintain the volume of the alveolar ridge over time, a factor of great importance to the maintenance of the long-term aesthetic outcome.

A collagen membrane, used as a barrier, is applied in two layers in order to improve the stability. Geistlich Bio-Gide^® acts as a temporary barrier instead of unnecessary blockade: once the protective function of Geistlich Bio-Gide^® has been fulfilled the membrane resorbs. The natural complex structures of the soft-tissue, with all the intrinsic components such as periosteum are formed.^1-3

Following the release of the flap by means of a mucoperiosteal incisions, a tension-free primary wound closure is achieved. Provisional implant prosthesis starts after 8 weeks.

Clinical and x-ray findings at the 4-year follow-up. The peri-implant bony conditions are absolutely stable.

The clinical and radiographic follow-up at 7 ½ years shows a pleasing esthetic long-term outcome and an intact facial bone wall in the Cone Beam CT.