A 50-year old female patient presented for a fixed restoration of the upper anterior jaw. During the examination it was decided to stage the treatment. First, the failing central incisors would be extracted. The narrow ridge in the area of the lateral would be prepared with decortication and augmentation using Bond Apatite. Since this is the esthetic zone, the preservation of the interdental papillae is important. Due to the presence of bony walls at the extraction sites, the flap was supported by stretching without any releasing incisions. To maintain the soft tissue architecture around the sockets, and to protect the exposed Bond Apatite at the crestal portion of the socket for the next 7-10 days, a collagen plug (see Bioplug) or sponge was placed and secured with stabilizing sutures above the graft. On the other hand, a zone without supporting bony walls (of at least 2 walls), must have maximal closure. An incision line opening of up to 3mm is acceptable but not more than that.
During the healing period, the patient had a provisional fixed partial denture. Ten days post-op, the surgical healing was terrific and the papillae were preserved. Three months post-op, the bone healing and augmentation is evident, in concert with papillae preservation. The soft tissue gap in the lateral area is noted due to patient induced trauma using tooth picks. The patient is to be instructed not to use these rigid implements during the healing phase.
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