Cássio Cardona Orth

Immediate implants in aesthetic areas with associated gingival recession and bone defect represent a challenging clinical condition. In addition to obtaining appropriate primary stability, the care of bone and soft tissue reconstruction must be meticulously conducted in order to obtain a balanced environment with function, aesthetics and long-term maintenance conditions. One of the most important aspects of this procedure is the making of a provisional with adequate contours, respecting the critical and sub-critical zone, allowing for the positioning of the gingival margin in a precise way. The video describes a clinical situation of a patient with the need to install an immediate implant in an aesthetic area, due to invasive root resorption, with extensive gingival recession associated with a large bone defect, close to the previously installed implant. In addition to these clinical conditions, the case presents an interproximal bone defect, a pseudo-papilla and the absence of keratinized mucosa. Initially, the extraction was carried out in a delicate manner, ensuring the possibility of using the same dental crown as a temporary one. To increase the possibility of immediate loading, the concept of osseodensification was used , maximizing the maintenance of the adjacent bone and effectively increasing the torque.After the implant installation, tissue reconstruction began with the harvesting of a connective tissue graft and delicate division of the recipient area was performed and the subsequent stabilization.Bone reconstruction followed with the use of a collagen membrane associated with particulate biomaterial of slow resorption and, after provisional placement, traction sutures were made to reposition the gingival margin. After 6 months, we observed the soft tissue with an excellent range of keratinized mucosa, the reconstructed papilla in front of the possible limit, the gingival margin in an adequate and stable position and the buccal bone totally regenerated, guaranteeing a completed, harmonic and functional result.

Cássio Cardona Orth received his dental degree from the Universidade Luterana do Brasil in 2008, is board certified in Maxillofacial Surgery at ULBRA/RS (2008) and in Implantology by CFO (2020); He completed his Masters in Implantology (2017) and Periodontology(2020) at São Leopoldo Mandic Dentistry Research Center in Campinas.He is pursuing a PHD in Periodontology at Federal University of Rio Grande do Sul.He is also a professor at the ImplantePerio Institute in research and advanced dental training, in São Paulo.