José Manuel Hernández Caldera

The implantology treatment in the aesthetic zone presents us with a great challenge nowadays, due to our patients’ high cosmetic and functional standards. For this reason, the implantology specialist must manage both aspects correctly, and have the ability to interrelate with the different specialists to achieve therapeutic success. In this clinical case, categorized as highly complex according to the SAC classification and as high aesthetic risk according to ERA, a diagnosis based on the fundamental principles of oral rehabilitation and a treatment plan that responds to the needs and expectations of the patient, are proposed to support efficient and functional intermaxillary relations and to obtain the required aesthetic outcomes.  In the first phase, dental-supported rehabilitation with a minimally invasive adhesive protocol, conventional fixed orthodontics assisted by TADS in infrazygomatic crest, alveolar ridge preservation with xenograft, implant placement surgery, and implant-supported rehabilitation with a cement-screw single fixed prosthesis were performed.  In the second phase, vertical and horizontal guided bone regeneration surgery was performed in the aesthetic zone, using a d-PTFE-Ti membrane with a mixture of autograft and allograft. In this phase, membrane exposure, being the most frequent complication reported in the literature for this procedure, appeared. The management of this complication was based on available current evidence and considering the patient’s expectations, controlling the local factors to avoid the occurrence of infection, and considering the planning of a surgical intervention at 12 weeks for the removal of the membrane, soft tissue management for the mucosal complication and the use of collagen membrane to continue with the biological timing of guided bone regeneration.

Dr. José Manuel Hernández received his DDS degree in 2015 and his specialist degree in oral and maxillofacial implantology after three-year program in 2023 at the University of Chile Currently, he works at Clínica Rocca and Clínica Las Condes in Santiago of Chile, focusing mainly in Prosthodontics and Oral implantology, Biomimetics and Restorative esthetic dentistry. He also is a Clinical Instructor of the Speciality of Oral and Maxillofacial Implantology at the graduate school of the University of Chile, ITI member and young Speaker.