Next, an open tray impression was made at implant level using a custom acrylic resin impression tray (Lightplast base plates; Dreve Dentamid GmbH, Unna, Germany) and a polyether impression material (Impregum Penta; 3 M ESPE, St. Paul, USA). Finally, a healing abutment (NobelReplace; Nobel Biocare AB) was placed, and any remaining residual space between the implant and the buccal bone wall was filled with a 1:1 mixture of autologous bone and Bio-Oss® (Geistlich Pharma AG) (Fig. 6). A Geistlich Bio-Gide (Geistlich Pharma AG) was used to cover the reconstructed alveolar process. The wound was closed with Ethilon 5–0 nylon sutures (Johnson & Johnson Gateway, Piscatatway, USA).

Six hours following implant placement, the healing abutment was removed, and a provisional crown was placed and torqued to 32 Ncm (Fig. 7). Special care was taken to prevent any contact with the antagonist teeth as well as that the provisional restoration was contoured for optimal support of the peri-implant soft tissue. In particular, the interproximal papillae were given sufficient space to regenerate.

The patient was instructed to follow a soft diet, to avoid exerting force on the provisional restoration, and to continue the chlorhexidine rinse (Corsodyl; GlaxoSmithKline) for 7 days. For pain control, 600 mg ibuprofen (Brufen Bruis 600; Abott BV, Hoofddorp, the Netherlands) was prescribed, to be taken three times daily for the time period needed. Two weeks following surgery, the sutures were removed.

Three months later, a screw-retained definitive all-ceramic crown was placed. Follow-up appointments were scheduled 1 and 12 months after installation of the definitive implant crown (Fig. 8) and consisted of intra-oral examination and radiographic assessment of the peri-implant bone level. At both follow-up visits, intra-oral examination revealed healthy peri-implant tissues. Radiographic examination showed minimal bone resorption mesial and distal of the implant (Fig. 9).