Results

According to the patient's request, a closure of the interdental gap was necessary to improve the cosmetic and functional outcome. Therefore, an implant placement was required. Alternative treatment options such as conventional prosthetics (bridge #27 to #30 and #31) would have to deal with a wide range and may result in reduced mechanical stability. In this case, the posterior teeth (#30 and #31) were attached to the implant abutment. These teeth needed reconstruction because of an inherent insufficiency of the old crowns (as shown in Figure 1 compared with Figure 11). To avoid the neighboring healthy tooth being affected (#27), implant placement in region #28 offered the possibility to close the existing gap (#29 and #28).

Twenty-four months after reconstruction, the bone graft appeared well consolidated, and the implants were stable without clinical or radiologic signs of peri-implant bone loss (Figures 9–11). The patient-specific customized titanium lattice structure shaped the area to be augmented by backward planning for the implant position scheduled by the prosthetic need.

A sample histologic analysis showed newly formed bone including integrated xenogenic bone substitute material particles using toluidine blue staining (Figure 12). Higher magnification revealed newly formed bone tightly adherent to the residual bone plate. Bio-Oss particles appeared in green colors embedded in newly formed bone.