Esthetic Zone: Single Tooth Alveolar Ridge Augmentation with rhBMP-2

This is a 17 year old caucasian female that presented with congenitally missing maxillary right lateral incisor (Figure 1).

Cone beam CT sagittal section showed a significant bony atrophy in a horizontal dimension (Figure 2).

The extent of this defect impacted both the facial and palatal aspect of the ridge necessitating augmentation on both sides of the existing ridge (Figure 3).

The proposed treatment plan included the use of rhBMP-2 with mineralized allograft and titanium mesh as a barrier and space maintenance element (Figures 4, 5).

Figure 6 shows the primary complication of the use of rhBMP-2 i.e. swelling. In this case even at 7 days significant edema was present in the right canine fossa infraorbital area. It is not uncommon for swelling to persist for up to 10 days.

Exposure of the site at 7 months showed excellent bone graft incorporation (8mm net horizontal augmentation), especially in comparison to the original clinical presentation (Figures 7, 8, 9). Figure 10 shows a volumetric rendering using Simplant software to place a virtual implant abutment crown complex within the confines of the augmented site in sagittal section.

Figure 11 shows a BioHorizon tapered internal Laser Lok implant 3.8 mm diameter which was placed in a nonsubmerged mode. Figures 12 and 13 show the clinical and sagittal section CBCT images of this patient at 3 years post prosthetic loading.

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