Anterior Implant with Augmentation: Precautions?

Hi , after a 14 year period and thousands of cases like this I would always place a the same ...not merely to save time and reduce the surgery for the patient but because of the benefits placing brings to the regeneration of the site .. Placing the semi-conductive Ti Implant leads to an up-reguation of host regeneration ( Sasaki et al JOMI 2013 ) and earlier loading will lead to a further up-regulation of host bone regeneration . The other factor is the Implant being placed helps stabalise the Graft material for improved regeneration The photo of the case shows a few things , even without an x-ray it can be seen that the defect is reasonably large due to the colour and shape of the profile . Another thing is the frenum and using my routine protocol I would do a frenectomy at the time of surgery. So I would raise a site specific flap retaining the adjacent papillae , clean the site very well ( I use Degranulation Burs from EK solutions ) as this is very important then place in the optimal position for the restoration and graft .... Here use the materials that you are comfortable with ........ I like stable materials allowing me never to use a membrane which impedes the host healing as seen in high impact factor medical research ( reducing blood supply and impeding the SCF induction ) . Regeneration of host tissue is all about blood supply and oxygenation of the site so suture the site closed using monofilament sutures , which I remove after only a few days as again soft tissue healing is improved without the use of a membrane.... Hope that helps a bit But as in all aspects of Dentistry , a lot of methods and materials work well ...... I just like to apply the logic of biologic healing Regards Peter

Ideally place at same time. I would use a pilot drill the osteotomes to condense the site as you widen the osteotomy place the implant to the ideal position then graft to cover the implant and thicken the buccal place a collage membrane and get primary closure. Essix temp while healing

Anyone have thoughts on using Augma graft (CaSO4 and reservable HA) in a defect such as this?

When I approach a case like this I drill the osteotomy without irrigation at 50 rpms. I save the autogenous bone from the drills and use it as my primary graft material. I place another graft material ( Novabone) over the autogenous bone and place tented barrier. Do not throw away autogenous bone. It costs only time and works great.