Immediate Implant and GTR

By |November 6th, 2017|Categories: Dental cases|Tags: , , |

Immediate Implant placement with Allograft Bone and Guided Tissue Regeneration

Case Introduction

This 56 year old lady was referred to me by a colleague to manage what seems to be a vertical root fracture on the first upper right Premolar. The patient complaints were pain when chewing and occlusal contact. Clinical tests showed deep probing (12mm) on the facial aspect, mobility typical with a root fracture and pain to percussion. The history of the tooth revealed an endodontic treatment  and crown done over 15 years ago.

The radiological exam revealed radioluscency on the mesial aspect and large cylinder shape post in the buccal canal. Most probable diagnosis: a vertical root fracture with a poor to hopeless prognosis. To be determined upon surgical entry. Medical history: within normal limits and determined at ASA1.


Surgical exploration confirms severe vertical buccal root fracture to apex (hopeless prognosis)

Note: heavy granulation tissue


Tooth removed, granulation tissue cleaned and periosteum properly elevated.

Socket cleaned to healthy bone.

Implant (and cover screw) is placed with good initial stability that is  obtained by engaging the palatal bone.


a) Connective tissue pediculed graft is prepared for primary occlusal coverage

b) Graft attached to palatal flap for increased vascularisation


Allograft mineralized bone  insertion directly over implant. I did not use a menbrane over the bone graft since the periosteum was intact.

If the periosteum was compromised, then I would have laid a resorbable membrane over the bone graft.


Connective tissue for complete primary closure.

You can substitute the connective tissue  graft by using a non-resobable membrane that would be removed 4 weeks after the surgery

Complete bone regeneration after 4 months
Notice bone regeneration distal 13


4 month post-op at second stage re-entry, note successful buccal wall reconstruction.  Also note reconstruction on distal and buccal wall on the canine.


Are these results Reproducible? In the 10 years or so that I have been applying this technique I have found that the results have been extremely favourable. In order to achieve predictable results, some variables must be well controlled. Bone graft stability, primary stable closure,  and tension free suturing are essential for success. Complete removal of any infected soft or hard tissue is also imperative.

About the Author:

Dr. Mazen Dagher, DMD and Olivier Sefler M.B.A. and Jeff Galamszegi co-founded Chapter2Dental in 2016. They lead a team of IT specialists, designers, and customer success agents to develop and market future forward digital solutions to help dental clinics around the world increase case acceptance conversion rate.