Highly restored dentition. Tooth 14 had too little existing tooth structure to be adequately restored with a crown. An implant was planned
The Palatinal root was dissected from the buccal. The buccal was drilled away till below the apical part. Only a thin buccal shield according Hurzeler was left. In our office we drill the root away till 3mm below the gingival zenith
The thin buccal 'shield' (<2mm) is visible and still attached to the cortical plate. It should not continu to the apical part, it is here around 5-6mm long
Preparation of the implant bed in the palatinal socket. Try to leave the bony intact between the buccal and palatinal socket: underprepare, osteotomes and splitting screws can come in handy. In this case those methods were not needed
Check with an x-ray if the whole root is removed. The buccal dentin plate should not be visible, otherwise it is probably too large.
Undertunnelling the buccal mucosa with a sharp, flat and thin bone curette. Move the instrument like a windscreen wiper to loosen the periost or connective tisse and create a pocket. Split thicknes sis no problem as long as there is room for the membrane
Placing the Legacy2 4.2x10mm implant in the palatinal socket. The neck should be 3mm below the buccal zenith.
Occlusal view. Since it's placed in the palatinal socket, the implant position is more to the palat. However still proper aligned for a screw retained crown.
A resorbable collagen membrane is placed in the undertunnelled buccal mucosa (pouch-technique). This is an EZ-Cure membrane. Since it is stiff when it's not hydrated the handling is excellent for this purpose.