Implant Placement in the Esthetic Zone with a Siebert Class III Ridge Deficiency

Georgios Pipis, BDS; Dumitru Gogarnoiu, DMD;

Department of Periodontics, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA

 

 

Introduction

 

The physiological and anatomical changes following tooth loss

compromise the periodontal tissues, making them less favorable for

optimal 3D implant positioning. To address the Siebert Class III ridge

deficiency, a prosthetically driven implant placement combined with guided

bone regeneration was performed to establish adequate bony housing and

support for the future peri-implant soft tissues. This single surgical

approach, with delayed provisionalization, can be considered a reliable

pathway for successful functional and esthetic outcomes.

 

Methods

 

A 30-year-old female patient presented to the clinic with a missing #9 and

an associated buccolingual and apicocoronal ridge deficiency. A CBCT

scan was taken and a digital wax-up was designed. The surgical approach

consisted of sulcular and vertical incisions, followed by full-thickness flap

reflection and implant placement using Densah Burs. Periosteal releasing

incisions and GBR using the lasso suturing technique were performed

achieving tension-free primary closure. At stage II surgery, a PMMA block-

carved provisional implant crown was fabricated chairside and delivered.

During follow-up, the critical and subcritical contours were modified to

optimise the gingival margin position and the soft tissue profile.

 

Results and Conclusion

 

Implant placement with GBR in the esthetic zone effectively addressed the

Siebert Class III ridge deficiency and resulted in successful implant

placement. Critical and subcritical contour management during delayed

provisionalization and follow-up optimized the peri-implant soft tissue

architecture and supported a natural, esthetic outcome.