17/07/2026
Preserving the Emergence Profile with the Extracted Tooth in Guided Surgery 🎯
In this video, Dr. Alberto Picó Ramírez presents a case of a #21 (FDI) with severe bone loss, grade III mobility, a distal bony defect, and pain.
THE PLAN
A guided surgery case was planned using the patient’s own tooth, set in an ideal position, as the prosthetically driven guide. This also allowed for an ideal digital wax-up - same anatomy as the patient’s natural tooth, just in the ideal position - and a repositioning jig to seat that tooth back in the ideal position once the Alef implant was placed exactly there. The jig can later be perforated from the palatal aspect and given to the patient to wear like a clear aligner, protecting the site from unwanted occlusal contacts.
SURGICAL & PROSTHETIC PROTOCOL
The provisional was fabricated on a straight temporary abutment, hollowing out the crown of the extracted tooth and seating it with the repositioning jig. The jump gap in the fresh socket was grafted with xenograft beforehand.
RESULTS
At two weeks, the soft tissue architecture was perfectly preserved. At 4 months, soft tissue volume had actually been gained. Final impressions were taken, and the restoration was designed with e.max on a 1.5 mm Ti-base - handling the subcritical contour — - Trilux Forte (VITA Zahnfabrik) managing the critical contour.
CLINICAL PEARL
“Whenever I restore a central, I always tell the patient the contralateral should be treated as well (a veneer) to match both incisors. For financial reasons, the patient declined - but she was delighted with the result. Happy patient, happy clinician.” - Dr. Alberto Picó Ramírez
