Hard and Soft Tissue Management of a Localized Alveolar Ridge Atrophy with Autogenous Sources and Biomaterials: A Challenging Clinical Case
Identifieur interne : 006B01 ( Ncbi/Merge ); précédent : 006B00; suivant : 006B02Hard and Soft Tissue Management of a Localized Alveolar Ridge Atrophy with Autogenous Sources and Biomaterials: A Challenging Clinical Case
Auteurs : C. Maiorana [Italie] ; D. Andreoni [Italie] ; P. P. Poli [Italie]Source :
- Case Reports in Dentistry [ 2090-6447 ] ; 2016.
Abstract
Particularly in the premaxillary area, the stability of hard and soft tissues plays a pivotal role in the success of the rehabilitation from both a functional and aesthetic aspect. The present case report describes the clinical management of a localized alveolar ridge atrophy in the area of the upper right canine associated with a thin gingival biotype with a lack of keratinized tissue. An autogenous bone block harvested from the chin associated with heterologous bone particles was used to replace the missing bone, allowing for a prosthetic driven implant placement. Soft tissues deficiency was corrected by means of a combined epithelialized and subepithelial connective tissue graft. The 3-year clinical and radiological follow-up demonstrated symmetric gingival levels of the upper canines, with physiological peri-implant probing depths and bone loss. Thus, the use of autogenous tissues combined with biomaterials might be considered a reliable technique in case of highly aesthetic demanding cases.
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DOI: 10.1155/2016/8468763
PubMed: 27738534
PubMed Central: 5050379
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Maiorana</name><affiliation wicri:level="3"><nlm:aff id="I1">Oral Surgery and Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, School of Dentistry, University of Milan, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Oral Surgery and Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, School of Dentistry, University of Milan, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Andreoni, D" sort="Andreoni, D" uniqKey="Andreoni D" first="D." last="Andreoni">D. 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Poli</name><affiliation wicri:level="3"><nlm:aff id="I3">Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27738534</idno><idno type="pmc">5050379</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050379</idno><idno type="RBID">PMC:5050379</idno><idno type="doi">10.1155/2016/8468763</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002A21</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002A21</idno><idno type="wicri:Area/Pmc/Curation">002A21</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002A21</idno><idno type="wicri:Area/Pmc/Checkpoint">000671</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000671</idno><idno type="wicri:Area/Ncbi/Merge">006B01</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Hard and Soft Tissue Management of a Localized Alveolar Ridge Atrophy with Autogenous Sources and Biomaterials: A Challenging Clinical Case</title><author><name sortKey="Maiorana, C" sort="Maiorana, C" uniqKey="Maiorana C" first="C." last="Maiorana">C. Maiorana</name><affiliation wicri:level="3"><nlm:aff id="I1">Oral Surgery and Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, School of Dentistry, University of Milan, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Oral Surgery and Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, School of Dentistry, University of Milan, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Andreoni, D" sort="Andreoni, D" uniqKey="Andreoni D" first="D." last="Andreoni">D. Andreoni</name><affiliation wicri:level="3"><nlm:aff id="I2">Private Practice, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Private Practice, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Poli, P P" sort="Poli, P P" uniqKey="Poli P" first="P. P." last="Poli">P. P. Poli</name><affiliation wicri:level="3"><nlm:aff id="I3">Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author></analytic><series><title level="j">Case Reports in Dentistry</title><idno type="ISSN">2090-6447</idno><idno type="eISSN">2090-6455</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Particularly in the premaxillary area, the stability of hard and soft tissues plays a pivotal role in the success of the rehabilitation from both a functional and aesthetic aspect. The present case report describes the clinical management of a localized alveolar ridge atrophy in the area of the upper right canine associated with a thin gingival biotype with a lack of keratinized tissue. An autogenous bone block harvested from the chin associated with heterologous bone particles was used to replace the missing bone, allowing for a prosthetic driven implant placement. Soft tissues deficiency was corrected by means of a combined epithelialized and subepithelial connective tissue graft. The 3-year clinical and radiological follow-up demonstrated symmetric gingival levels of the upper canines, with physiological peri-implant probing depths and bone loss. Thus, the use of autogenous tissues combined with biomaterials might be considered a reliable technique in case of highly aesthetic demanding cases.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Milinkovic, I" uniqKey="Milinkovic I">I. Milinkovic</name></author><author><name sortKey="Cordaro, L" uniqKey="Cordaro L">L. Cordaro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cordaro, L" uniqKey="Cordaro L">L. Cordaro</name></author><author><name sortKey="Torsello, F" uniqKey="Torsello F">F. Torsello</name></author><author><name sortKey="Tindara Miuccio, M" uniqKey="Tindara Miuccio M">M. Tindara Miuccio</name></author><author><name sortKey="Di Torresanto, V M" uniqKey="Di Torresanto V">V. M. di Torresanto</name></author><author><name sortKey="Eliopoulos, D" uniqKey="Eliopoulos D">D. Eliopoulos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ersanli, S" uniqKey="Ersanli S">S. Ersanli</name></author><author><name sortKey="Arisan, V" uniqKey="Arisan V">V. Arisan</name></author><author><name sortKey="Bedelo Lu, E" uniqKey="Bedelo Lu E">E. Bedeloğlu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maiorana, C" uniqKey="Maiorana C">C. Maiorana</name></author><author><name sortKey="Beretta, M" uniqKey="Beretta M">M. Beretta</name></author><author><name sortKey="Salina, S" uniqKey="Salina S">S. Salina</name></author><author><name sortKey="Santoro, F" uniqKey="Santoro F">F. Santoro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, A" uniqKey="Lee A">A. Lee</name></author><author><name sortKey="Fu, J H" uniqKey="Fu J">J.-H. Fu</name></author><author><name sortKey="Wang, H L" uniqKey="Wang H">H.-L. Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Verdugo, F" uniqKey="Verdugo F">F. Verdugo</name></author><author><name sortKey="Simonian, K" uniqKey="Simonian K">K. Simonian</name></author><author><name sortKey="Frydman, A" uniqKey="Frydman A">A. Frydman</name></author><author><name sortKey="D Addona, A" uniqKey="D Addona A">A. D'Addona</name></author><author><name sortKey="Pont N, J" uniqKey="Pont N J">J. Pontón</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Levine, R A" uniqKey="Levine R">R. A. Levine</name></author><author><name sortKey="Huynh Ba, G" uniqKey="Huynh Ba G">G. Huynh-Ba</name></author><author><name sortKey="Cochran, D L" uniqKey="Cochran D">D. L. Cochran</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seibert, J S" uniqKey="Seibert J">J. S. Seibert</name></author><author><name sortKey="Louis, J V" uniqKey="Louis J">J. V. Louis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stimmelmayr, M" uniqKey="Stimmelmayr M">M. Stimmelmayr</name></author><author><name sortKey="Guth, J F" uniqKey="Guth J">J.-F. Güth</name></author><author><name sortKey="Iglhaut, G" uniqKey="Iglhaut G">G. Iglhaut</name></author><author><name sortKey="Beuer, F" uniqKey="Beuer F">F. Beuer</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Dent</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Dent</journal-id><journal-id journal-id-type="publisher-id">CRID</journal-id><journal-title-group><journal-title>Case Reports in Dentistry</journal-title></journal-title-group><issn pub-type="ppub">2090-6447</issn><issn pub-type="epub">2090-6455</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27738534</article-id><article-id pub-id-type="pmc">5050379</article-id><article-id pub-id-type="doi">10.1155/2016/8468763</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Hard and Soft Tissue Management of a Localized Alveolar Ridge Atrophy with Autogenous Sources and Biomaterials: A Challenging Clinical Case</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-8748-9483</contrib-id><name><surname>Maiorana</surname><given-names>C.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Andreoni</surname><given-names>D.</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-3739-1490</contrib-id><name><surname>Poli</surname><given-names>P. P.</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Oral Surgery and Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, School of Dentistry, University of Milan, Milan, Italy</aff><aff id="I2"><sup>2</sup>Private Practice, Milan, Italy</aff><aff id="I3"><sup>3</sup>Center for Maxillary Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy</aff><author-notes><corresp id="cor1">*P. P. Poli: <email>pierpaolo.poli@unimi.it</email></corresp><fn fn-type="other"><p>Academic Editor: Giovanna Orsini</p></fn></author-notes><pub-date pub-type="ppub"><year>2016</year></pub-date><pub-date pub-type="epub"><day>21</day><month>9</month><year>2016</year></pub-date><volume>2016</volume><elocation-id>8468763</elocation-id><history><date date-type="received"><day>10</day><month>7</month><year>2016</year></date><date date-type="accepted"><day>17</day><month>8</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016 C. Maiorana et al.</copyright-statement><copyright-year>2016</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Particularly in the premaxillary area, the stability of hard and soft tissues plays a pivotal role in the success of the rehabilitation from both a functional and aesthetic aspect. The present case report describes the clinical management of a localized alveolar ridge atrophy in the area of the upper right canine associated with a thin gingival biotype with a lack of keratinized tissue. An autogenous bone block harvested from the chin associated with heterologous bone particles was used to replace the missing bone, allowing for a prosthetic driven implant placement. Soft tissues deficiency was corrected by means of a combined epithelialized and subepithelial connective tissue graft. The 3-year clinical and radiological follow-up demonstrated symmetric gingival levels of the upper canines, with physiological peri-implant probing depths and bone loss. Thus, the use of autogenous tissues combined with biomaterials might be considered a reliable technique in case of highly aesthetic demanding cases.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Clinical view of the lateral aspect of the edentulous site.</p></caption><graphic xlink:href="CRID2016-8468763.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Clinical view of the occlusal aspect of the edentulous ridge.</p></caption><graphic xlink:href="CRID2016-8468763.002"></graphic></fig><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>Cross-sectional CBCT scan showing the residual graft material and the cortical screw more coronally.</p></caption><graphic xlink:href="CRID2016-8468763.003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>Apicoectomy surgery performed in the symphyseal area.</p></caption><graphic xlink:href="CRID2016-8468763.004"></graphic></fig><fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>Harvesting procedure of a corticocancellous bone block in the mandibular symphysis.</p></caption><graphic xlink:href="CRID2016-8468763.005"></graphic></fig><fig id="fig6" orientation="portrait" position="float"><label>Figure 6</label><caption><p>Anatomical view of the occlusal aspect of the edentulous ridge. The horizontal bone resorption is clearly represented.</p></caption><graphic xlink:href="CRID2016-8468763.006"></graphic></fig><fig id="fig7" orientation="portrait" position="float"><label>Figure 7</label><caption><p>Bone block fixed to the vestibular cortex of the edentulous ridge by means of two transcortical screws.</p></caption><graphic xlink:href="CRID2016-8468763.007"></graphic></fig><fig id="fig8" orientation="portrait" position="float"><label>Figure 8</label><caption><p>Particulated anorganic bovine bone placed on top of the bone block to reduce the physiological shrinkage of the graft due to bone remodelling.</p></caption><graphic xlink:href="CRID2016-8468763.008"></graphic></fig><fig id="fig9" orientation="portrait" position="float"><label>Figure 9</label><caption><p>Resorbable collagen membrane laid over the graft to prevent soft tissue cells ingrowth.</p></caption><graphic xlink:href="CRID2016-8468763.009"></graphic></fig><fig id="fig10" orientation="portrait" position="float"><label>Figure 10</label><caption><p>Clinical view of the bone block during the reentry procedure. The graft is completely integrated with the surrounding bone, with no volumetric resorption as demonstrated by the bone levels circumferentially around the transcortical screw.</p></caption><graphic xlink:href="CRID2016-8468763.010"></graphic></fig><fig id="fig11" orientation="portrait" position="float"><label>Figure 11</label><caption><p>Dental implant inserted in a prosthetically guided position in augmented bone.</p></caption><graphic xlink:href="CRID2016-8468763.011"></graphic></fig><fig id="fig12" orientation="portrait" position="float"><label>Figure 12</label><caption><p>Connective tissue graft harvested from the palatal mucosa of the flap to increase soft tissue thickness.</p></caption><graphic xlink:href="CRID2016-8468763.012"></graphic></fig><fig id="fig13" orientation="portrait" position="float"><label>Figure 13</label><caption><p>Soft tissues defect after 4 months of healing.</p></caption><graphic xlink:href="CRID2016-8468763.013"></graphic></fig><fig id="fig14" orientation="portrait" position="float"><label>Figure 14</label><caption><p>A free deepithelized gingival graft was used to enhance the amount of peri-implant soft tissues.</p></caption><graphic xlink:href="CRID2016-8468763.014"></graphic></fig><fig id="fig15" orientation="portrait" position="float"><label>Figure 15</label><caption><p>First provisional crown in situ. After a 2-month healing time, the soft tissue profile was still unaesthetic when compared to the contralateral side.</p></caption><graphic xlink:href="CRID2016-8468763.015"></graphic></fig><fig id="fig16" orientation="portrait" position="float"><label>Figure 16</label><caption><p>Detail of the epithelialized (lower part) and subepithelial (upper part) connective tissue graft.</p></caption><graphic xlink:href="CRID2016-8468763.016"></graphic></fig><fig id="fig17" orientation="portrait" position="float"><label>Figure 17</label><caption><p>Detail of the epithelial half-moon coronal portion of the graft facing toward the prosthetic crown.</p></caption><graphic xlink:href="CRID2016-8468763.017"></graphic></fig><fig id="fig18" orientation="portrait" position="float"><label>Figure 18</label><caption><p>Combined soft tissue graft in situ.</p></caption><graphic xlink:href="CRID2016-8468763.018"></graphic></fig><fig id="fig19" orientation="portrait" position="float"><label>Figure 19</label><caption><p>New temporary crown placed and adapted to the recipient site.</p></caption><graphic xlink:href="CRID2016-8468763.019"></graphic></fig><fig id="fig20" orientation="portrait" position="float"><label>Figure 20</label><caption><p>Final gold ceramic crown placed after 6 months of healing.</p></caption><graphic xlink:href="CRID2016-8468763.020"></graphic></fig><fig id="fig21" orientation="portrait" position="float"><label>Figure 21</label><caption><p>Three-year clinical follow-up demonstrating the volumetric stability of the soft tissue graft and the acceptable aesthetic result compared to the contralateral side.</p></caption><graphic xlink:href="CRID2016-8468763.021"></graphic></fig><fig id="fig22" orientation="portrait" position="float"><label>Figure 22</label><caption><p>Three-year periapical X-ray. The implant appeared well integrated and the mesial and distal bone levels showed a physiological remodelling.</p></caption><graphic xlink:href="CRID2016-8468763.022"></graphic></fig></floats-group></pmc><affiliations><list><country><li>Italie</li></country><region><li>Lombardie</li></region><settlement><li>Milan</li></settlement></list><tree><country name="Italie"><region name="Lombardie"><name sortKey="Maiorana, C" sort="Maiorana, C" uniqKey="Maiorana C" first="C." last="Maiorana">C. Maiorana</name></region><name sortKey="Andreoni, D" sort="Andreoni, D" uniqKey="Andreoni D" first="D." last="Andreoni">D. Andreoni</name><name sortKey="Poli, P P" sort="Poli, P P" uniqKey="Poli P" first="P. P." last="Poli">P. P. Poli</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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