Aesthetic Surgical Approach for Bone Dehiscence Treatment by Means of Single Implant and Interdental Tissue Regeneration: A Case Report with Five Years of Follow-Up
Identifieur interne : 002A14 ( Pmc/Curation ); précédent : 002A13; suivant : 002A15Aesthetic Surgical Approach for Bone Dehiscence Treatment by Means of Single Implant and Interdental Tissue Regeneration: A Case Report with Five Years of Follow-Up
Auteurs : Giorgio Lombardo [Italie] ; Jacopo Pighi [Italie] ; Giovanni Corrocher [Italie] ; Anna Mascellaro [Italie] ; Jeffrey Lehrberg [États-Unis] ; Mauro Marincola [Colombie] ; Pier Francesco Nocini [Italie]Source :
- Case Reports in Dentistry [ 2090-6447 ] ; 2016.
Abstract
The replacement of single anterior teeth by means of endosseous implants implies the achievement of success in restoring both aesthetic and function. However, the presence of wide endoperiodontal lesions can lead to horizontal hard and soft tissues defects after tooth extraction, making it impossible to correctly place an implant in the compromised alveolar socket. Vertical augmentation procedures have been proposed to solve these clinical situations, but the amount of new regenerated bone is still not predictable. Furthermore, bone augmentation can be complicated by the presence of adjacent teeth, especially if they bring with them periodontal defects. Therefore, it is used to restore periodontal health of adjacent teeth before making any augmentation procedures and to wait a certain healing period before placing an implant in vertically augmented sites, otherwise risking to obtain a nonsatisfactory aesthetic result. All of these procedures, however, lead to an expansion of treatment time which should affect patient compliance. For this reason, this case report suggests a surgical technique to perform vertical bone augmentation at a single gap left by a central upper incisor while placing an implant and simultaneously to regenerate the periodontal attachment of an adjacent lateral incisor, without compromising the aesthetic result.
Url:
DOI: 10.1155/2016/1236310
PubMed: 27119031
PubMed Central: 4812909
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<front><div type="abstract" xml:lang="en"><p>The replacement of single anterior teeth by means of endosseous implants implies the achievement of success in restoring both aesthetic and function. However, the presence of wide endoperiodontal lesions can lead to horizontal hard and soft tissues defects after tooth extraction, making it impossible to correctly place an implant in the compromised alveolar socket. Vertical augmentation procedures have been proposed to solve these clinical situations, but the amount of new regenerated bone is still not predictable. Furthermore, bone augmentation can be complicated by the presence of adjacent teeth, especially if they bring with them periodontal defects. Therefore, it is used to restore periodontal health of adjacent teeth before making any augmentation procedures and to wait a certain healing period before placing an implant in vertically augmented sites, otherwise risking to obtain a nonsatisfactory aesthetic result. All of these procedures, however, lead to an expansion of treatment time which should affect patient compliance. For this reason, this case report suggests a surgical technique to perform vertical bone augmentation at a single gap left by a central upper incisor while placing an implant and simultaneously to regenerate the periodontal attachment of an adjacent lateral incisor, without compromising the aesthetic result.</p>
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<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>
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<issn pub-type="ppub">2090-6447</issn>
<issn pub-type="epub">2090-6455</issn>
<publisher><publisher-name>Hindawi Publishing Corporation</publisher-name>
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<article-id pub-id-type="pmc">4812909</article-id>
<article-id pub-id-type="doi">10.1155/2016/1236310</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
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<title-group><article-title>Aesthetic Surgical Approach for Bone Dehiscence Treatment by Means of Single Implant and Interdental Tissue Regeneration: A Case Report with Five Years of Follow-Up</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Lombardo</surname>
<given-names>Giorgio</given-names>
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<xref ref-type="aff" rid="I1"><sup>1</sup>
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</contrib>
<contrib contrib-type="author"><name><surname>Pighi</surname>
<given-names>Jacopo</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Corrocher</surname>
<given-names>Giovanni</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mascellaro</surname>
<given-names>Anna</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lehrberg</surname>
<given-names>Jeffrey</given-names>
</name>
<xref ref-type="aff" rid="I2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Marincola</surname>
<given-names>Mauro</given-names>
</name>
<xref ref-type="aff" rid="I3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nocini</surname>
<given-names>Pier Francesco</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
</contrib>
</contrib-group>
<aff id="I1"><sup>1</sup>
Clinic of Dentistry and Maxillofacial Surgery, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37100 Verona, Italy</aff>
<aff id="I2"><sup>2</sup>
Department of Biomaterials, Implant Dentistry Centre, 501 Arborway, Jamaica Plain, Boston, MA 02130, USA</aff>
<aff id="I3"><sup>3</sup>
Universidad de Cartagena, Avenida del Consulado, Calle No. 30, No. 48-152, Cartagena, Bolívar, Colombia</aff>
<author-notes><corresp id="cor1">*Giorgio Lombardo: <email>giorgio.lombardo@univr.it</email>
</corresp>
<fn fn-type="other"><p>Academic Editor: Adrian Kasaj</p>
</fn>
</author-notes>
<pub-date pub-type="ppub"><year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>16</day>
<month>3</month>
<year>2016</year>
</pub-date>
<volume>2016</volume>
<elocation-id>1236310</elocation-id>
<history><date date-type="received"><day>13</day>
<month>1</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>15</day>
<month>2</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2016 Giorgio Lombardo 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>The replacement of single anterior teeth by means of endosseous implants implies the achievement of success in restoring both aesthetic and function. However, the presence of wide endoperiodontal lesions can lead to horizontal hard and soft tissues defects after tooth extraction, making it impossible to correctly place an implant in the compromised alveolar socket. Vertical augmentation procedures have been proposed to solve these clinical situations, but the amount of new regenerated bone is still not predictable. Furthermore, bone augmentation can be complicated by the presence of adjacent teeth, especially if they bring with them periodontal defects. Therefore, it is used to restore periodontal health of adjacent teeth before making any augmentation procedures and to wait a certain healing period before placing an implant in vertically augmented sites, otherwise risking to obtain a nonsatisfactory aesthetic result. All of these procedures, however, lead to an expansion of treatment time which should affect patient compliance. For this reason, this case report suggests a surgical technique to perform vertical bone augmentation at a single gap left by a central upper incisor while placing an implant and simultaneously to regenerate the periodontal attachment of an adjacent lateral incisor, without compromising the aesthetic result.</p>
</abstract>
</article-meta>
</front>
<floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label>
<caption><p>Front side view of patient upon presentation.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.001"></graphic>
</fig>
<fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label>
<caption><p>Intraoral periapical radiograph showing bone loss around the right central incisor and involving the mesial alveolar wall of the right lateral incisor.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.002"></graphic>
</fig>
<fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label>
<caption><p>Plaque and calculus can be observed on the root surface at the time of extraction, performed with minimal trauma.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.003"></graphic>
</fig>
<fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label>
<caption><p>Occlusal view of the fresh alveolar socket after extraction and application of Spongostan<italic>™</italic>
.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.004"></graphic>
</fig>
<fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label>
<caption><p>The crown of the extracted tooth was splinted to the adjacent elements and used as provisional pontic.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.005"></graphic>
</fig>
<fig id="fig6" orientation="portrait" position="float"><label>Figure 6</label>
<caption><p>Postoperative X-ray after tooth extraction.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.006"></graphic>
</fig>
<fig id="fig7" orientation="portrait" position="float"><label>Figure 7</label>
<caption><p>Frontal (a) and occlusal (b) views after six weeks of healing.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.007"></graphic>
</fig>
<fig id="fig8" orientation="portrait" position="float"><label>Figure 8</label>
<caption><p>The radiograph taken before implant insertion shows a complete loss of the buccal and palatal bone.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.008"></graphic>
</fig>
<fig id="fig9" orientation="portrait" position="float"><label>Figure 9</label>
<caption><p>Occlusal view of the surgical incision at implant insertion time. A full thickness flap at the single gap continued with a partial thickness flap to harvest a connective tissue graft.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.009"></graphic>
</fig>
<fig id="fig10" orientation="portrait" position="float"><label>Figure 10</label>
<caption><p>Aspect of the harvested connective tissue graft.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.010"></graphic>
</fig>
<fig id="fig11" orientation="portrait" position="float"><label>Figure 11</label>
<caption><p>Surgical placement of the Bicon implant. The implant lies 1 mm below the margin of the buccal bone dehiscence.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.011"></graphic>
</fig>
<fig id="fig12" orientation="portrait" position="float"><label>Figure 12</label>
<caption><p>A stealth abutment was tested (a) and then modified on its top (b) to primarily close the wound maintaining a proper bone and mucosal tunnel.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.012"></graphic>
</fig>
<fig id="fig13" orientation="portrait" position="float"><label>Figure 13</label>
<caption><p>After fixation of the connective tissue graft to the buccal flap (a), Emdogain® was applied on the lateral incisor root surface to regenerate the lost periodontal attachment (b).</p>
</caption>
<graphic xlink:href="CRID2016-1236310.013"></graphic>
</fig>
<fig id="fig14" orientation="portrait" position="float"><label>Figure 14</label>
<caption><p>Bio-Oss® was applied to cover the defect around the implant.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.014"></graphic>
</fig>
<fig id="fig15" orientation="portrait" position="float"><label>Figure 15</label>
<caption><p>Frontal (a) and occlusal (b) view at the end of the surgical intervention.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.015"></graphic>
</fig>
<fig id="fig16" orientation="portrait" position="float"><label>Figure 16</label>
<caption><p>Postoperative X-ray shows fulfilling of the defect, with the implant lying in native bone below the grafted material.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.016"></graphic>
</fig>
<fig id="fig17" orientation="portrait" position="float"><label>Figure 17</label>
<caption><p>Frontal view following provisional pontic removal, after four months of healing.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.017"></graphic>
</fig>
<fig id="fig18" orientation="portrait" position="float"><label>Figure 18</label>
<caption><p>Radiograph at four months of healing showing good integration of the implant and the grafted material.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.018"></graphic>
</fig>
<fig id="fig19" orientation="portrait" position="float"><label>Figure 19</label>
<caption><p>After performing a circular incision (a), the provisional stealth abutment was removed (b).</p>
</caption>
<graphic xlink:href="CRID2016-1236310.019"></graphic>
</fig>
<fig id="fig20" orientation="portrait" position="float"><label>Figure 20</label>
<caption><p>The provisional integrated abutment crown before fixation.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.020"></graphic>
</fig>
<fig id="fig21" orientation="portrait" position="float"><label>Figure 21</label>
<caption><p>Frontal view after application of the provisional integrated abutment crown.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.021"></graphic>
</fig>
<fig id="fig22" orientation="portrait" position="float"><label>Figure 22</label>
<caption><p>Radiograph showing the long abutment post, chosen to respect the bone and mucosal tunnel.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.022"></graphic>
</fig>
<fig id="fig23" orientation="portrait" position="float"><label>Figure 23</label>
<caption><p>Frontal view before prostheses delivery. The implant abutment was tested before extraoral cementation of the crown.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.023"></graphic>
</fig>
<fig id="fig24" orientation="portrait" position="float"><label>Figure 24</label>
<caption><p>Aspect of the implant crown after extraoral cementation.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.024"></graphic>
</fig>
<fig id="fig25" orientation="portrait" position="float"><label>Figure 25</label>
<caption><p>The abutment and crown were inserted through the long axis of the implant well (a) and then manually pressed (b) before tapping with mallet.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.025"></graphic>
</fig>
<fig id="fig26" orientation="portrait" position="float"><label>Figure 26</label>
<caption><p>Frontal view after prostheses delivery.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.026"></graphic>
</fig>
<fig id="fig27" orientation="portrait" position="float"><label>Figure 27</label>
<caption><p>The patient's natural looking smile at the end of the therapy.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.027"></graphic>
</fig>
<fig id="fig28" orientation="portrait" position="float"><label>Figure 28</label>
<caption><p>Control X-ray at the end of therapy.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.028"></graphic>
</fig>
<fig id="fig29" orientation="portrait" position="float"><label>Figure 29</label>
<caption><p>Frontal view showing the aesthetic result at the five-year follow-up examination.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.029"></graphic>
</fig>
<fig id="fig30" orientation="portrait" position="float"><label>Figure 30</label>
<caption><p>The radiograph performed after five years shows full integration of the implant and good stability of interproximal soft tissues, along with almost full filling of the lateral incisor's periodontal defect.</p>
</caption>
<graphic xlink:href="CRID2016-1236310.030"></graphic>
</fig>
</floats-group>
</pmc>
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