Limits...
Single-tooth morse taper connection implant placed in grafted site of the anterior maxilla: clinical and radiographic evaluation.

Mangano FG, Zecca P, Luongo F, Iezzi G, Mangano C - Case Rep Dent (2014)

Bottom Line: Guided bone regeneration (GBR) technique was employed, with a biphasic calcium-phosphate (BCP) block graft placed in the extraction socket in conjunction with granules of the same material and a resorbable barrier membrane.The acrylic provisional restoration remained in situ for 3 months and then was substituted with the definitive crown.Localized severe alveolar bone resorption of the anterior maxilla associated with chronic periodontal disease can be successfully treated by means of ridge reconstruction with GBR and delayed implant insertion; the placement of an early-loaded, Morse taper connection implant in the grafted site was effective to create an excellent clinical aesthetic result and to maintain it along time.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical and Morphological Science, Dental School, University of Insubria, 21100 Varese, Italy ; ITEB Research Centre, University of Insubria, 21100 Varese, Italy.

ABSTRACT
The aim of this study was to achieve aesthetically pleasing soft tissue contours in a severely compromised tooth in the anterior region of the maxilla. For a right-maxillary central incisor with localized advanced chronic periodontitis a tooth extraction followed by reconstructive procedures and delayed implant placement was proposed and accepted by the patient. Guided bone regeneration (GBR) technique was employed, with a biphasic calcium-phosphate (BCP) block graft placed in the extraction socket in conjunction with granules of the same material and a resorbable barrier membrane. After 6 months of healing, an implant was installed. The acrylic provisional restoration remained in situ for 3 months and then was substituted with the definitive crown. This ridge reconstruction technique enabled preserving both hard and soft tissues and counteracting vertical and horizontal bone resorption after tooth extraction and allowed for an ideal three-dimensional implant placement. Localized severe alveolar bone resorption of the anterior maxilla associated with chronic periodontal disease can be successfully treated by means of ridge reconstruction with GBR and delayed implant insertion; the placement of an early-loaded, Morse taper connection implant in the grafted site was effective to create an excellent clinical aesthetic result and to maintain it along time.

No MeSH data available.


Related in: MedlinePlus

The definitive, ceramo-metallic restoration in position. The prosthetic restoration showed a good aesthetic integration: patient's smile aesthetics was improved and a satisfying harmony and symmetry with the contralateral tooth was achieved.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4238176&req=5

fig20: The definitive, ceramo-metallic restoration in position. The prosthetic restoration showed a good aesthetic integration: patient's smile aesthetics was improved and a satisfying harmony and symmetry with the contralateral tooth was achieved.

Mentions: A 60-year-old male patient, nonsmoker, nonbruxist, and without any history of systemic disease, was referred to a single private practice (Gravedona, Como, Italy) for the evaluation and treatment of his right-maxillary central incisor. His chief complaints were of mobility and slight localized pain during oral function. The patient reported episodes of swelling in the right central incisor area. The tooth was considerably extruded (Figure 1). Vitality tests on tooth (cold) were positive. Clinical examination revealed poor oral hygiene, localized gingival recessions, and thick gingival tissues. Probing pocket depth (PPD) was measured using a light probing force (approximately 25 g), with a conventional periodontal probe (PCP-UNC 15, Hu-Friedy Manufacturing, Chicago, IL, USA) at 4 sites per tooth (mesially, mid-buccally, distally, and mid-lingually). PPD ranging from 3 to 6 mm were registered in all other teeth; for the right-maxillary central incisor, a localized 12 mm PPD with bleeding on probing and suppuration was detected at the buccal face, while PPD of 9, 8, and 9 mm were detected at the mesial, distal, and palatal faces, respectively. A periapical radiograph was taken, revealing a localized, severe bone resorption affecting the right-maxillary central incisor (Figure 2). For a better investigation of the local anatomy, CBCT datasets of the failing tooth were acquired using a modern cone beam scanner (CS9300, Carestream Health, Rochester, NY, USA). A small, 5 × 5 cm FOV was selected, with a voxel size of 90 μm in order to obtain the best image resolution for the selected area, at lower radiation dose. CBCT dataset was then transferred to an implant navigation software (Invivo Dental 5, Anatomage, San Jose, CA, USA) to perform a 3D reconstruction of the anterior maxilla. The CBCT with 3D reconstruction confirmed the presence of the advanced, localized bone resorption (Figure 3). Based on clinical and radiographic examinations, tooth extraction followed by reconstructive procedures and delayed implant placement was proposed and accepted by the patient. Information was given to the patient regarding alternative treatment options (fixed partial denture on natural teeth). The patient received thorough explanations about the planned treatment and its potential risks and complications and signed a written informed consent form. Before the start of the treatment, for aesthetic reasons, an alginate impression was taken and a plaster cast was made, to fabricate a resin-bonded fixed partial denture as interim prosthesis. In addition, a diagnostic wax-up for the missing teeth structure was done, to provide the clinician with a better understanding of the patient's prosthetic needs and to ascertain the aesthetic outcome. Two weeks before extraction, the patient underwent a periodontal treatment, involving instructions and reinforcement in his oral hygiene efforts, followed by a scaling and root planning in the entire dentition. Surgery was performed under a local anaesthesia, obtained by infiltrating articaine 4%, containing 1 : 100,000 adrenaline (Ubistesin; 3M Espe, St. Paul, MN, USA). An intrasulcular incision was done, connected by two vertical releasing incisions and a full-thickness flap was reflected. The hopeless tooth was extracted avoiding any movement that might damage the residual buccal bone plate. Once the tooth was removed, the socket was thoroughly debrided with curettes and irrigated with sterile saline. The adjacent teeth were scaled and planed. The socket walls were then carefully probed, in order to assess the presence of any fenestration or dehiscence defects. The alveolar bone review depicted a huge bone defect (>8 mm) with loss of a considerable amount of buccal bone (Figure 4). In particular, the residual buccal bone wall was thin (width <2 mm). A technique for ridge reconstruction was adopted. A synthetic, micromacroporous biphasic calcium-phosphate block (Biocer, Biocer Entwicklungs GmbH, Bayreuth, Germany) was placed into the socket (Figure 5); then, granules of the same material were applied to completely fill the bone defect. The granules were mixed with tetracycline powder (Ambramicina; Scharper Spa, Sesto San Giovanni, Italy) to obtain a local antibiotic effect, and this mixture was moistened with physiological saline solution so that the composition could be more easily moulded to cover the defect (Figure 6). Finally, an absorbable collagen membrane (EZ Cure, Leone Implants, Florence, Italy) was placed over the graft, covering all the defect and adjacent bone borders (Figure 7). The flap was moved coronally to completely cover the membrane barrier and sutured in position by means of interruptedsutures (Supramid; Novaxa Spa, Milan, Italy) (Figure 8). A postoperative periapical radiograph was taken to confirm the filling of the postextraction socket (Figure 9). The patient was prescribed oral antibiotics, 2 g of amoxicillin/clavulanic acid each day for 6 days (Augmentin; Glaxo-Smithkline Beecham, Brentford, UK). Postoperative pain was controlled by administering 100 mg nimesulide (Aulin; Roche Pharmaceutical, Basel, Switzerland) every 12 h for 2 days, and detailed instructions about oral hygiene were given, including mouth rinses with 0.12% chlorhexidine (Chlorexidine; OralB, Boston, MA, USA) administered for 7 days. An interim prosthesis was delivered by using an adhesive system to attach to the adjacent teeth. This prosthesis was key in achieving an acceptable aesthetic outcome. The patient was seen two weeks after surgery for suture removal. He had mild swelling for 2-3 days after surgery, but no further discomfort during the healing period. Regular postoperatively examinations were performed at 3-month intervals and included oral hygiene instructions and professional plaque control. After 6 months of uneventful healing, the placement of a dental implant was planned, to restore aesthetics and function. A periapical radiograph was taken, showing an apparent good integration of the material used for regeneration (Figure 10). Again, local anaesthesia was obtained by infiltrating articaine 4% containing 1 : 100.000 adrenaline. Exposure of the regenerated ridge was achieved with a crestal incision and two lateral releases. Care was taken to preserve the papillae of the adjacent teeth. A mucoperiosteal flap was elevated. The patient showed great bone augmentation, confirming the possibility of placing a dental implant in the proper position (Figure 11). The osteotomy started with a 2 × 10 mm trephine bur, which was used to retrieve a bone core (approximately 2 × 6 mm) biopsy at the site of implant placement, via a transcrestal path, under saline solution irrigation. The bone core biopsy was retrieved with the aim of performing a histologic evaluation of the augmented bone. The biopsy was immediately stored in 10% buffered formalin and was subsequently processed (Precise 1 Automated System, Assing, Rome, Italy) to obtain thin ground sections. The specimens were dehydrated in an ascending series of alcohol rinses and embedded in glycol methacrylate resin (Technovit 7200 VLC, Heraeus Kulzer GmbH & Co., Wehrheim, Germany). After polymerization, the specimens were sectioned lengthwise along the longer axis, using a high-precision diamond disk saw, to about 150 μm and ground down to about 30 μm. Two slides were obtained from each specimen. The slides were stained with basic fuchsin and toluidine blue and the histologic evaluation was performed. The specimens were made of preexisting, compact mature bone undergoing remodeling, marrow spaces, and newly formed trabecular bone surrounded by several residual biomaterial particles. The newly formed bone appeared well organized. Close to the porous BCP particles, new bone formation was observed, with newly formed osteoid matrix undergoing mineralization (Figure 12). The preparation of implant site progressed with spiral drills of increasing diameter (2.8 and 3.5 mm, to place an implant with 4.1 mm diameter) under constant saline irrigation. The socket preparation was deepened beyond the alveolar apex, engaging the native apical bone, in order to obtain an optimal implant stability. A 4.1 × 12 mm implant (Leone Implants, Florence, Italy) was installed in the prepared site, using 20 rpm at 40 Ncm torque (Figure 13). This implant is characterized by a cone Morse taper interference-fit (TIF) locking-taper combined with an internal hexagon. The Morse taper presents a taper angle of 1.5° (Figure 14). The implant was positioned at the bone crest level, 2 mm apically to the cementoenamel junction of the left maxillary central incisor. Care was taken to ensure the correct 3D position of the implant and to keep a safe distance from the reconstructed buccal bone wall. A nonsubmerged, single-stage approach was followed. Immediately after implant placement, a healing abutment was connected to the implant. The mucosal flap was adjusted to the healing abutment and then sutured in position (Figure 15). The patient underwent a second 5 × 5 cm FOV CBCT examination with a voxel size of 90 μm: the 3D reconstruction confirmed the optimal implant placement in the regenerated bone (Figure 16). The patient was seen on a weekly basis during the first 2 weeks. At the first control visit, 7 days after the surgery, a clinically healthy marginal area was present and no postoperative pain or swelling was reported. There was no bleeding or wound infection. After 14 days, sutures were removed; the healing abutment was removed and an impression coping was connected to the implant. Impressions were taken, using a vinylpolysiloxane material (EliteHd Plus, Zhermack, Badia Polesine, Italy). One week later, a standard prefabricated prepared and finished titanium abutment was placed and activated (Figure 17), and the acrylic resin provisional restoration was provided (Figure 18) and cemented with zinc-eugenol oxide cement (Temp-Bond, Kerr, Orange, CA, USA). Occlusion was checked using standard occluding papers (Bausch Articulating Papers, Bausch Inc, Nashua, NH, USA). The provisional restoration was carefully evaluated for proper occlusion; after that, it was polished with abrasive points. The acrylic provisional restoration remained in situ for 3 months: it was used to monitor the implant stability under a progressive load and to obtain a good soft-tissue healing around the implant before fabrication of the definitive restorations. At the end of this period, the patient showed remarkable healing of the soft tissues, and the gingiva showed an excellent color and texture. It also began to outline the proper and harmonious design of the facial mucosa curvatures, which were conditioned by the provisional restoration (Figure 19), so that the definitive, ceramo-metallic restoration could be provided (Figure 20) and cemented with zinc-eugenol oxide cement. The prosthetic restoration showed a good aesthetic integration: the patient's smile aesthetics was improved and a satisfying harmony and symmetry with the contralateral tooth were achieved. A periapical radiograph was taken to check definitive restoration seating (Figure 21). Two years after implant placement, the implant was stable and in function, with no clinical issues; clinical examination showed absence of gingival recession, no probing pocket depths, and no bleeding on probing or suppuration (Figure 22). Periapical radiographic evaluation revealed a stable alveolar bone gain, especially in the vertical dimension (Figure 23). The definitive restoration was removed and a new 5 × 5 cm FOV CBCT examination with a voxel size of 90 μm, combined with 3D reconstruction, was taken. It confirmed excellent osseointegration of the implant with unchanged peri-implant marginal bone levels, indicating that the treatment proposed was able to restore the functional and aesthetic parameters (Figure 24). Finally, in order to evaluate precisely the hard tissue stability along time, the data of the second (6 months after grafting) and the third (2 years) CBCT were segmented by digital imaging software (Mimics, Materialise, Leuven, Belgium). Based on the result of segmentation, according to Chappuis and colleagues [9] a surface mesh model was generated according to conventional marching cube algorithms, followed by automated surface mesh model generation. The two-year mesh model was superimposed on the 6-month mesh model and rigidly aligned by anatomical landmarks with the help of software for the overlapping of digital images (Geomagic Studio, Morrisville, NC, USA). The distance between the 2 surface meshes was presented as color-coded graded figures to identify zones of facial bone resorption (Figure 25). The overlapping of digital images confirmed the hard tissue stability along time, with little or no bone resorption (Figure 26).


Single-tooth morse taper connection implant placed in grafted site of the anterior maxilla: clinical and radiographic evaluation.

Mangano FG, Zecca P, Luongo F, Iezzi G, Mangano C - Case Rep Dent (2014)

The definitive, ceramo-metallic restoration in position. The prosthetic restoration showed a good aesthetic integration: patient's smile aesthetics was improved and a satisfying harmony and symmetry with the contralateral tooth was achieved.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4238176&req=5

fig20: The definitive, ceramo-metallic restoration in position. The prosthetic restoration showed a good aesthetic integration: patient's smile aesthetics was improved and a satisfying harmony and symmetry with the contralateral tooth was achieved.
Mentions: A 60-year-old male patient, nonsmoker, nonbruxist, and without any history of systemic disease, was referred to a single private practice (Gravedona, Como, Italy) for the evaluation and treatment of his right-maxillary central incisor. His chief complaints were of mobility and slight localized pain during oral function. The patient reported episodes of swelling in the right central incisor area. The tooth was considerably extruded (Figure 1). Vitality tests on tooth (cold) were positive. Clinical examination revealed poor oral hygiene, localized gingival recessions, and thick gingival tissues. Probing pocket depth (PPD) was measured using a light probing force (approximately 25 g), with a conventional periodontal probe (PCP-UNC 15, Hu-Friedy Manufacturing, Chicago, IL, USA) at 4 sites per tooth (mesially, mid-buccally, distally, and mid-lingually). PPD ranging from 3 to 6 mm were registered in all other teeth; for the right-maxillary central incisor, a localized 12 mm PPD with bleeding on probing and suppuration was detected at the buccal face, while PPD of 9, 8, and 9 mm were detected at the mesial, distal, and palatal faces, respectively. A periapical radiograph was taken, revealing a localized, severe bone resorption affecting the right-maxillary central incisor (Figure 2). For a better investigation of the local anatomy, CBCT datasets of the failing tooth were acquired using a modern cone beam scanner (CS9300, Carestream Health, Rochester, NY, USA). A small, 5 × 5 cm FOV was selected, with a voxel size of 90 μm in order to obtain the best image resolution for the selected area, at lower radiation dose. CBCT dataset was then transferred to an implant navigation software (Invivo Dental 5, Anatomage, San Jose, CA, USA) to perform a 3D reconstruction of the anterior maxilla. The CBCT with 3D reconstruction confirmed the presence of the advanced, localized bone resorption (Figure 3). Based on clinical and radiographic examinations, tooth extraction followed by reconstructive procedures and delayed implant placement was proposed and accepted by the patient. Information was given to the patient regarding alternative treatment options (fixed partial denture on natural teeth). The patient received thorough explanations about the planned treatment and its potential risks and complications and signed a written informed consent form. Before the start of the treatment, for aesthetic reasons, an alginate impression was taken and a plaster cast was made, to fabricate a resin-bonded fixed partial denture as interim prosthesis. In addition, a diagnostic wax-up for the missing teeth structure was done, to provide the clinician with a better understanding of the patient's prosthetic needs and to ascertain the aesthetic outcome. Two weeks before extraction, the patient underwent a periodontal treatment, involving instructions and reinforcement in his oral hygiene efforts, followed by a scaling and root planning in the entire dentition. Surgery was performed under a local anaesthesia, obtained by infiltrating articaine 4%, containing 1 : 100,000 adrenaline (Ubistesin; 3M Espe, St. Paul, MN, USA). An intrasulcular incision was done, connected by two vertical releasing incisions and a full-thickness flap was reflected. The hopeless tooth was extracted avoiding any movement that might damage the residual buccal bone plate. Once the tooth was removed, the socket was thoroughly debrided with curettes and irrigated with sterile saline. The adjacent teeth were scaled and planed. The socket walls were then carefully probed, in order to assess the presence of any fenestration or dehiscence defects. The alveolar bone review depicted a huge bone defect (>8 mm) with loss of a considerable amount of buccal bone (Figure 4). In particular, the residual buccal bone wall was thin (width <2 mm). A technique for ridge reconstruction was adopted. A synthetic, micromacroporous biphasic calcium-phosphate block (Biocer, Biocer Entwicklungs GmbH, Bayreuth, Germany) was placed into the socket (Figure 5); then, granules of the same material were applied to completely fill the bone defect. The granules were mixed with tetracycline powder (Ambramicina; Scharper Spa, Sesto San Giovanni, Italy) to obtain a local antibiotic effect, and this mixture was moistened with physiological saline solution so that the composition could be more easily moulded to cover the defect (Figure 6). Finally, an absorbable collagen membrane (EZ Cure, Leone Implants, Florence, Italy) was placed over the graft, covering all the defect and adjacent bone borders (Figure 7). The flap was moved coronally to completely cover the membrane barrier and sutured in position by means of interruptedsutures (Supramid; Novaxa Spa, Milan, Italy) (Figure 8). A postoperative periapical radiograph was taken to confirm the filling of the postextraction socket (Figure 9). The patient was prescribed oral antibiotics, 2 g of amoxicillin/clavulanic acid each day for 6 days (Augmentin; Glaxo-Smithkline Beecham, Brentford, UK). Postoperative pain was controlled by administering 100 mg nimesulide (Aulin; Roche Pharmaceutical, Basel, Switzerland) every 12 h for 2 days, and detailed instructions about oral hygiene were given, including mouth rinses with 0.12% chlorhexidine (Chlorexidine; OralB, Boston, MA, USA) administered for 7 days. An interim prosthesis was delivered by using an adhesive system to attach to the adjacent teeth. This prosthesis was key in achieving an acceptable aesthetic outcome. The patient was seen two weeks after surgery for suture removal. He had mild swelling for 2-3 days after surgery, but no further discomfort during the healing period. Regular postoperatively examinations were performed at 3-month intervals and included oral hygiene instructions and professional plaque control. After 6 months of uneventful healing, the placement of a dental implant was planned, to restore aesthetics and function. A periapical radiograph was taken, showing an apparent good integration of the material used for regeneration (Figure 10). Again, local anaesthesia was obtained by infiltrating articaine 4% containing 1 : 100.000 adrenaline. Exposure of the regenerated ridge was achieved with a crestal incision and two lateral releases. Care was taken to preserve the papillae of the adjacent teeth. A mucoperiosteal flap was elevated. The patient showed great bone augmentation, confirming the possibility of placing a dental implant in the proper position (Figure 11). The osteotomy started with a 2 × 10 mm trephine bur, which was used to retrieve a bone core (approximately 2 × 6 mm) biopsy at the site of implant placement, via a transcrestal path, under saline solution irrigation. The bone core biopsy was retrieved with the aim of performing a histologic evaluation of the augmented bone. The biopsy was immediately stored in 10% buffered formalin and was subsequently processed (Precise 1 Automated System, Assing, Rome, Italy) to obtain thin ground sections. The specimens were dehydrated in an ascending series of alcohol rinses and embedded in glycol methacrylate resin (Technovit 7200 VLC, Heraeus Kulzer GmbH & Co., Wehrheim, Germany). After polymerization, the specimens were sectioned lengthwise along the longer axis, using a high-precision diamond disk saw, to about 150 μm and ground down to about 30 μm. Two slides were obtained from each specimen. The slides were stained with basic fuchsin and toluidine blue and the histologic evaluation was performed. The specimens were made of preexisting, compact mature bone undergoing remodeling, marrow spaces, and newly formed trabecular bone surrounded by several residual biomaterial particles. The newly formed bone appeared well organized. Close to the porous BCP particles, new bone formation was observed, with newly formed osteoid matrix undergoing mineralization (Figure 12). The preparation of implant site progressed with spiral drills of increasing diameter (2.8 and 3.5 mm, to place an implant with 4.1 mm diameter) under constant saline irrigation. The socket preparation was deepened beyond the alveolar apex, engaging the native apical bone, in order to obtain an optimal implant stability. A 4.1 × 12 mm implant (Leone Implants, Florence, Italy) was installed in the prepared site, using 20 rpm at 40 Ncm torque (Figure 13). This implant is characterized by a cone Morse taper interference-fit (TIF) locking-taper combined with an internal hexagon. The Morse taper presents a taper angle of 1.5° (Figure 14). The implant was positioned at the bone crest level, 2 mm apically to the cementoenamel junction of the left maxillary central incisor. Care was taken to ensure the correct 3D position of the implant and to keep a safe distance from the reconstructed buccal bone wall. A nonsubmerged, single-stage approach was followed. Immediately after implant placement, a healing abutment was connected to the implant. The mucosal flap was adjusted to the healing abutment and then sutured in position (Figure 15). The patient underwent a second 5 × 5 cm FOV CBCT examination with a voxel size of 90 μm: the 3D reconstruction confirmed the optimal implant placement in the regenerated bone (Figure 16). The patient was seen on a weekly basis during the first 2 weeks. At the first control visit, 7 days after the surgery, a clinically healthy marginal area was present and no postoperative pain or swelling was reported. There was no bleeding or wound infection. After 14 days, sutures were removed; the healing abutment was removed and an impression coping was connected to the implant. Impressions were taken, using a vinylpolysiloxane material (EliteHd Plus, Zhermack, Badia Polesine, Italy). One week later, a standard prefabricated prepared and finished titanium abutment was placed and activated (Figure 17), and the acrylic resin provisional restoration was provided (Figure 18) and cemented with zinc-eugenol oxide cement (Temp-Bond, Kerr, Orange, CA, USA). Occlusion was checked using standard occluding papers (Bausch Articulating Papers, Bausch Inc, Nashua, NH, USA). The provisional restoration was carefully evaluated for proper occlusion; after that, it was polished with abrasive points. The acrylic provisional restoration remained in situ for 3 months: it was used to monitor the implant stability under a progressive load and to obtain a good soft-tissue healing around the implant before fabrication of the definitive restorations. At the end of this period, the patient showed remarkable healing of the soft tissues, and the gingiva showed an excellent color and texture. It also began to outline the proper and harmonious design of the facial mucosa curvatures, which were conditioned by the provisional restoration (Figure 19), so that the definitive, ceramo-metallic restoration could be provided (Figure 20) and cemented with zinc-eugenol oxide cement. The prosthetic restoration showed a good aesthetic integration: the patient's smile aesthetics was improved and a satisfying harmony and symmetry with the contralateral tooth were achieved. A periapical radiograph was taken to check definitive restoration seating (Figure 21). Two years after implant placement, the implant was stable and in function, with no clinical issues; clinical examination showed absence of gingival recession, no probing pocket depths, and no bleeding on probing or suppuration (Figure 22). Periapical radiographic evaluation revealed a stable alveolar bone gain, especially in the vertical dimension (Figure 23). The definitive restoration was removed and a new 5 × 5 cm FOV CBCT examination with a voxel size of 90 μm, combined with 3D reconstruction, was taken. It confirmed excellent osseointegration of the implant with unchanged peri-implant marginal bone levels, indicating that the treatment proposed was able to restore the functional and aesthetic parameters (Figure 24). Finally, in order to evaluate precisely the hard tissue stability along time, the data of the second (6 months after grafting) and the third (2 years) CBCT were segmented by digital imaging software (Mimics, Materialise, Leuven, Belgium). Based on the result of segmentation, according to Chappuis and colleagues [9] a surface mesh model was generated according to conventional marching cube algorithms, followed by automated surface mesh model generation. The two-year mesh model was superimposed on the 6-month mesh model and rigidly aligned by anatomical landmarks with the help of software for the overlapping of digital images (Geomagic Studio, Morrisville, NC, USA). The distance between the 2 surface meshes was presented as color-coded graded figures to identify zones of facial bone resorption (Figure 25). The overlapping of digital images confirmed the hard tissue stability along time, with little or no bone resorption (Figure 26).

Bottom Line: Guided bone regeneration (GBR) technique was employed, with a biphasic calcium-phosphate (BCP) block graft placed in the extraction socket in conjunction with granules of the same material and a resorbable barrier membrane.The acrylic provisional restoration remained in situ for 3 months and then was substituted with the definitive crown.Localized severe alveolar bone resorption of the anterior maxilla associated with chronic periodontal disease can be successfully treated by means of ridge reconstruction with GBR and delayed implant insertion; the placement of an early-loaded, Morse taper connection implant in the grafted site was effective to create an excellent clinical aesthetic result and to maintain it along time.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical and Morphological Science, Dental School, University of Insubria, 21100 Varese, Italy ; ITEB Research Centre, University of Insubria, 21100 Varese, Italy.

ABSTRACT
The aim of this study was to achieve aesthetically pleasing soft tissue contours in a severely compromised tooth in the anterior region of the maxilla. For a right-maxillary central incisor with localized advanced chronic periodontitis a tooth extraction followed by reconstructive procedures and delayed implant placement was proposed and accepted by the patient. Guided bone regeneration (GBR) technique was employed, with a biphasic calcium-phosphate (BCP) block graft placed in the extraction socket in conjunction with granules of the same material and a resorbable barrier membrane. After 6 months of healing, an implant was installed. The acrylic provisional restoration remained in situ for 3 months and then was substituted with the definitive crown. This ridge reconstruction technique enabled preserving both hard and soft tissues and counteracting vertical and horizontal bone resorption after tooth extraction and allowed for an ideal three-dimensional implant placement. Localized severe alveolar bone resorption of the anterior maxilla associated with chronic periodontal disease can be successfully treated by means of ridge reconstruction with GBR and delayed implant insertion; the placement of an early-loaded, Morse taper connection implant in the grafted site was effective to create an excellent clinical aesthetic result and to maintain it along time.

No MeSH data available.


Related in: MedlinePlus