Case Study

Helme Altaee1* and Ana Luisa Santos2
1Oral Maxillofacial surgeon, U.A.E
2GP dentist, Implants trainer, graduated from University of Coimbra/Portugal

*Corresponding Author: Helme Altaee, Oral Maxillofacial surgeon, U.A.E.

Received: October 01, 2016; Published: October 26, 2016

Introduction

An interesting case of 52 years old female with tooth #14 extraction with reconstruction of alveolar bone and immediate implant placement in one visit. The tooth was root canal filled with periapical lesion. The buccal plate showed dehiscence and resorption which needed to be replaced by autogenous bone that we found it covering an impacted #18. All the procedures were done at the same time including tooth extraction #14, Impacted tooth removal #18, Implant placement #14, and ridge reconstruction with bone grafting.

Procedures

After a good pre-operative assessment, the decision was first to remove the crown of the tooth and then to remove the root with atraumatic extraction by the use of chisels and root forceps (Figure 3).

Before the extraction, an impression of the upper and lower teeth were done and we sent it to the lab for preparation of a Maryland bridge for replacement of the tooth # 14 (with 2 wings on #13 and # 15) immediately after the extraction (Figure 4).

Later on after completion of the extraction, a good enucleation of the soft tissue in the periapical area of the socket, and checking of the labial plate were done. There was labial bone loss at the middle third of the root (Figure 5).

The post extraction pictures showed that there was no labial bone and we needed to reconstruct this bone after placement of the implant, in order to give better stability and osteo-integration for our future implant, as well as for esthetic reasons.

We used a special device to determine the amount of bone present there and the diameter of the socket (Figure 6-8). These measures helped us to decide which size of implant we should use and the areas of bone loss.

The Biotec implant GMBH size 4.2 mm x 11.5 mm was our choice.

We started to do the pilot drill inside the socket, initially vertical and then with an angulation of 15 degrees palatally, in order to use the palatal bone and get primary stability because there was a deficient labial plate (Figure 9-12).

The placement of the implant went perfect and we got primary stability, however, there was a space between the implant and the labial soft tissue (Figure 13 and 14). So, we decided to do bone grafting and augmentation into the area.

The OPG x-ray and the CT scan showed that there was an impacted #18, which needed to be extracted (Figure15 and 16). After anesthesia and removal of the impacted tooth, we used the labial bone that was covering the impacted tooth, as a graft for the missing alveolar plate in our socket (Figure 17-19). The autogenous bone was shaped according to the missing alveolar plates and was placed buccally to the implant (between the implant and the periosteum), which represents the future alveolar plate (Figure 20). We also got some chips of spongeous bone from the extraction area along with bovine bone which, mixed together and placed in the empty space (Figure 21).

Finally, the implant and the augmented bone were covered by Jason pericardium membrane. A 3/0 black silk suture was used to suture the area and the Maryland bridge was placed immediately after the surgical intervention (Figure 22-26).

One week later, the sutures were removed and the area was irrigated and cleaned.
The Maryland Bridge was placed back and left there for exactly 12 weeks.
3 months later we continued the prosthetic protocol for the placement of the final prosthesis (Figure 27-33).

Conclusions

1. Early diagnosis of any and early treatment may ends in very acceptable results
2. Immediate implantation after tooth extraction can be achieved only after complete cleaning of the socket and the periapical area.
3. Autogenous bone graft still the best source of graft that we can get for ridge reconstruction.
4. Osteointegration with the use of autogenous bone graft gives faster and more ferm results than with other types of grafts.
5. Biotec Implants was our right choice for this case according to the surface topography of the implant which helps in using this implant in soft bone or in a fresh socket.

Bibliography

1. Devorah Schwartz-Arad. “Autologous Intraoral Block Bone Grafting for Augmentation of Severe Atrophic MaxillaAdvantages of Combined Therapy”. Horizontal Alveolar Ridge Augmentation in Implant Dentistry: A Surgical Manual (2016): 125-135.
2. N.Y. Altintas., et al. “Immediate implant placement in fresh sockets versus implant placement in healed bone for full-arch fixed prostheses with conventional loading”. International Journal of Oral and Maxillofacial Surgery 45.2 (2016): 226-231.
3. Cristina Hita-Iglesias., et al. “Immediate Implants Placed in Fresh Sockets Associated with Periapical Pathology: A Split-Mouth Design and Survival Evaluation after 1-Year Follow-Up”. Clinical Implant Dentistry and Related Research (2015).
4. Barry D Wagenberg and Stuart J Froum. “Implant complications related to immediate implant placement into extraction sites”. Dental Implant Complications (2015): 457-480.
5. Steven J Sadowsky and Peter W. Hansen. “Evidence-Based Criteria for Differential Treatment Planning of Implant Restorations for the Mandibular Edentulous Patient”. Journal of Prosthodontics on Dental Implants 23.2 (2014): 104-111.
6. Zeinab Rezaee Esfarhoudi and Maryam Nourelahi. “Immediate Implantation in Maxillary Molar Sites: A Literature Review”. Middle East Journal of Rehabilitation and Health 2.3 (2015): e30616.
7. Hatice Hasturk., et al. “The Use of Light/Chemically Hardened Polymethylmethacrylate, Polyhydroxylethylmethacrylate, and Calcium Hydroxide Graft Material in Combination With Polyanhydride Around Implants and Extraction Sockets in Minipigs: Part II: Histologic and Micro-CT Evaluations”. Journal of Periodontology 85.9 (2014): 1230-1239.