PMC4555940_01
Initial clinical aspect
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F1
A 48-year-old male patient had a clinical examination of the tooth left maxillary first premolar with grade 3 mobility [Figure 1].
Radiographic exam
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F2
In the radiographic examination, there was an advanced bone loss and tooth extraction was indicated [Figure 2].
Extension of periodontal bone loss
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F3
After flap elevation, it was possible to observe the extent of bone loss induced by the periodontal disease, which included all the vestibular wall of the socket [Figure 3].
Remaining alveolar bone after curettage
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F4
Curettage and vigorous irrigation of the socket with the saline solution were performed [Figure 4].
Obtaining bone shavings of the oblique line
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F5
With the aid of a bone scraper (Autogenous , Serson, Sao Paulo, Brazil.) zest of mandibular cortical bone was obtained in sufficient quantity to fill the defect [Figures 5 and 6].
Amount of obtained bone shavings
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F6
With the aid of a bone scraper (Autogenous , Serson, Sao Paulo, Brazil.) zest of mandibular cortical bone was obtained in sufficient quantity to fill the defect [Figures 5 and 6].
Filling of the defect with grafting
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F7
The autogenous bone graft was positioned, filling the defect in the alveolar region of the tooth left maxillary first premolar, with a normal blood clot in the defect [Figure 7].
Covering with absorbable membrane
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F8
Paulo, Brazil) [Figure 8]. Periosteal incisions were made in order to increase the elasticity of the flap and to obtain the closing of the wound by first intention without tensional forces that could cause ischemia and wound dehiscence.
Six months postoperative
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F9
After 6 months of undistributed healing, the area was exposed to implant installation [Figure 9].
Installed implant
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F10
A 3.75 mm diameter and 13 mm height cylindrical implant were installed (SIN , Sao Paulo, Brazil) and a cover screw was screwed [Figure 10].
Histological examination: Observe vital tissue, neo-formed bone with the presence of particles of remaining bone shavings inside (H and E, x40)
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F11
There is a suggestion of partial resorption of autogenous bone particles [Figure 11].
Periapical radiograph immediately after implant installation
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F12
Furthermore, a metal-ceramic crown was fabricated and screwed onto the implant [Figures 12 and 13].
Finalized metal-ceramic prosthesis
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F13
Furthermore, a metal-ceramic crown was fabricated and screwed onto the implant [Figures 12 and 13].
Ten years control - Periapical radiograph
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F14
In the following years, the patient was followed up annually, and bone loss in crest level remained stable, as well as the peri-implant soft tissues [Figures 14 and 15].
Ten years control - Clinical aspect
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F15
In the following years, the patient was followed up annually, and bone loss in crest level remained stable, as well as the peri-implant soft tissues [Figures 14 and 15].