PMC4238035_01
Pre-operative intraoral examination (a). Teeth 46 an 47 are
lacking (b).
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The patient was missing teeth 46 and 47 (Fig. 1a, 1b); clinical and radiographic examination revealed a severe vertical defect of the corresponding alveolar ridge (Fig. 2).
Flap preparation. Mental nerve isolation (a) and alveolar
ridge exposure (b).
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On the buccal side, the inferior mental nerve was isolated, and the flap was released with a horizontal periosteal incision to provide passive adaptation (Fig. 3a, 3b).
Flap preparation. Lingual flap isolation (a); the mylohyoid
muscle insertion is removed and flap released (b).
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On the lingual side, the flap was elevated until reaching the mylohyoid line (Fig. 4a). The blunt instrument was therefore positioned below the connective band, and with gentle traction in the coronal direction, the muscular insertion was detached from the lingual flap (Fig. 4b).
Implant-like pin in position.
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Implant, Biotec BTK, Italy) was placed (Fig. 5). Its platform on the ideal line was located 2 mm below the cementoenamel junction (CEJ) of the adjacent teeth but 2.5 mm above the alveolar ridge because of the vertical bone defect in the first molar region (Fig. 6).
Positioned dental implant with a cower screw on it in frontal
(a) and occlusal (b) views.
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Implant, Biotec BTK, Italy) was placed (Fig. 5). Its platform on the ideal line was located 2 mm below the cementoenamel junction (CEJ) of the adjacent teeth but 2.5 mm above the alveolar ridge because of the vertical bone defect in the first molar region (Fig. 6).
Positioning of the high density d-PTFE titaniumreinforced
membrane to cover the grafted site. Heterologous porcine-
derived biomaterial positioned to fill the peri-implant defect
and to support the membrane (a); note the series of holes on the
vestibular surface performed to induce bleeding and trigger bone
regeneration. Definitive membrane fixing (b).
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To obtain profuse bleeding from the marrow of the bone graft recipient sites, a series of holes were drilled on the vestibular and crestal bone surfaces in zone 46, using a round bur with a diameter of 1.2 mm (Fig. 7a, 7b).
Post-surgical endoral x-ray showing the correct implant
positioning and bone defect restoration.
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Radiographic examination was performed to verify correct implant positioning and bone- defect restoration (Fig. 8).
Second surgery showing the membrane retrieval (a) and
the uneventful healing of the recipient site (b).
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The screws were removed, and the membrane was retrieved (Fig. 9a, 9b, 10a).
The uneventful healing of the recipient site (a). Histological
analysis of the biopsy collected at the regenerating site
showing the presence of acidophilic bone tissue in close contact
with basophilic graft material and no fibrous tissue interposition.
Osteocytes in the lacunae indicate that the acidophilic tissue is
newly-formed vital bone (b).
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The screws were removed, and the membrane was retrieved (Fig. 9a, 9b, 10a). After hematoxylin-eosin staining, slides were observed under an optical microscope with transmitted light to analyze bone tissue and assess bone formation at the grafted site (Fig. 10b).
Single-crown definitive restoration in frontal (a) and
occlusal (b) views.
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A single-crown definitive restoration was delivered 1 month (Fig. 11a, 11b).
Follow-up x-ray at 1-month.
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Follow-up radiographs were taken at 1, 12, and 24 months after prosthesis delivery (Fig. 12, 13, 14).
Follow-up x-ray at 12-months.
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Follow-up radiographs were taken at 1, 12, and 24 months after prosthesis delivery (Fig. 12, 13, 14).
Follow-up x-ray at 24 months displaying the stable maintenance
of the peri-implant bone tissue levels and no sign of bone
resorption.
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Follow-up radiographs were taken at 1, 12, and 24 months after prosthesis delivery (Fig. 12, 13, 14).