PMC9681553_01
The patient had been diagnosed with aggressive periodontitis 4 years ago. Teeth #16 and #26 were severely compromised with bone loss to the apical third of root. (a) Intraoral photographs. (b) Periapical radiographs.
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The alveolar bone of teeth #16 and #26 was resorbed to the apical third of root so that both teeth were rated as hopeless (Figure 1).
Tooth #16 acquired periodontally healthy status after active periodontal treatment. (a) Before periodontal treatment. (b) After 3 months of initial periodontal treatment (IPT) and supportive periodontal treatment (SPT). (c) After 5 months of IPT and SPT. (d) After 7 months of IPT and SPT. (e) After 10 months of IPT and SPT, a remittent status was acquired before the surgery.
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After the gingiva turned pink and firm without bleeding upon probing or deepening pocket (Figure 2), the periodontal status was improved to a remittent level, and MSFE was performed on tooth #16.
CBCT and pantomograph follow-up for tooth #16. (a) Before MSFE. (b) Immediately after MSFE (pantomograph). (c) 3 months after MSFE. (d) 10 months after MSFE. (e) 15 months after MSFE. (f) 26 months after MSFE. (g) 35 months after MSFE.
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Only 1-2 mm of available bone height was observed, indicating LSFE before implant placement (Figure 3(a)). Little resorption (less than 2 mm of height) of bone substitute was observed (Figures 3 and 8).
The process of the modified lateral sinus floor elevation. (a) Access window on the lateral wall. (b) Grafting materials at the sinus floor. (c) Collagen membrane covering access window. (d) Suturing.
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Interrupted sutures were created using non-absorbable suture material (PROLENE 4-0, Ethicon, Somerville, NJ, USA; Figure 4).
The process of implant placement. (a) Before the extraction. (b) The extracted teeth. (c) Immediate placement of implant.
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Thus, the site was rated ready for a dental implant (Table 1 and Figure 5(a)). Finally, the implant was covered with a healing abutment and sutured with non-absorbable sutures (PROLENE 4-0, Ethicon; Figure 5).
Periapical photographs follow-up for tooth #16. (a) Immediately after implant placement. (b) 5 months after implant placement. (c) 17 months after implant placement. (d) 26 months after implant placement.
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To double-check the implant position, post-operation periapical radiographs using the paralleling technique were taken (Figure 6(a)). After nearly 3 years of loading, both implants are in good condition without obvious sign of peri-implantitis or mobility (Tables 1 and 2; Figures 6 and 10).
The process of delivering the superstructure.
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The superstructure was fixed on the implant with torque of 35 N cm one month after the impression-taking, and postoperative instructions including oral hygiene care were given to the patient (Figure 7).
CBCT and pantomograph follow-up for tooth #26. (a) Before MSFE. (b) Immediately after MSFE (pantomograph). (c) 3 months after MSFE (pantomograph). (d) 7 months after MSFE. (e) 14 months after MSFE. (f) 20 months after MSFE. (g) 32 months after MSFE.
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It revealed that the residual bone height remained about 1-2 mm (Figure 8(a)). Little resorption (less than 2 mm of height) of bone substitute was observed (Figures 3 and 8).
Visual analog scales (VAS) for discomfort were distributed to patient at 6 months after MSFE and immediately after crown placement.
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The VAS was recorded as 2 at 6 months after MSFE, while the score was recorded as 10 on the opposite side (Figure 9).
Periapical photographs follow-up for tooth #26. (a) Immediately after crown placement (5 months after implant placement). (b) 19 months after implant placement. (c) 28 months after implant placement. (d) 34 months after implant placement.
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After nearly 3 years of loading, both implants are in good condition without obvious sign of peri-implantitis or mobility (Tables 1 and 2; Figures 6 and 10).
Histological evaluation of tooth #16. (a) The biopsy sample. (b) Representative section stained with hematoxylin-eosin (H&E) (x10). (c) Representative section stained with modified Mallory aniline blue (x20). Newly formed bone (asterisk), nonvital bone (star), blood marrow (diamond), bone lining cells (arrowhead), and an osteoclast (arrow) are visible.
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On the MSFE side, scores were 3 for vital bone, 3 for mature newly formed bone, 2 for osteoblasts, 1 for osteoclasts, and 4 for bone marrow (Figure 11).