PMC5863393_01
Immediate after implant placement 5 months back, showed residual infection//past incident-associated bone resorption w.r.t #11
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F1
Past dental history reported Adin implant 3.75 and 13 mm was placed utilizing conventional flap technique with less primary stability and immediately intraoral periapical (IOPA)-X-ray was taken [Figure 1] followed by gingival former placement 5 months back. Prophylactic antibiotics and anti-inflammatory were prescribed.
Preoperative clinical probing at mesial, distal, labial, and palatal aspect of implant w.r.t #11 region clockwise
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F2
Intraoral examination revealed mild bleeding on probing; 3-4 mm pocket depth (PD) all around labially positioned implant w.r.t #11, but only on labial surface, 4 mm pocket with 2 mm of clinical attachment loss was present as implant threads were palpable with probe [Figure 2].
Preoperative intraoral sinus at labial attached gingiva w.r.t #11
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F3
Intraoral sinus involved labial attached gingiva [Figure 3] w.r.t #11 but no clinically visible communication was observed between sinus site and labial pocket after probing.
Mild interdental alveolar bone loss observed in intraoral periapical X-ray w.r.t #11 region
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F4
IOPA X-ray showed mild interproximal alveolar bone resorption [Figure 4]. Immediate adjacent teeth were vital on cold testing with healthy periodontium.
After full thickness flap reflection, early labial bone loss (bone dehiscence) in coronal <1/3rd with transparency of implant through rest of the body of implant along with mild interdental bone loss w.r.t #11 was observed
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F5
Full-thickness flap was reflected, and early bone dehiscence in the coronal third and transparency of implant through apical two-third labial bone was evident w.r.t #11 [Figure 5]. A noninvasive, economical parallel profile radiographic (PPRx) technique-assisted IOPA X-ray through lateral view showed labial bone regeneration w.r.t #11 [Figure 10a and b] in comparison to clinical baseline [Figure 5].
Recipient bed was prepared with surgical round carbide bur under copious irrigation on labial bone w.r.t #11 after apical two-third area debridement showed transparency of implant throughout clearly followed by mechanical and chlorhexidine-assisted decontamination at throughout implant site
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F6
Recipient bed was prepared in the apical two-third area of labial bone [Figure 6] and surgical site including implant surface was thoroughly decontaminated utilizing implant maintenance plastic curettes followed by irrigation with 0.2% CHX.
Clinically, gingiva is healthy with the excellent color match, and well-developed scalloped margin and radiograph showed no interproximal bone loss 3 months postoperatively
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F7
Crown cementation was done at 3 months postoperatively, as scalloped gingival margins, with good gingival esthetic and healed labial pocket (with gain in 2 mm of clinical attachment with 2 mm of gingival sulcus), with no interproximal bone loss was observed [Figure 7].
Clinical healing was excellent with the excellent color match with scalloped margins and thick keratinized gingiva at surgical site. Clinically labial, mesial and distal, robing depth was 2 and 5 mm, respectively, as well as intraoral periapical radiograph showed no interproximal bone loss 6 months postoperatively
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F8
Clinical healing was excellent with the excellent color match with scalloped margins and thick keratinized gingiva at the surgical site along with labial, mesial and distal probing depth was 2 and 5 mm, respectively, as well as IOPA radiograph showed no interproximal bone loss 6 months postoperatively [Figure 8].
Distal pocket reduced to 3 mm at 12 months postoperatively whereas rest of the clinical and radiographical parameters remained stationary as observed at 6 months postoperatively
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F9
All the parameters reported to be normal at 12 months postoperatively [Figure 9].
(a) 13 months postoperatively parallel profile radiographic technique-assisted intraoral periapical X-ray showed bone regeneration at labial surface, (b) (1) dentogingival unit, (2) bone thickness at crestal third, (3) midlabial, and (4) at apical labial bone
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F10
A noninvasive, economical parallel profile radiographic (PPRx) technique-assisted IOPA X-ray through lateral view showed labial bone regeneration w.r.t #11 [Figure 10a and b] in comparison to clinical baseline [Figure 5].