PMC5078642_01
Panoramic radiograph at the initial appointment (#30 was extracted by the referring dentist).
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fig1
Tooth #30 had previously been extracted due to a combained periodontic-endodontic lesion (Figure 1).
Preoperative views: (a) intraoral; (b) periapical radiograph.
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fig2
The patient elected to follow through with implant therapy for #30 with a single implant-supported crown (Figure 2).
Guided bone regeneration procedure was performed on the erratic extraction site (a-f). After a full-thickness flap was elevated, granulation tissue was noted filling the previously extracted site (a and b). Following thorough debridement and irrigation, the site was determined to be a containable defect (c). FDBA was gently packed in the socket and covered with non-cross-linked collagen membrane (d and e). Complete primary closure was achieved with a combination of horizontal mattress and single interrupted sutures (f).
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fig3
Primary closure of the site was obtained with single interrupted and horizontal mattress sutures, using 4-0 Cytoplast suture material (Figure 3).
The removed specimen and histopathological picture (H&E stain). Approximate 5 x 5 x 3 mm elastic hard granulation tissue was removed from the erratic extraction site (a). Fibrous connective tissue with inflammatory cells infiltration (b).
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fig4
The diagnosis given was residual chronically inflamed granulation tissue with fibrous connective scar tissue (Figure 4).
Implant placement five months after the graft procedure. The erratic healing extraction site showed increased radioopacity five months after the bone graft surgery (a). Bone fill was found on the crestal portion of the site (b). Implant was placed at a restoratively driven position (c).
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fig5
A Zimmer implant 4.7 x 11.5 (D x H) was placed with insertion torque of 35 N/cm (Figure 5).
One-year follow-up after crown delivery. There is no evidence of inflammation or symptoms (a). Crestal bone loss or typical retrograde peri-implantitis was not noted on the periapical radiograph (b).
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fig6
Radiograph and clinical features showed soft and hard tissue stability at one year following crown delivery, without any symptoms or radiographic evidence of retrograde peri-implantitis (Figure 6).