PMC6304909_01
Preoperative smile view.
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A 24-year-old female patient in a good health condition without any chronic diseases reported to the Postgraduate Department of Prosthodontics, SGT University, Gurgaon, with a chief complaint of abnormal-looking upper front teeth since 10 years (Figure 1).
Preop intraoral frontal view.
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On examination, the retained deciduous maxillary right lateral incisor and canine and deciduous left canine were observed along with the congenitally missing permanent maxillary left lateral incisor (Figure 2).
Preop OPG.
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Preoperative orthopantomograph (Figure 3) and RVGs with respect to 52, 53, and 63 were taken.
Atraumatic extraction.
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After administration of local anesthesia, the procedure was performed atraumatically with the careful use of luxators (SDI ) and periotomes (Medessa ) to avoid damage of the continuity of the alveolar ridge and with anterior forceps (Figure 4) with minimal tissue damage to preserve the gingiva as well as the socket.
Root length measurements.
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The extraction sites were examined for the presence of any bony defect, and the root measurements of the extracted teeth were taken to decide the tentative implant sizes (Figure 5).
Withdrawing venous blood.
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Ten milliliters of venous blood was withdrawn from the antecubital vein of the patient (Figure 6) and immediately centrifuged (PRF Duo ) at 3000 rpm for 13 min to obtain an L-PRF clot (Figure 7).
PRF machine.
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Ten milliliters of venous blood was withdrawn from the antecubital vein of the patient (Figure 6) and immediately centrifuged (PRF Duo ) at 3000 rpm for 13 min to obtain an L-PRF clot (Figure 7).
Preparation of the L-PRF membrane.
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L-PRF membrane (Figure 8).
Apical and palatal preparation of the osteotomy site.
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The osteotomy sites were prepared on the palatal and apical aspects (Figure 9).
Palatal orientation of the osteotomy sites.
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The palatal orientation of the osteotomy sites was checked using paralleling pins (Figure 10).
PRF gel-coated implant surface.
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The implant surfaces were coated with PRF gel (Figure 11). The implants were placed in the sockets, and cover screws were placed along with the L-PRF membrane using the poncho technique.
Poncho technique.
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In this, PRF membranes were wrapped around the healing cap to favor soft tissue attachment and prevent infection and help to maintain the soft tissue profile (Figures 12 and 13).
Final implant in placement.
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In this, PRF membranes were wrapped around the healing cap to favor soft tissue attachment and prevent infection and help to maintain the soft tissue profile (Figures 12 and 13).
Temporization irt implants placed in positions of 53, 53, and 63.
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Following completion of the endodontic therapy, temporization was done wrt tooth no. 23 as well (Figure 14).
Postop OPG.
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Augmentin (625 mg) TID for 5 days and the tablet Enzoflam D TID for 3 days were prescribed. A postoperative OPG was taken, and the patient was recalled after 1 week for follow-up (Figure 15).