PMC5093866_01
Badly carious lower left second premolar, with chronic periodontal lesion.
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When the patient was examined clinically, a badly carious tooth with a 5-mm swelling buccally Fig. (1) and grade I tooth mobility was found with mild tenderness to percussion.
Conservative tooth extraction start with luxator to cut the periodontium and make tooth mobility.
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Fig. (2). Finally, a lower forceps was used to remove the tooth without trauma.
With microsurgery instrument, pouch was tried to be done around the buccal bone defect. inter dental papillae also tried to be reflected to allow the insertion collagen membrane under the mucoperiosteum and the bone.
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Using a scalpel, a small pouch was created between the bone and the gingiva, which will allow the periosteal elevator to reflect the gingiva around the defect for placement of the collagen membrane Fig. (3).
Collagen membrane was shaped to fit the defect with at least 1mm of membrane siting on sound bone to prevent membrane collapse into the socket. The shape of the membrane look like "ice man". The lower part covering the defect site of the socket while the head covering the top of the socket and the grafting material.
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The membrane was shaped according to the shape of the bone defect; in this case, it was shaped like an "Ice Man" Fig. (4).
Collagen membrane placed above the bone and under the mucogingival tissue, to cover buccal bone defect before bone graft placement.
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The membrane was placed above the bone and below the gingiva, and the membrane was confirmed to be resting on the remaining buccal bone plate Fig. (5).
Bovine bone graft was placed in the socket after mixed with saline. The graft particle placed in layers and without heavy condensation.
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Bovine bone (Cerabone, Botiss, Berlin, Germany) was mixed with saline and applied in layers inside the socket without packing until reaching the bone level Fig. (6).
After 6 months healing we can observe buccal wall resorption and decrease in the depth of the vestibule.
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Vicryal suture 4/0 was used to secure the membrane in place with a Fig. (8) suture Fig. (7). There was mild buccal plate resorption and shallowing of the buccal vestibule Fig. (8).
Implant placed with sufficient buccal bone thickness around the implant.
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The implant was placed with more than 45 Ncm torque with high primary stability Fig. (9).