PMC9030314_01
(a) Intraoral view showing missing anterior tooth (b), harvesting of bone block from symphysis, (c) harvested bone block, (d) block graft fixed at recipient site using osteosynthesis screws, (e) platelet-rich fibrin preparation, (f) platelet-rich fibrin membrane
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F1
Clinical examinations showed the absence of anterior maxillary tooth [Figure 1a]. After elevating the graft from the donor site, it was stored in a mixture of saline and the patient's blood, with addition of 80 mg gentamicin [Figure 1b and c]. One or two screws of diameter 1.5 mm were used (1.5 mm x 8 mm, titanium, Orthomax) to stabilize the bone block graft at recipient site [Figure 1d]. The fibrin clot was removed with the use of a surgical pincer, then separated from the red blood cells with the use of scissors, and then compressed to be used as a PRF membrane [Figure 1e and f].
(a and b) Cone-beam computed tomography images 6 months after grafting showing increase in bone width, (c) implant placement with respect to 21 region
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F2
Cone-beam computed tomography (CBCT) scan showed an increase in bone width from 1.8 to 4.1 mm at the alveolar crest [Figure 2a and b]. The implant was provided with cover screw [Figure 2c].
(a) Intraoral periapical radiograph obtained 6 months after implant placement, (b) open tray impression coping attached to the implant, (c) impression made using open tray technique, (d) impression removed from the mouth along with coping and implant analog attached, (e) jig trial, (f) abutment attached to the implant, (g) metal-ceramic crown cemented to the implant
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F3
In the 10th postoperative month, a periapical radiograph was obtained to evaluate the osseointegration of the implant [Figure 3a]. After stabilization of gingival tissues, implant level impression was made using open tray impression coping (SKY Bredent), and a master cast was fabricated with implant body analogs [Figure 3b-d]. The metal porcelain crowns were finished and cemented on to the implants using glass ionomer cement (Gc Gold Label 1) [Figure 3e-g].
Cone-beam computed tomography images at 24 months of follow-up showing well-osseointegrated implant
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F4
Follow-up images at the end of 24 months are shown in Figure 4.