PMC7245675_01
Panoramic radiograph (a) and intraoral buccal view, showing permanent tooth absences and presence of several deciduous teeth.
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In the mandible, the patient presented all the deciduous teeth, and only permanent teeth present were #36 and #46 (Figure 1).
Preoperatory tomography of the anterior mandible region.
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This situation made impossible the placement of implants in the ideal three-dimensional position, requiring previous bone reconstruction (Figure 2).
Intraoral view of the surgery steps: (a) incision and total flap detachment, (b) cortical perforations, (c) bone substitute accommodation, (d) double layer collagen membrane, (e) single sutures, and (f) bandage (Micropore ).
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After the surgical procedure, a bandage (Micropore ) was performed to compress the surgical area to diminish possible edema (Figure 3).
Postoperatory tomography radiograph 12 months after the horizontal bone augmentation, showing new bone formation, allowing the correct three-dimensional placement of dental implants.
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Clinically, the success of the procedure was confirmed, as well as the presence of good health of the gingival tissue (Figures 4 and 5).
3D resin prototype of the appearance of the ridge before (a) and after (b) the volume increase of the alveolar ridge. There was a 5 mm gain in bone thickness.
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Clinically, the success of the procedure was confirmed, as well as the presence of good health of the gingival tissue (Figures 4 and 5).
Intraoral view of the alveolar ridge before (a) and after (b) augmentation. Removal of bone fragment using a 2.0 mm trephine for histological analysis of the grafted area (c). Six implants in place with initial torque of 35 N/cm (d).
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At this moment, a bone fragment of approximately 3 mm was removed using a 2.0 mm trephine drill in a buccolingual direction for histological analysis of the grafted area (Figure 6).
(a) Image of a grafted material interface (red arrow) and cortical bone. It is clearly shown the formation of cortical bone with osteocytes; (b) enlarged image of (a). Grafted material (red arrow). Osteocytes present in the gaps (green arrow); (c) well-formed Haversian system: note the arrangement of concentric lamellae, with the central channel of Havers (blue arrow). Osteocytes homogeneously distributed, demonstrating the usual architecture of cortical bone; (c) enlarged image of (d). In detail, the Havers channel, with endosteum (orange arrow) and red blood cells (white arrow).
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However, it could be confirmed on the clinical observation that the regenerated bone was similar to the natural bone (Figure 7).
Installation of the definitive prosthetic abutments and delivery of the temporary cemented restoration with immediate load.
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A temporary acrylic resin fixed prosthesis was installed immediately to the surgical procedure, within 24 hours (Figure 8).
Four-year follow-up CT, showing the stability of the bone tissue around the implants (a, b). Panoramic radiograph of the 4-year follow-up (c).
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Buccal view of the four-year follow-up.
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