PMC8612795_01
(a) Frontal area of the upper jaw. (b) After removal of metal-ceramic crowns. (c) Periapical X-ray of the tooth 11.
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fig1
An excess of root filling material was detected beyond the apex (Figure 1).
(a) Situation after tooth extraction. (b) Extracted tooth 11.
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Atraumatic extraction of the tooth was implemented (Figure 2).
(a) Insertion of Bio-Oss collagen in a dry form. (b) The alveolus is completely packed with the material. (c) A resorbable membrane is laid, and stabilizing sutures are applied.
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fig3
The bone-substitute material was covered with a Bio-Gide native resorbable collagen membrane (Geistlich Pharma AG), which was fixed by Prolene monofilament 6-0 cross suture (Ethicon W8005, Johnson & Johnson) (Figure 3).
(a, b) 4 months after the operation. (c) After the removal of the temporary appliance, a change in the contour of the crest in the vestibular-oral direction.
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fig4
However, soft tissue deficiency was found in the area of the 11 tooth socket on the vestibular surface (Figure 4).
(a) The mucoperiosteal flap is detached. (b) The implant bed preparation. (c) The implant placement.
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Tech dental implant (Dentsply Sirona, York, Pennsylvania) 3.5 x 11 was placed at the site of the extracted tooth 11. The implant insertion torque was 35 N/cm; the implant stability quotient (ISQ) value was 60 (Figure 5).
(a) Fixation of free connective tissue grafts from the maxillary tuberosity. (b) Final suturing.
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(a) Appearance of the alveolar crest 14 days after surgery. (b) 3 months after surgery.
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However, at 3 months postsurgery, the soft tissue volume of the vestibular surface was not sufficient (Figure 7).
(a) Deepithelization of the free connective tissue graft from the hard palate. (b) Projection of the graft on the formed tunnel from the vestibular surface. (c) The graft is placed in the formed bed; the wound is sutured.
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fig8
After that, healing abutment was performed; simple interrupted sutures were applied (Ethicon W8005, Johnson & Johnson) (Figure 8).
(a) Condition of soft tissues at the beginning of the prostheses stage. (b) Fixation of the individual zirconium abutment. (c) Final restoration.
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fig9
Paul, MN, USA) using a rubber dam (Figure 9).
(a) 7 years after the treatment. (b) Stable volume of bone tissue.
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The soft tissues were completely healthy at the follow-up time (Figure 10).