PMC6893273_01
(a) Pretreatment intraoral photographs (April 2004). Generalized inflammation is observed, particularly between tooth #11 and tooth #12, where a fistula is present. (b) Pretreatment periodontal chart. Teeth #11, #12, #16, #21, and #22 were evaluated as "hopeless"; #46 and #47 were "poor" (PPD: periodontal probing depth; G: good; F: fair; Q: questionable; P: poor; H: hopeless, red: bleeding). (c) Pretreatment radiographs. Thirteen dental X-ray films show severe bone loss in the maxillary anterior and mandibular right molar regions.
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Pathologic tooth migration was observed in teeth #11 and #12 (overjet 5 mm, overbite 7 mm) (Figure 1(a)). Sixty-one percent of the teeth had a deep periodontal probing depth (PPD) over 4 mm (PPD >= 4), 61% had bleeding on probing (BOP) (Figure 1(b)), and all teeth scored 100% on O'Leary's plaque control record. Radiographic examination revealed periodontal tissue destruction, generally with 3 to 5 mm of horizontal bone resorption and 4 to 6 mm of vertical bone resorption in teeth #16, #14, #26, and #46 (Figure 1(c)).
Reevaluation radiographs. Panoramic radiography revealed partially edentulous maxilla and mandible.
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Root canal treatment was performed for the distal root of tooth #46; while the medial root was prognosed to be impossible to preserve due to furcation involvement, trisection was adopted (Figure 2).
Clinical situation at the delivery of prosthetic rehabilitation: (a) at #12 and #22, (b) at #16, (c) at #41, (d) at #36, and (e) postoperative radiographs.
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All custom abutments and porcelain-fused-to-metal crowns were retained with side screws (Figures 3(a)-3(e)).
Composite resin was built up on palatal aspect of both canines: (a) setup model and (b) posttreatment.
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In addition, the palatal surface at sites #13 and #23 was adjusted, molding both in composite resin, to obtain disclusion during lateral movement, according to the pretreatment setup model (Figure 4).
(a) 12-year postoperative intraoral photographs (April 2016). Intraoral view after completion of care. The gingival texture and peri-implant mucosa appear healthy. (b) 12-year postoperative periodontal chart. Prognoses ranged from "fair" to "good" (PPD: periodontal probing depth; yellow: implant). (c) 12-year postoperative radiographs. Posttreatment radiographs suggest improvement of the severe bone resorption lesions. No bone resorption is seen around the five implants.
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We did not observe inflammatory signs such as redness, swelling, pus, or other dysfunctions in the peri-implant mucosa during the maintenance period (Figure 5(a)). Periodontal pockets have been maintained with less than 3 mm PPD and below 10% BOP in natural teeth (Figure 5(b)). No pathological finding of remodeling surrounding implants was recognized on radiographic examination (Figure 5(c)).