PMC5925184_01
Radiograph of tooth #3 showed periapical radiolucency on the mesial buccal root.
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The dental history of tooth #3 revealed periapical radiolucency in 2013, on the mesial buccal root (Figure 1), measuring ~5.4 x 8.7 mm in a cone beam CT (Figure 2).
A cone beam CT of tooth #3 in 2013 showed periapical radiolucency of the mesial buccal root (~5.4 x 8.8 mm).
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The dental history of tooth #3 revealed periapical radiolucency in 2013, on the mesial buccal root (Figure 1), measuring ~5.4 x 8.7 mm in a cone beam CT (Figure 2).
Intraoral picture of tooth #3 at the time of tooth extraction. A draining fistula was noted on the distal surface of #3.
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Freeze-dried bone allograft (FDBA), a collagen membrane, and a nonresorbable high density PTFE membrane were used for ridge preservation and grafting of the buccal plate of area #3 (Figures 3-5).
Intraoral picture of the extraction site of #3. The buccal plate showed horizontal deficiency. The nonresorbable high density PTFE membrane was placed on the lingual aspect of #3.
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Freeze-dried bone allograft (FDBA), a collagen membrane, and a nonresorbable high density PTFE membrane were used for ridge preservation and grafting of the buccal plate of area #3 (Figures 3-5).
The collagen membrane was placed on the buccal aspect to cover the grafted buccal plate. The nonresorbable high density PTFE membrane was placed on the lingual aspect to cover the grafted socket.
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Freeze-dried bone allograft (FDBA), a collagen membrane, and a nonresorbable high density PTFE membrane were used for ridge preservation and grafting of the buccal plate of area #3 (Figures 3-5).
A periapical radiograph 3 months after the extraction and ridge preservation showed no signs of residual pathology.
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A periapical X-ray was taken with the surgical guide before the implant placement, showing no residual radiographic pathology (Figure 6).
The site of #3, 3 months after the ridge preservation showed complete epithelization.
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The implant was torqued in 35 N/cm, and a healing abutment was placed (Figures 7-9).
A 4.7/11 mm endosseous implant was placed at site #3 with the use of osteotome sinus floor elevation technique.
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The implant was torqued in 35 N/cm, and a healing abutment was placed (Figures 7-9).
The implant was torqued in 35 N/cm, and a healing abutment was placed. The site was sutured with three 5-0 chromic gut single-interrupted sutures.
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The implant was torqued in 35 N/cm, and a healing abutment was placed (Figures 7-9).
A periapical radiograph was taken after the implant placement. Bone condensation is noted apical to implant #3 due to the use of the osteotome sinus floor elevation technique. Mesial of #2, a deep unrestorable decay was observed.
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fig10
The implant was referred to the predoctoral clinic for final restoration with cement-retained porcelain fused to metal (PFM) crown (Figure 10).
The same protocol of extraction, ridge preservation and subsequent implant placement, was followed successfully for site #2. The implant at site #3 did not show any signs of infection or inflammation, radiographically nor clinically.
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The same surgical and restorative approach was uneventfully followed for site #2, as well (Figure 11). The patient was given an occlusal stabilization splint and was placed on a 6-month maintenance protocol in 2014.
The patient presented at the day of surgical debridement of site #3 with a nondraining fistula at the same site where the fistula was noted before the extraction of #3. The picture is taken after the intrasulcular incisions were performed, with the use of a 15c blade.
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The patient presented for surgical implant debridement with a nondraining fistula (Figure 12) in July of 2016.
A periapical radiograph on the day of surgical debridement showing a 5 x 5 mm lack of bone density around the implant apex.
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The site #3 implant showed ~5.5 mm lack of radiographic bone density around the apex (Figure 13).
Following reflection of full thickness mucoperiosteal flap, a fenestration of 2 x 2 mm width and 7 mm depth was revealed.
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fig14
Upon reflection of a full thickness flap, a fenestration of 2 x 2 mm and 7 mm depth was revealed around the apex of implant #3 (Figure 14).
The air powder flow was used to decontaminate the implant surface.
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The implant surface was initially decontaminated utilizing an air-abrasive device with amino acid glycine powder avoiding direct contact with the implant surface and copious amounts of sterile saline to remove the powder from the implant surface and bone defect (Figure 15).