Dr Dima Cosmin
Title : Tridimensional Reconstruction of the Bone and Soft Tissue Improvement in Challenging Cases of the Esthetic Zone.
INTRODUCTION AND BACKGROUND
– 47 years old female patient presented at our practice in September 2015 with shocking precedent in dental trauma caused historically in various dental practices. The case study revealed both functional and aesthetic issues given by multiple extractions which have caused, during the years, major bone loss and huge gingival recession defects. She accepted the proposed treatment consisting in 8 implants (12, 13, 23, 25, 35, 37, 44, 47), bone augmentation, soft tissue preservation and development ( CTG and Roll Flap), which are paramount to long term success in achieving the best natural aesthetic and functional outcome, both vital to patients satisfaction.
MEDICAL HISTORY
– No known drug allergies, nonsmoker, no medications
DENTAL HISTORY
– The patient did not went for a dental check-up for 5 years and she no longer had confidence in dentists due to old experience in dental practice
PERIODONTAL DIAGNOSTIC FINDINGS :
– Oral hygiene: good, less than 10% of tooth surfaces with plaque
TREATMENT GOAL :
– Functional and aesthetic rehabilitation, bone augmentation, soft tissue management, preservation and development, surgical strategy in implant placement and long term stability.
– Explore different possibilities of functional and aesthetic rehabilitation in conditions of bone resorption and high gingival recessions.
SURGICAL TREATMENT :
– The exposed root surface of tooth 23 was scaled. No vertical incisions were made. The gingiva was elevated on both sides of the recession using MB69 micro-blade and tunneling instruments fallowed by mucosal detaching. The second step was to harvest a sub-epithelial connective tissue graft from the palatal mucosa (Fig.8). The area extended from the mesial aspect of the left first premolar to the mesial aspect of the left first molar. The single-incision technique was used to remove the graft and the palatal site was stitched with single sutures (Fig.9). The graft was positioned under the flap and over the exposed root surface of tooth 23 and secured with 6/0 PTFE sutures (Fig.10, Fig.11). The next stage of the treatment included implants Mis Seven insertion on the position of 12 and 13 (Fig.12), bone augmentation (Fig.13) and soft tissue management covered by two layers of collagen membrane (Fig.14). The healing process was uneventful on both left and right sides. Immediate aesthetic results were observed, full coverage of the recession (Fig.16) , a gain of keratinized tissue and horizontal and vertical bone volume on the right side (Fig.16, Fig.18). After 3 months, the root 23 was extracted and the patient received a conical connection implant Mis C1 (Fig.19) covered by a collagen sponge (Fig.20) and a Mis SEVEN implant on the position of 25 (Fig.21), then a roll flap was used to increase the aesthetic outcome in the right lateral incisor and canine (Fig.22). The final impression for 17 dental crowns and 8 implant crowns, was taken with Impregum soft polyether material in an open tray using 8 Mis copings. Implant restorations in the frontal maxillary area and not only, offer a challenge in terms of both functionality and aesthetics outcome. The essential goal of the treatment was achieving a final functional result and as aesthetic as possible for the this patient (Fig.25, Fig.27).
CONCLUSION :
– Even in situations with bone loss and high gingival recessions, aesthetic and functional outcomes can be achieved using well designed implants if bone regeneration and soft tissue management are managed properly and the materials used are suitable to the clinical situation.
