Dr Serhat Aslan
Reconstructive periodontal-plastic surgery around implant: Correction of treatment errors
This systemically healthy, non-smoker young lady received an implant treatment for 11 and reported several attempts for the coverage of mucosal dehiscence. Her complaints were bleeding and unesthetic appearance. She was willing to maintain the implant fixture.
Following the evaluation of the initial radiograph, it was quite obvious that the prosthetic components of the implant were not fitting and unfortunately, crowns were splinted. Also, implant placement was too deep. Bleeding on probing was positive.
Following the local anaesthesia, crown was separated and removed. Then, bone sounding confirmed the presence of the buccal bone. In this session, correct abutment seating was performed and confirmed with the radiograph. Implant site left for soft tissue healing. After 8-weeks of soft tissue healing, connective tissue graft (CTG) surgery was planned with envelope type, oblique rotated papilla flap using submarginal incisions. A split-full-split approach provided adequate mobility to mucosal flap. Coronal portions of submarginal incisions were de-epithelialized. CTG was harvested with de-epithelization technique. To compensate the mucosal defect and dehiscence, CTG was double-folded and sutured with resorbable suture material prior to fixation sutures. CTG was fixed buccally, embracing the abutment surface. Passive, tension-free mucosal flap was coronally advanced and sutured.
Early wound healing and increase in buccal mucosal thickness were satisfactory. Three months after the periodontal-plastic surgery, patient reported a fistula in the apical region of tooth no. 21. Probing depth measurements were 2-3 mm. Due to the misfitting crown, heavy post and excessive forces, an apical fracture was evident. Possible outcomes of the tooth extraction were explained to the patient. If possible, she decided to receive an immediate implant with provisional in the presence of buccal bone plate.
After the tooth extraction, apical granulation tissue was carefully removed under magnification and illumination. Drilling of palatal bone provided primary stability and provisional restoration was fabricated. To protect the buccal contour, remaining gap between the buccal bone plate and implant was grafted with demineralized bovine bone mineral. Provisional restoration was tightened onto the implant at a torque of 15 Ncm.
After 6-month of healing, provisional restorations were removed and customized abutments were placed. Case was finalized with lithium disilicate crowns for the implants and laminate veneers for lateral incisors (Prosthetic work: Prof. Dr. Erhan Comlekoglu).
