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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 92-94

Maxillary anterior implant placement with autogenous guided bone regeneration


Department of Oral and Maxillofacial Surgery, Lady Hardinge Medical College, New Delhi, India

Date of Submission02-Dec-2020
Date of Decision03-Dec-2020
Date of Acceptance04-Dec-2020
Date of Web Publication22-Mar-2021

Correspondence Address:
Dr. Pratibha Chaudhary
Department of Oral and Maxillofacial Surgery, Lady Hardinge Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_151_20

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  Abstract 


Anterior implant placement is quite a challenge that clinicians face due to ridge deformity as it is an esthetic zone. This case report presents an innovative approach of using autogenous bone graft (ABG) to correct an atrophic ridge in conjunction with implant placement. A 23-year-old male patient lost a maxillary central incisor tooth due to trauma followed by abscess formation. Due to severe and active infection, ridge augmentation was not feasible at the time of tooth extraction, resulting in prominent loss of buccal plate. The guided bone regeneration was performed at the extracted site procuring graft from the parasymphysis region, followed by the implant placement. After 1 year of function, both clinical and radiographic examinations revealed promising and stable treatment outcomes. ABG from the parasymphysis region is a good option for ridge augmentation procedures. The only disadvantage is the second operating site.

Keywords: Bone graft, bone regeneration, dental implant, extraction, ridge augmentation, socket preservation


How to cite this article:
Chaudhary P, Mehra P. Maxillary anterior implant placement with autogenous guided bone regeneration. Indian J Med Spec 2021;12:92-4

How to cite this URL:
Chaudhary P, Mehra P. Maxillary anterior implant placement with autogenous guided bone regeneration. Indian J Med Spec [serial online] 2021 [cited 2021 Nov 29];12:92-4. Available from: http://www.ijms.in/text.asp?2021/12/2/92/311695




  Background Top


Tooth extraction is followed by marked bone resorption and within first 6 months of extraction, alveolar ridge loses its height and width by ≥50%.[1],[2] However, such remodeling could jeopardize the subsequent implant placement for two main reasons: first, the insufficient bone levels makes implant placement impossible and second, esthetic problems. Thus, to maintain the bone volume necessary for the optimal functional and esthetic outcome of a dental implant, ridge preservation is the need of hour.

Literature has reported alveolar ridge preservation using autogenous, allogeneic, xenograft, and alloplast graft materials.[3],[4],[5] For most favorable results, an ideal bone graft should have the properties of osteoconduction, osteoinduction, and osteoproliferation. Out of all the available options, allografts, xenografts, and alloplasts demonstrate only osteoconduction (except demineralized freeze-dried bone allograft which is osteoinductive), whereas autogenous bone possesses all three properties; thus, it is still considered as the gold standard.[6]

This case report describes a novel approach of performing a guided bone regeneration (GBR) using autogenous bone graft (ABG) in preserving alveolar ridge dimensions in maxillary aesthetic zone of a young patient who is under social inhibitions [Figure 1].
Figure 1: (a) Pre-operativeE, (b) Post-operative

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  Clinical Presentation Top


A 23-year-old male with a noncontributory medical history presented with nonrestorable tooth 12 was referred to us. The patient's chief complaint was absence of the front tooth due to which he was hesitant in smiling; clinical examination showed that 12 presented a mesio-distal vertical fracture. The tooth was deemed hopeless and advised for extraction [Figure 2]. Written informed consent was obtained from the patient prior to treatment, during the extraction procedure buccal bone was fractured. The bone defect was classified as Seibert Class ll. In detail, treatment was planned and referring to parameters cited; the decision was taken to fill the extraction socket with ABG. As the buccal bone fractured, it was impossible to place the implant, so the GBR procedure was performed by procuring ABG from the parasymphysis region followed by the placement of the barrier membrane, and after 6 months, implant was placed.
Figure 2: (a) Mesio-distal fracture, (b) cone-beam computed tomography scan shows a thin buccal plate

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  Case Management Top


The GBR procedure was performed on the patient via a flap approach under antisepsis and localized anesthesia [Figure 3]. With the number 15 blade, a horizontal incision was given on the crestal buccal mucosa inclined toward the palatal side and the buccal flap was opened with the help of a periosteal elevator. The defect was debrided with a curette and irrigated with saline to remove granulomatous tissue if any. The second operating site was prepared that is parasymphysis by infiltrating local anesthesia. Once the area was anesthetized, a horizontal incision was given in the vestibule from mesial aspect of 32 to distal aspect of 42, and the flap was raised with periosteal elevator. The trephine bur was used with micromotor handpiece attachment to procure the graft in Olympic ring fashion. The graft was collected in the sterilized bone well, and then with the help of bone crusher, bone pieces were squeezed out.[7] The graft was placed and stabilized with the resorbable membrane and secured with Mersilk sutures. Antibiotics (500 mg amoxicillin, every 8 h) and acetaminophen (650 mg, SOS) were prescribed for 7 days. After uneventful healing for 4 months, reentry was performed for implant placement. An intact buccal bony wall was successfully regenerated at site #12, covering all the defects. The implant (Adin) and cover screw was placed at 12th region (3.2 mm × 10 mm implant) with good primary stability, and finally, after 6 months, the patient was recalled for second-stage surgery. The site was sutured after placement of healing abutment. Pain relief medication (acetaminophen, 650 mg) was given as needed.
Figure 3: Surgical procedure. (a) Defect in 12 region, (b) Trephine bur impressions, (c) bone graft collected, (d) membrane stabilized, (e) sutures placed

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  Clinical Outcomes Top


Implant was stable at the time of crown delivery [Figure 4]b. Radiographs and cone-beam computed tomography (CBCT) [Figure 4]a and [Figure 4]c revealed favorable bone regeneration and successful implant outcome with the absence of peri-implant defects at the 1-year follow-up [Figure 4]d and [Figure 4]e. The patient is being followed up.
Figure 4: Implant placement. (a) Cone beam computed tomography scan after 4 months, (b) implant placed, (c) intraoral periapical just after implant placement, (d) Prosthesis placed, (e) Intraoral periapical 1 year postoperative

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  Discussion Top


The use of bone grafts for reconstructing osseous defects dates back to Hegedus in 1923 when the tibia was used as the source of graft for treatment of periodontal defects. ABGs are considered as the “gold standard” by many authors due to their multiple advantages over other graft materials available.[8] They can be obtained from both extraoral and intraoral sources. Although extraoral ABGs from iliac cancellous bone and marrow were of high interest due to their high potential for true osteogenesis,[9] ankylosis and root resorption (2.8%) have been reported with their use, which has limited their clinical use. Therefore, intraoral sources provide a better alternative. Common donor sites include the symphysis, ramus, and body of mandible; the coronoid process; the maxillary tuberosity; the zygomatic buttress, bone from healing extraction wound and edentulous ridges; bone trephined from within the jaw without damaging the roots; bone removed during osteoplasty and ostectomy (tori, exostoses); and scraped bone.

ABGs have shown improved results in bone fill in periodontal osseous defects and bone augmentation procedures for implants. They have been used as a GBR material for implant stabilization and in treatment of peri-implantitis. Al-Sulaimani et al. showed that the filling of the peri-implant bone defects with ABGs showed a better outcome compared to unfilled defects.[8] Pandit et al. reported an improved prognosis of hopeless teeth when treated with ABG.[9] Verdugo and D'Addona described a successful resolution of bilateral mandibular vertical defects on both molars and premolars and the eradication of subgingival periopathogens by the use of ABG.[10]

The major limitation of ABGs is the limited availability of bone graft and increased chairside time. With the advancement in commercially available trephine burs, these limitations can be successfully overcome and autogenous grafts can be used widely for better results. CBCT scan being three dimensional in nature has helped us to evaluate changes in alveolar bone in all possible dimensions and measure them precisely.


  Conclusion Top


This case report presents maxillary anterior implant placement using autogenous GBR in case where there is total destruction of buccal bone.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 2005;32:212-8.  Back to cited text no. 1
    
2.
Araujo MG, Wennstrom JL. Modeling of the buccal and lingual bone walls in fresh extraction sites following implant installation. Clin Oral Implants Res 2006;17:600-14.  Back to cited text no. 2
    
3.
Iasella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: A clinical and histologic study in humans. J Periodontol 2003;74:990-9.  Back to cited text no. 3
    
4.
Lekovic V, Camargo PM, Klokkevold PR, Weinlaender M, Kenney EB, Dimitrijevic B, et al. Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. J Periodontol 1998;69:1044-9.  Back to cited text no. 4
    
5.
Ten Heggeler JM, Slot DE, Van der Weijden GA. Effect of socket preservation therapies following tooth extraction in non-molar regions in humans: A systematic review. Clin Oral Implants Res 2011;22:779-88.  Back to cited text no. 5
    
6.
Nampo T, Watahiki J, Enomoto A, Taguchi T, Ono M, Nakano H, et al. A new method for alveolar bone repair using extracted teeth for the graft material. J Periodontol 2010;81:1264-72.  Back to cited text no. 6
    
7.
Zaner DJ, Yukna RA. Particle size of periodontal bone grafting materials. J Periodontol 1984;55:406-9.  Back to cited text no. 7
    
8.
Al-Sulaimani AS, Mokeem SA, Anil S. Peri-inplant defect augmentation with autogenous bone: A study in beagle dogs. J Oral Implantol 2013;39:30-6.  Back to cited text no. 8
    
9.
Pandit N, Pandit IK, Malik R, Bali D, Jindal S. Autogenous bone block: A hope for hopeless teeth. Contemp Clin Dent 2012;3:437-42.  Back to cited text no. 9
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10.
Verdugo F, D′Addona A. Long-term stable periodontal regeneration by means of autologous bone grafting in patients with severe periodontitis. Int J Periodontics Restorative Dent 2012;32:157-64.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
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