Abstract
The main requirement for the insertion of dental implants is a good bone and gum condition and guided bone regeneration (GBR) combines grafts and membranes to increase such parameters in tissue deficiencies and thus achieve treatment success. This clinical case reports the oral rehabilitation of the anterosuperior area by the association of bone graft, autologous membrane and implantodontic therapy. Female patient, 45 years old, normosystemic, reported aesthetic complaint and implant mobility in the maxilla. Upon clinical and radiographic examination, an implant was diagnosed in the region of tooth 11 with unfavorable esthetics, mobility, inadequate prosthesis and bone loss, and tooth 22 with suppuration, fracture line and periapical radiolucency. The treatment consisted of removal of the implant and tooth 22, with immediate GBR using filling with Bio-Oss® and liquid leukocyte- and platelet-rich fibrin (L-PRF) and coating with L-PRF membrane. After 7 months, the second GBR was performed with the installation of 2 dental implants. After 6 months, healers were placed and 20 days after the adaptation of the provisional implant-supported single prostheses. There was a good gain in thickness and mucogingival limit, bone dimensions in height and thickness, and the case continues to be followed up until the final prosthesis is completed. This case suggests that sticky bone and L-PRF membrane can contribute to multiple GBR in the anterior maxillary region, favoring bone gain and osseointegration.
Highlights
The harmony of the smile in the anterior region of the edentulous maxilla or with an indication for dental extraction challenges the dentist, who seeks the integrity of the support structures for the satisfactory placement of osseointegrated implants and dental prostheses on the implants (Souza et al, 2015)
Whether for technical or physiological reasons, the failure of a dental implant, which needs to be removed or is lost, is another complication that must be diagnosed in time to avoid continuous alveolar bone loss and great aesthetic damage, with a relationship between early failures and overheating, contamination, surgical trauma, low bone quantity or quality, lack of primary stability and indication of incorrect immediate loading, while late failures would result from periimplantitis, occlusal trauma and overload (Levin, 2008)
The aim of this study was to report a clinical case of oral rehabilitation of the anterior maxillary region by the use of guided bone regeneration, by the association of mixed bone graft and autologous membrane, combined with implantodontic and prosthetic therapy
Summary
The harmony of the smile in the anterior region of the edentulous maxilla or with an indication for dental extraction challenges the dentist, who seeks the integrity of the support structures for the satisfactory placement of osseointegrated implants and dental prostheses on the implants (Souza et al, 2015). Whether for technical or physiological reasons, the failure of a dental implant, which needs to be removed or is lost, is another complication that must be diagnosed in time to avoid continuous alveolar bone loss and great aesthetic damage, with a relationship between early failures and overheating, contamination, surgical trauma, low bone quantity or quality, lack of primary stability and indication of incorrect immediate loading, while late failures would result from periimplantitis, occlusal trauma and overload (Levin, 2008). In a Brazilian sample of 166 patients, there were higher failure rates of grafts and implants in the anterior region of the maxilla (2.4% and 2.6%, respectively) and in patients older than 40 years (Salmen et al, 2017)
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