Abstract

  Vertical regeneration of resorbed alveolar ridges in aesthetic areas is a challenging procedure with several anatomic limitations. To allow immediate implant placement with less interference in tissue aesthetics, detailed planning is needed. A few methods of bone reconstruction have been suggested to be performed simultaneous with implant placement, for example given in fresh extraction sockets, guided bone regeneration ensures bone formation in the peri-implant spaces and function as a framework for tissue remodeling. Combining the use of a resorbable membrane as a barrier during tissue regeneration, dehiscences are prevented, and buccal bone resorption is reduced more effectively. In the present case report, a male patient presented with severe root exposure in the anterior region of the maxilla due to post-traumatic resorption of the buccal plate. The study aimed to demonstrate the use a technique of association between pedicled roll flap and interpositional bone graft with the objective of making the bone resorption region uniform in a single procedure and improving the aesthetic results. After opening an intrasulcular flap with care taken to preserve the keratinized mucosa on both sides of the incision, a full-thickness mucoperiosteal flap was reflected on the buccal side, and a pouch was created on the palatal side to place the membrane, allowing the performance of an atraumatic extraction. Using the interproximal bone plates as depth reference and the adjacent teeth for three-dimensional positioning, the implant was inserted with apical anchorage. For the collection of the tissue graft, a straight palatal incision was made to remove the subepithelial tissue, which was divided to harvest a connective tissue graft. To overcome treatment limitations, such as poor blood supply, it was chosen to maintain the connective tissue pedicled, and a subperiosteal soft tissue pocket was created at the deformed ridge interface. The combination of two types of grafts was applied, autogenous particulate bone graft associated with xenogenous bone graft (BioOss®) covered with resorbable collagen membrane (BioGide®). Allied to this technique, aiming to improve tissue regeneration of the aesthetic zone and soft tissue volume with keratinized tissue gain, the subepithelial connective tissue flap was then reflected and rotated, traversed through the pouch to cover the defect and increase the soft tissue thickness. The results demonstrated an increase in bone thickness, confirming the efficacy of guided bone regeneration using composite bone graft (autogenous bone graft and anorganic bovine bone graft [BioOss®] along with resorbable collagen membrane [BioGide®]). A substantial gain in tissue thickness was also observed, showing the quality of local blood supply maintenance. This combined technique may mean a new approach to the use of the roll flap in association with interpositional grafting in order to reduce the number of surgical interventions and obtain more favorable aesthetic results.

Keywords: Reconstructive Surgical Procedures; Alveolar Ridge Augmentation; Guided Bone Regeneration; Guided Tissue Regeneration; Immediate Dental Implant Loading

References

1. McDermott NE., et al. “Complications of dental implants: identification, frequency and associated risk factors”. The International Journal of Oral and Maxillofacial Implants 18.6 (2003): 848-855. 
2. Sheikh Z., et al. “Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation”. Materials (Basel) 8.6 (2015): 2953-2993. 
3. Ribeiro CG., et al. “An Alternative Approach for Augmenting the Anterior Maxilla Using Autogenous Free Gingival Bone Graft for Implant Retained Prosthesis”. Journal of Oral Implantology 40.2 (2014): 183-187. 
4. Tolstunov L. “Classification of the Alveolar Ridge Width: Implant-Driven Treatment Considerations for the Horizontally Deficient Alveolar Ridges”. Journal of Oral Implantology 40.1 (2014): 365-370. 
5. Grunder U., et al. “Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: Report of 24 consecutive cases”. International Journal of Periodontics and Restorative Dentistry 31.1 (2011): 9-17. 
6. Chen ST., et al. “Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes”. The International Journal of Oral and Maxillofacial Implants 19 (2004): 12-25. 
7. Buser D., et al. “Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations”. The International Journal of Oral and Maxillofacial Implants 19 (2004): 43-61. 
8. Ayub LG., et al. “Guided bone regeneration and their therapeutic applications”. Brazilian Journal of Periodontology 21.4 (2011): 24-31. 
9. Chen ST., et al. “A prospective clinical study of nonsubmerged immediate implants: Clinical outcomes and esthetic results”. Clinical Oral Implants Research 18.5 (2007): 552-562. 
10. Le BT and Borzabadi-Farahani A. “Simultaneous implant placement and bone grafting with particulate mineralized allograft in sites with buccal wall defects, a three-year follow-up and review of literature”. Journal of Cranio-Maxillo-Facial Surgery 42.5 (2014): 552-559. 
11. Oh Sang-Chun., et al. “Combined application of roll flap and combination onlay-interpositional graft to enhance esthetics of maxillary anterior fixed partial denture: A case report”. The Journal of Advanced Prosthodontics 8.1 (2016): 70-74. 
12. Reddy PK., et al. “Long palatal connective tissue rolled pedicle graft with demineralized freeze-dried bone allograft plus platelet-rich fibrin combination: A novel technique for ridge augmentation - Three case reports”. Journal of Indian Society of Periodontology 19.2 (2015): 227-231. 
13. Sanctis M., et al. “Immediate implants at fresh extraction sockets: bone healing in four different implant systems”. Journal of Clinical Periodontology 36.8 (2009): 705-711. 
14. Seibert JS and Cohen DW. “Periodontal considerations in preparations for fixed and removable prosthodontics”. Dental Clinics of North America 31.3 (1987): 529-555. 
15. Seibert JS and Louis JV. “Soft tissue ridge augmentation utilizing a combination onlay interproximal graft procedures: a case report”. International Journal of Periodontics and Restorative Dentistry 16.4 (1996): 310-321. 

Citation

Citation: Capobianco TTR., et al. “Guided Bone Regeneration and Guided Tissue Regeneration in Maxillary Aesthetic Zone - Reconstruction of Post- Traumatic Defect in A Single Procedure”. Acta Scientific Dental Sciences 4.2 (2020): 120-125.

Copyright

Copyright: © 2020 Capobianco TTR., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.