case_images: PMC10861280_01
case_images: Initial clinical frontal image of the case.
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case_images: fig1
case_images: The patient utilized an adhesive prosthesis for tooth 13, affixed to teeth 12 and 14, which had become loose at the time of assessment (Figures 1 and 2).
case_images: Initial clinical lateral image of the case.
case_images: CRID2024-6509451.002.jpg
case_images: PMC10861280_01_CRID2024-6509451.002.jpg
case_images: fig2
case_images: The patient utilized an adhesive prosthesis for tooth 13, affixed to teeth 12 and 14, which had become loose at the time of assessment (Figures 1 and 2).
case_images: Tomographic section of element 13. It is noted that the thickness is insufficient to install the implant in an adequate position.
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case_images: fig3
case_images: After analyzing the computed tomography and clinical examination, it was observed that the thickness of the alveolar bone was inadequate (Figure 3), and there was a reduction in the volume of vestibular soft tissue.
case_images: Flap created before the start of the osseodensification technique. Note the buccal bone bulging.
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case_images: fig4
case_images: A scalpel was employed to execute an incision at the central margin of element 13, accompanied by relieving sulcular incisions, resulting in the propagation of the flap along the buccal and palatal areas (Figure 4).
case_images: Three-dimensional assessment of surgical preparation.
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case_images: fig5
case_images: After this stage, the parallelometer was utilized to evaluate the three-dimensional position of the preparation (Figure 5). Figures 15-17 depict soft tissue stability 5 years after the follow-up.
case_images: Surgical aspect of the osseodensification technique after the second milling session.
case_images: CRID2024-6509451.006.jpg
case_images: PMC10861280_01_CRID2024-6509451.006.jpg
case_images: fig6
case_images: The objective was to compress the alveolar bone against the walls to expand the surgical socket instead (Figures 6 and 7).
case_images: Surgical aspect after the osseodensification technique. Note the characteristic of the condensed bone against the walls of the preparation.
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case_images: fig7
case_images: The objective was to compress the alveolar bone against the walls to expand the surgical socket instead (Figures 6 and 7).
case_images: Implant installed 2 mm infra bone, with primary stability of 45 N/cm.
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case_images: fig8
case_images: Torque), measuring 3.5 mm in diameter and 11.5 mm in height, was inserted using a surgical contra-angle. The implant was secured to achieve a torque of 20 N/cm with the aid of a ratchet and finished at a position 2 mm below the bone surface with a torque of 45 N/cm, in accordance with the initial plan (Figure 8).
case_images: Guided bone regeneration (Stick Bone), to increase bone volume.
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case_images: fig9
case_images: Subsequently, the Stick Bone was positioned along the vestibular wall to increase bone volume (Figure 9).
case_images: Lateral view of the installation of L-PRF membranes.
case_images: CRID2024-6509451.010.jpg
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case_images: fig10
case_images: The Choukroun technique was employed, and the resulting membranes were superimposed onto the graft and implant materials to provide protection (Figures 10 and 11).
case_images: Occlusal view of the installation of L-PRF membranes. It is noted that this involved all the graft material and the implant.
case_images: CRID2024-6509451.011.jpg
case_images: PMC10861280_01_CRID2024-6509451.011.jpg
case_images: fig11
case_images: The Choukroun technique was employed, and the resulting membranes were superimposed onto the graft and implant materials to provide protection (Figures 10 and 11).
case_images: Closure of the surgical wound in first intention. It is noted that the flap was closed without tension, an important factor to avoid suture dehiscence.
case_images: CRID2024-6509451.012.jpg
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case_images: fig12
case_images: After ensuring that the tissue was free from tension, we used silk threads (Ethicon 4.0, needle 17 cm, and reverse cut 3/8, Johnson & Johnson ) to perform a suture with simple stitches, coapting the borderlines in the first intention (Figure 12).
case_images: Immediate soft tissue stability was obtained after guided tissue regeneration within the sutures. Note the difference between resorbable and nonresorbable sutures and the characteristics of the provisional post before receiving the immediate crown. The crown was removed temporarily to analyze the characteristics of the provisional abutment.
case_images: CRID2024-6509451.013.jpg
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case_images: fig13
case_images: After securing the membrane over the flap, it was moved coronally and sutured according to the manufacturer's instructions, with nonresorbable stitches being removed within 10 days (Figure 13).
case_images: Computed tomography after 5 years of follow-up. It is noted that the buccal and palatal walls were maintained after expansion.
case_images: CRID2024-6509451.014.jpg
case_images: PMC10861280_01_CRID2024-6509451.014.jpg
case_images: fig14
case_images: Upon analysis of the tomographic examination, it was observed that the implant remained completely encased by bone tissue with vestibular and lingual surrounding walls preserved (Figure 14).
case_images: Frontal view of the stability of crown in position after 5 years of follow-up. Note the stability of the peri-implant soft tissue.
case_images: CRID2024-6509451.015.jpg
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case_images: fig15
case_images: Figures 15-17 depict soft tissue stability 5 years after the follow-up.