case_images: PMC10586895_01
case_images: Radiograph of the upper right first premolar showing radicular radiolucency.
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case_images: fig1
case_images: A 60-year-old male, ASA I patient, without previous history or treatment of periodontal disease was referred to a private periodontal office for extraction and replacement of an upper right first premolar with history of endodontic treatment and restorative hopeless prognosis due to vertical root fracture (Figure 1).
case_images: CBCT scan showing adequate bone volume to proceed with the implant placement.
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case_images: fig2
case_images: Four months postoperatively, a CBCT scan of the area was taken showing adequate bone volume to proceed with the implant placement (Figure 2).
case_images: Clinical presentation of a fistula in the buccal mucosa apical to the implant.
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case_images: fig3
case_images: Clinically, the patient had developed a fistula in the buccal mucosa apical to the implant and to the second upper premolar (Figure 3).
case_images: Radiographic presentation of the implant periapical lesion.
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case_images: fig4
case_images: A periapical radiograph was taken (Figure 4) showing a periapical lesion apical to the implant but also proximal to the apex of the distal neighboring tooth.
case_images: Endodontic treatment of the upper right second premolar.
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case_images: fig5
case_images: Endodontic treatment of the nonvital tooth was completed (Figure 5), and two months of healing time were allotted prior to follow-up.
case_images: Full-thickness flap reflected showing granulation tissue around the implant apex.
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case_images: fig6
case_images: A full-thickness flap was then reflected showing an area at the apex of the implant in which the cortical bone was completely resorbed and replaced by granulation tissue (Figure 6).
case_images: Granultion tissue completely removed.
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case_images: fig7
case_images: Using spoon curettes, the granulation tissue was carefully removed (Figure 7).
case_images: Decontamination with tetracycline paste for 2 minutes.
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case_images: fig8
case_images: The area was then decontaminated using a tetracycline paste created mixing 250 mg of tetracycline powder with sterile saline solution (Figure 8).
case_images: Presentation of the exposed implant treads after decontamination with tetracycline.
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case_images: fig9
case_images: The tetracycline paste was left in place for 2 minutes and then was carefully rinsed with saline solution (Figure 9).
case_images: Demineralized ground cortical bone placed around the apex of the implant.
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case_images: fig10
case_images: The bone defect was filled with 0.5 cc of allograft particulate bone graft (AlloGraft demineralized ground cortical 250-1000 mum, Straumann Group) (Figure 10) covered with a cross-linked collagen membrane (BioMend Collagen Membrane, Zimmer Biomet) 15 x 20 mm (Figure 11).
case_images: Collagen membrane placed over the grafted site.
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case_images: fig11
case_images: The bone defect was filled with 0.5 cc of allograft particulate bone graft (AlloGraft demineralized ground cortical 250-1000 mum, Straumann Group) (Figure 10) covered with a cross-linked collagen membrane (BioMend Collagen Membrane, Zimmer Biomet) 15 x 20 mm (Figure 11).
case_images: Surgical site sutured with primary closure.
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case_images: fig12
case_images: The flap was sutured with single interrupted Vicryl 5-0 and chromic gut 5-0 sutures, and primary closure was achieved (Figure 12).
case_images: Sutures removed at 10 days postoperative appointment.
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case_images: fig13
case_images: The patient returned for a 10-day post-operative follow-up appointment and suture removal appointment (Figure 13).
case_images: Complete clinical healing at the 6-month postoperative appointment.
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case_images: fig14
case_images: The patient then returned for a 6-month follow-up appointment in which a new periapical X-ray was taken (Figures 14 and 15) showing normal bone density around the implant and there were no clinical signs of a residual IPL.
case_images: Radiographic healing, showing normal bone density at the 6-month postoperative appointment.
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case_images: fig15
case_images: The patient then returned for a 6-month follow-up appointment in which a new periapical X-ray was taken (Figures 14 and 15) showing normal bone density around the implant and there were no clinical signs of a residual IPL.