case_images: PMC5863393_01
case_images: Immediate after implant placement 5 months back, showed residual infection//past incident-associated bone resorption w.r.t #11
case_images: CCD-9-114-g001.jpg
case_images: PMC5863393_01_CCD-9-114-g001.jpg
case_images: F1
case_images: Past dental history reported Adin implant 3.75 and 13 mm was placed utilizing conventional flap technique with less primary stability and immediately intraoral periapical (IOPA)-X-ray was taken [Figure 1] followed by gingival former placement 5 months back. Prophylactic antibiotics and anti-inflammatory were prescribed.
case_images: Preoperative clinical probing at mesial, distal, labial, and palatal aspect of implant w.r.t #11 region clockwise
case_images: CCD-9-114-g002.jpg
case_images: PMC5863393_01_CCD-9-114-g002.jpg
case_images: F2
case_images: Intraoral examination revealed mild bleeding on probing; 3-4 mm pocket depth (PD) all around labially positioned implant w.r.t #11, but only on labial surface, 4 mm pocket with 2 mm of clinical attachment loss was present as implant threads were palpable with probe [Figure 2].
case_images: Preoperative intraoral sinus at labial attached gingiva w.r.t #11
case_images: CCD-9-114-g003.jpg
case_images: PMC5863393_01_CCD-9-114-g003.jpg
case_images: F3
case_images: Intraoral sinus involved labial attached gingiva [Figure 3] w.r.t #11 but no clinically visible communication was observed between sinus site and labial pocket after probing.
case_images: Mild interdental alveolar bone loss observed in intraoral periapical X-ray w.r.t #11 region
case_images: CCD-9-114-g005.jpg
case_images: PMC5863393_01_CCD-9-114-g005.jpg
case_images: F4
case_images: IOPA X-ray showed mild interproximal alveolar bone resorption [Figure 4]. Immediate adjacent teeth were vital on cold testing with healthy periodontium.
case_images: After full thickness flap reflection, early labial bone loss (bone dehiscence) in coronal <1/3rd with transparency of implant through rest of the body of implant along with mild interdental bone loss w.r.t #11 was observed
case_images: CCD-9-114-g006.jpg
case_images: PMC5863393_01_CCD-9-114-g006.jpg
case_images: F5
case_images: Full-thickness flap was reflected, and early bone dehiscence in the coronal third and transparency of implant through apical two-third labial bone was evident w.r.t #11 [Figure 5]. A noninvasive, economical parallel profile radiographic (PPRx) technique-assisted IOPA X-ray through lateral view showed labial bone regeneration w.r.t #11 [Figure 10a and b] in comparison to clinical baseline [Figure 5].
case_images: Recipient bed was prepared with surgical round carbide bur under copious irrigation on labial bone w.r.t #11 after apical two-third area debridement showed transparency of implant throughout clearly followed by mechanical and chlorhexidine-assisted decontamination at throughout implant site
case_images: CCD-9-114-g007.jpg
case_images: PMC5863393_01_CCD-9-114-g007.jpg
case_images: F6
case_images: Recipient bed was prepared in the apical two-third area of labial bone [Figure 6] and surgical site including implant surface was thoroughly decontaminated utilizing implant maintenance plastic curettes followed by irrigation with 0.2% CHX.
case_images: Clinically, gingiva is healthy with the excellent color match, and well-developed scalloped margin and radiograph showed no interproximal bone loss 3 months postoperatively
case_images: CCD-9-114-g008.jpg
case_images: PMC5863393_01_CCD-9-114-g008.jpg
case_images: F7
case_images: Crown cementation was done at 3 months postoperatively, as scalloped gingival margins, with good gingival esthetic and healed labial pocket (with gain in 2 mm of clinical attachment with 2 mm of gingival sulcus), with no interproximal bone loss was observed [Figure 7].
case_images: Clinical healing was excellent with the excellent color match with scalloped margins and thick keratinized gingiva at surgical site. Clinically labial, mesial and distal, robing depth was 2 and 5 mm, respectively, as well as intraoral periapical radiograph showed no interproximal bone loss 6 months postoperatively
case_images: CCD-9-114-g009.jpg
case_images: PMC5863393_01_CCD-9-114-g009.jpg
case_images: F8
case_images: Clinical healing was excellent with the excellent color match with scalloped margins and thick keratinized gingiva at the surgical site along with labial, mesial and distal probing depth was 2 and 5 mm, respectively, as well as IOPA radiograph showed no interproximal bone loss 6 months postoperatively [Figure 8].
case_images: Distal pocket reduced to 3 mm at 12 months postoperatively whereas rest of the clinical and radiographical parameters remained stationary as observed at 6 months postoperatively
case_images: CCD-9-114-g010.jpg
case_images: PMC5863393_01_CCD-9-114-g010.jpg
case_images: F9
case_images: All the parameters reported to be normal at 12 months postoperatively [Figure 9].
case_images: (a) 13 months postoperatively parallel profile radiographic technique-assisted intraoral periapical X-ray showed bone regeneration at labial surface, (b) (1) dentogingival unit, (2) bone thickness at crestal third, (3) midlabial, and (4) at apical labial bone
case_images: CCD-9-114-g011.jpg
case_images: PMC5863393_01_CCD-9-114-g011.jpg
case_images: F10
case_images: A noninvasive, economical parallel profile radiographic (PPRx) technique-assisted IOPA X-ray through lateral view showed labial bone regeneration w.r.t #11 [Figure 10a and b] in comparison to clinical baseline [Figure 5].