case_images: PMC7306078_01
case_images: (a) Preoperative occlusal view; (b) orthopantomography; (c) preoperative periapical radiograph.
case_images: CRID2020-5073519.001.jpg
case_images: PMC7306078_01_CRID2020-5073519.001.jpg
case_images: fig1
case_images: The intraoral exam revealed a nonrestorable carious lesion in the upper right first premolar (Figure 1(a)), confirmed with orthopantomography (Figure 1(b)) and periapical radiograph performed with Rinn holder (Figure 1(c)), in which a periapical periodontitis was highlighted.
case_images: (a) L-PRF clots placed on a plate; (b) L-PRF membranes; (c) postextractive socket; (d) socket grafted with L-PRF membranes; (e) suture; (f) suture removal; (g) 14 days after tooth extraction; (h) 28 days after tooth extraction; (i) 60 days after tooth extraction.
case_images: CRID2020-5073519.002.jpg
case_images: PMC7306078_01_CRID2020-5073519.002.jpg
case_images: fig2
case_images: L-PRF clots were collected from each tube and separated from the red thrombus (composed of red cells), obtaining a fibrin clot with a small red portion in order to include the intermediate portion rich in leucocytes and platelets. L-PRF clots were then placed in a sterile box and slightly compressed for about 5 minutes under a stainless steel plate to form 4 membranes (Figures 2(a) and 2(b)). Atraumatic extraction was performed using a piezoelectric device (Piezosurgery , Mectron, Genova, Italy) to preserve the buccal bone and avoid soft tissue laceration, followed by alveolar debridement and irrigation with sterile saline solution (Figure 2(c)). The socket was then filled with three L-PRF membranes previously folded and condensed with a sterile gauze (Figure 2(d)). Soft tissues were sutured (4/0 nylon suture, 20 mm needle) at the mesial, median, and distal aspects of the socket, without primary closure (Figure 2(e)).
case_images: Histological specimen of the bone tissue taken at the center of the grafted site showing bone tissue surrounded by connective tissue matrix. Hematoxylin-eosin staining; (a) original magnification x5; (b) surgical trephine bur with bone tissue sample.
case_images: CRID2020-5073519.003.jpg
case_images: PMC7306078_01_CRID2020-5073519.003.jpg
case_images: fig3
case_images: After 3 months, before implant placement, a bone biopsy was performed with a surgical trephine bur (2.0 mm internal diameter) at the center of the ridge for histomorphometric analysis of the grafted site (Figures 3(a) and 3(b)) according to Corsi et al..
case_images: (a) Implant site preparation; (b) implant placement; (c) suture; (d) periapical radiograph after implant placement; (e) soft tissue conditioning; (f) screw-retained zirconia crown; (g) follow-up 6 months after final restoration.
case_images: CRID2020-5073519.004.jpg
case_images: PMC7306078_01_CRID2020-5073519.004.jpg
case_images: fig4
case_images: After bone biopsy (Figure 4(a)), a 3.7 x 10 mm implant (Intra-Lock , Boca Raton, Florida, USA) was placed (Figure 4(b)) and soft tissues sutured (4/0 nylon suture, 20 mm needle) with primary closure (Figure 4(c)). A periapical radiograph was also performed at this time to check correct implant placement (Figure 4(d)). Sutures were then removed 7 days after implant surgery, and a healing abutment was positioned during the second surgery two months later to obtain soft tissue conditioning (Figure 4(e)). A silicone impression with individual tray was taken one month later to fabricate a screw-retained zirconia crown (Figure 4(f)).