case_images: PMC10874294_01
case_images: (A) The clinical examination showed class I tooth mobility, unsatisfactory endodontic treatment, and a ceramic crown. (B) The periodontal probing confirmed 10 mm of probing depth in the buccal side. (C) Periapical radiograph revealed an inadequate endodontic treatment and vertical bone loss on the mesial and distal of the tooth, and the bone height above the root apex was 8 mm. (D) After prosthesis removal, a vertical fracture in the mesial side of the teeth was observed, which indicated its extraction.
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case_images: fig1
case_images: The clinical examination showed endodontic treatment, signs of class I tooth mobility, and a ceramic crown (Figure 1(A)). During periodontal probing, it was verified 10 mm of probing depth in the buccal side (Figure 1(B)). Periapical radiograph revealed an inadequate endodontic treatment, vertical bone loss on the mesial, and distal side of the tooth, and the reminiscent bone height above the root apex was 10 mm (Figure 1(C)). After removing the prosthesis, it noted a vertical fracture in the mesial side of the teeth, which indicates its extraction (Figure 1(D)).
case_images: (A) After tooth removal, a dental implant (3.5 x 13 mm, Cone Morse Drive, Neodent, Curitiba, PR, Brazil) was placed into the fresh extraction socket. The drilling sequence started with a spear drill, followed by a 2 mm cylindrical drill, and a 3.5 mm conical-shaped drill concerning the mesial, distal, and palatal spaces to accomplish adequate tridimensional positioning. (B) The implant placement was performed with a flapless technique preserving the interdental papillae. (C) Implant alignment was slightly palatal, at least 2 mm distant from the nearby teeth in the mesial and distal region, and the primary implant stability achieved was 42 Ncm. (D) A titanium cylinder was attached to the implant platform.
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case_images: fig2
case_images: Afterward, a titanium cylinder was connected to the implant platform (Figures 2(A)-2(D)).
case_images: (A) The maxillary tuberosity was the region utilized to obtain the autogenous bone block graft. (B) After local infiltrative anesthesia, a vertical and crestal incision was performed following a full-thickness flap to access the right maxillary tuberosity. (C) A straight chisel (Quinelato, Rio Claro, SP, Brazil) was used to harvest the block bone. (D) The bone graft was customized according to the form of the bone defect, (E) and it was then inserted gently into the alveolar defect above the implant threads using the flapless technique. (F) Occlusal view of the fresh extraction socket with the dental implant positioned immediately after the buccal wall reconstruction with the tuberosity bone graft, allowing a reminiscent gap between the block bone and the implant. (G) The gap was filled with particulate bone harvested from the tuberosity and ground with a bone mill (Neodent, Curitiba, PR, Brazil) to guarantee the bone block maintenance and support. (H) Final occlusal view of the particulate bone completely inserted into the gap between the block bone and the implant.
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case_images: fig3
case_images: The gap between the block bone and the implant was filled with particulate bone also collected from the tuberosity and ground with a bone mill (Neodent, Curitiba, PR, Brazil) to ensure block bone graft stabilization (Figures 3(A)-3(H)).
case_images: (A) After the surgical procedures, the provisional resin crown was customized. (B) Prosthesis adjustments were performed to guarantee a proper emergence profile. (C) The tooth incisal height was reduced to avoid occlusal contact during chewing and phonation.
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case_images: fig4
case_images: The patient received postoperative recommendations comprising oral hygiene teachings and plaque control monthly for 3 months (Figures 4(A)-4(C)).
case_images: (A) Follow-up after 6 months showed a favorable esthetic result without gingival recession. (B) The clinical view after removal of the provisional crown showed excellent tissue healing and contour with no tissue inflammation.
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case_images: fig5
case_images: (A) A titanium abutment was installed with its cervical portion narrower than the implant diameter to create an esthetic contour of the gingival margin. (B) Insertion of light body silicone around the plastic abutment impression coping. (C) Final completed impression with the impression coping into silicone impression. (D) A porcelain crown of IPS Empress II was manufactured and cemented over the abutment. The clinical aspect demonstrated a satisfactory contour at the gingival margin.
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case_images: fig6
case_images: Next, a definitive porcelain crown was manufactured and cemented over the abutment (Figures 6(A)-6(D)).
case_images: (A) The periapical radiography showed a complete implant osseointegration without signs of bone resorption. (B) The computed tomography scan showed no bone alterations in width and height surrounding the implant.
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case_images: fig7
case_images: Therefore, IDR treatment effectively replaces the tooth, obtaining an adequate esthetic and functional result (Figures 7(A) and 7(B)).
case_images: (A) Periapical radiographs after 9 years of follow-up showed the implant position and the vertical bone gain without marginal bone resorption. (B) The clinical examination revealed an adequate gingival thickness, without gingival recession or probing depths, confirming the satisfying esthetic result by the IDR treatment.
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case_images: fig8
case_images: Thus, the functional and esthetic expectations of the patient were accomplished by the IDR technique (Figures 8(A) and 8(B)).