case_images: PMC5543658_01
case_images: Retained root 23 is extracted, and the socket is left to heal for 2 months before implant placement.
case_images: TODENTJ-11-284_F1.jpg
case_images: PMC5543658_01_TODENTJ-11-284_F1.jpg
case_images: F1
case_images: Two months after (Fig. 1) the implant was placed, a full-thickness envelope was raised with the adjacent papillae.
case_images: Full-thickness flap is raised using crestal incision with papillary involvement to place an implant in the 23 area.
case_images: TODENTJ-11-284_F2.jpg
case_images: PMC5543658_01_TODENTJ-11-284_F2.jpg
case_images: F2
case_images: An osteotomy was performed according to manufacturer recommendations, and an implant 16 mm in length and 3.7 mm in diameter was placed (Fig. 2).
case_images: Re-entry surgery is performed 3 months after implant placement and palatal rotational flap performed simultaneously with a temporary abutment and crown. A three-sided flap with a more palatally placed crestal incision and the papillae reserved is created. Two vertical incisions are made to the vestibule so that the flap could be freely rotated.
case_images: TODENTJ-11-284_F3.jpg
case_images: PMC5543658_01_TODENTJ-11-284_F3.jpg
case_images: F3
case_images: After de-epithelization with scalpel the flap was rotated inward with the keratinized mucosa facing the temporary crown and simple interrupted suturing with vicryl suture was performed to fix the rotated flap against the crown and the palatal tissue (Fig. 3).
case_images: After one month, the crown is modified by adding composite filling material to shape the emergence profile to mimic a natural tooth.
case_images: TODENTJ-11-284_F4.jpg
case_images: PMC5543658_01_TODENTJ-11-284_F4.jpg
case_images: F4
case_images: After one month, the crown removed and reshaped by increasing the diameter; it was still kept out of occlusion (Fig. 4).
case_images: Soft tissue adaptation occurred and an emergence profile was shaped when a provisional crown was used. Bleeding occurred after the provisional crown was removed, which is a sign that the lining mucosa was attaching to the crown structure.
case_images: TODENTJ-11-284_F5.jpg
case_images: PMC5543658_01_TODENTJ-11-284_F5.jpg
case_images: F5
case_images: After 3 months with complete soft tissue maturation, the temporary crown was removed to reveal an excellent emergence profile (Fig. 5), the temporary abutment was removed, and impression coping was placed to make an impression at the bone level.
case_images: The permanent crown is placed, and gingival bulk is achieved. Still, gingival indentation persists at the vertical gingival incision, and partially loss of mesial and distal papillae is obvious.
case_images: TODENTJ-11-284_F6.jpg
case_images: PMC5543658_01_TODENTJ-11-284_F6.jpg
case_images: F6
case_images: The permanent crown was placed, excess cement was removed, and occlusion was adjusted (Fig. 6).
case_images: Periapical radiograph at the time the crown was placed shows a good crestal bone level.
case_images: TODENTJ-11-284_F7.jpg
case_images: PMC5543658_01_TODENTJ-11-284_F7.jpg
case_images: F7
case_images: After one month, the patient was followed up and radiographed (Fig. 7), and the papillae were still partially filling the interdental space.
case_images: Six months after the permanent crown is placed, the papillae regenerate and fill the gap, and the indentation scar from the vertical incision starts to disappear.
case_images: TODENTJ-11-284_F8.jpg
case_images: PMC5543658_01_TODENTJ-11-284_F8.jpg
case_images: F8
case_images: The patient was seen again after 3 months, at which time the papillae were almost filling the interdental space and the scar was faded (Fig. 8).
case_images: PMC5543658_02
case_images: Socket grafting after 21 extraction. The bone graft is covered with a collagen membrane and secured with sutures.
case_images: TODENTJ-11-284_F9.jpg
case_images: PMC5543658_02_TODENTJ-11-284_F9.jpg
case_images: F9
case_images: A cancellous bone graft was placed, covered with a collagen membrane (double layer) and secured with mattress sutures (Fig. 9).
case_images: Buccal contour concavity after 3 months period of implant placement.
case_images: TODENTJ-11-284_F10.jpg
case_images: PMC5543658_02_TODENTJ-11-284_F10.jpg
case_images: F10
case_images: A horizontal depression was observed in the center of implant site (Fig. 10).
case_images: Healing one week after the palatal rotational flap is performed. Overcorrection is mandatory to compensate for soft tissue remodeling.
case_images: TODENTJ-11-284_F11.jpg
case_images: PMC5543658_02_TODENTJ-11-284_F11.jpg
case_images: F11
case_images: The wound healed uneventfully, and ample gingival tissue thickness and even overbulging was observed (Fig. 11).
case_images: Soft tissue healing one month after rotational flap. A, the normal contour of the implant buccal gingiva; B, thick and healthy gingival tissue around the implant after the healing abutment is removed.
case_images: TODENTJ-11-284_F12.jpg
case_images: PMC5543658_02_TODENTJ-11-284_F12.jpg
case_images: F12
case_images: The wound was left to heal for 4 weeks (Fig. 12), and then an impression was taken with impression coping.
case_images: A permanent crown with a customized abutment is fabricated, a marked gingival augmentation can be appreciated.
case_images: TODENTJ-11-284_F13.jpg
case_images: PMC5543658_02_TODENTJ-11-284_F13.jpg
case_images: F13
case_images: A customized abutment with porcelain fused to metal crown was fabricated (Fig. 13) and cemented on, and the occlusion was adjusted for centric and eccentric movement.
case_images: Periapical radiograph at the time the crown was placed shows a good crestal bone level.
case_images: TODENTJ-11-284_F14.jpg
case_images: PMC5543658_02_TODENTJ-11-284_F14.jpg
case_images: F14
case_images: Patient was followed up by radiograph that show stable crestal bone level (Fig. 14).