case_images: PMC7245675_01
case_images: Panoramic radiograph (a) and intraoral buccal view, showing permanent tooth absences and presence of several deciduous teeth.
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case_images: fig1
case_images: In the mandible, the patient presented all the deciduous teeth, and only permanent teeth present were #36 and #46 (Figure 1).
case_images: Preoperatory tomography of the anterior mandible region.
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case_images: fig2
case_images: This situation made impossible the placement of implants in the ideal three-dimensional position, requiring previous bone reconstruction (Figure 2).
case_images: Intraoral view of the surgery steps: (a) incision and total flap detachment, (b) cortical perforations, (c) bone substitute accommodation, (d) double layer collagen membrane, (e) single sutures, and (f) bandage (Micropore ).
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case_images: fig3
case_images: After the surgical procedure, a bandage (Micropore ) was performed to compress the surgical area to diminish possible edema (Figure 3).
case_images: Postoperatory tomography radiograph 12 months after the horizontal bone augmentation, showing new bone formation, allowing the correct three-dimensional placement of dental implants.
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case_images: fig4
case_images: Clinically, the success of the procedure was confirmed, as well as the presence of good health of the gingival tissue (Figures 4 and 5).
case_images: 3D resin prototype of the appearance of the ridge before (a) and after (b) the volume increase of the alveolar ridge. There was a 5 mm gain in bone thickness.
case_images: CRID2020-6723936.005.jpg
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case_images: fig5
case_images: Clinically, the success of the procedure was confirmed, as well as the presence of good health of the gingival tissue (Figures 4 and 5).
case_images: Intraoral view of the alveolar ridge before (a) and after (b) augmentation. Removal of bone fragment using a 2.0 mm trephine for histological analysis of the grafted area (c). Six implants in place with initial torque of 35 N/cm (d).
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case_images: fig6
case_images: At this moment, a bone fragment of approximately 3 mm was removed using a 2.0 mm trephine drill in a buccolingual direction for histological analysis of the grafted area (Figure 6).
case_images: (a) Image of a grafted material interface (red arrow) and cortical bone. It is clearly shown the formation of cortical bone with osteocytes; (b) enlarged image of (a). Grafted material (red arrow). Osteocytes present in the gaps (green arrow); (c) well-formed Haversian system: note the arrangement of concentric lamellae, with the central channel of Havers (blue arrow). Osteocytes homogeneously distributed, demonstrating the usual architecture of cortical bone; (c) enlarged image of (d). In detail, the Havers channel, with endosteum (orange arrow) and red blood cells (white arrow).
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case_images: fig7
case_images: However, it could be confirmed on the clinical observation that the regenerated bone was similar to the natural bone (Figure 7).
case_images: Installation of the definitive prosthetic abutments and delivery of the temporary cemented restoration with immediate load.
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case_images: fig8
case_images: A temporary acrylic resin fixed prosthesis was installed immediately to the surgical procedure, within 24 hours (Figure 8).
case_images: Four-year follow-up CT, showing the stability of the bone tissue around the implants (a, b). Panoramic radiograph of the 4-year follow-up (c).
case_images: CRID2020-6723936.009.jpg
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case_images: fig9
case_images: Buccal view of the four-year follow-up.
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case_images: fig10