A 39-year-old man had complaints of pain in the teeth 1.1, 2.1 while clenching them. The results of the investigation showed that his dental prosthesis had been made on the basis of metal ceramics. In the apical area of 1.1 a mucus fistula was seen. During the procedure the patient was prescribed X-ray radiography. Together with that treatment history was recorded which had no relevance to the situation being described. According to the history, it can be concluded that before the decision to place the prosthesis was made the teeth had been treated twice.
Radiography and other investigations showed a vertical fracture of the teeth 1.1 and 2.1 (Fig. 1).
Before the surgery the patient had taken 2 g of beta-lactam antibiotics. The surgery had a diagnostic flapped character, due to that a correct diagnosis was made and right treatment was planned.
The doctors took a decision to make preventive treatment of ridge bone atrophy: to fill the area around the problematic spot with bone composition (Fig. 2).
To close the flap special absorbable threads were used. In order neighbouring teeth were closer to each other the doctors mounted subsidiary prosthesis with a cohesive component which promoted their attractive appearance (Fig. 3).
In three months the patient was examined, and it was detected that maximum tissue healing took place, and the gum was in a perfect condition. Gum curvatures became more correct due to additional prosthesis (Fig. 4).
In six months radiography of alveolar sockets showed that bone content was lost moderately. It happened because of using steel wire in intermediate prosthesis (Fig. 5).
A dental bridge was extracted for placement of two implants. With the help of bone trephine a sample was taken and bone structure and quality were estimated. A perfect condition for implantation is maximum possible stability at the top of teeth. In this case the length of the extracted roots was 11 mm. It was decided to place implants 3.75 mm in diameter and 13 mm in length (Fig. 6).
After examining the patient was prescribed to clean his mouth thoroughly. He had to brush his teeth regularly and use dental floss.
Full healing of the tissues took place in 12 months. The patient’s oral cavity acquired aesthetic look. X-ray showed implant osseointegration (Fig. 7).
Control examination of the patient was done in three and five years. During this period the doctors prescribed another radiography that showed perfect implant osseointegration (Fig. 8).
Massimo Amato, Vincenzo Bruno, Giuseppe Pantaleo, Antonio Cerutti, Gianrico Spagnuolo and Gilberto Sammartino. Source: http://www.ncbi.nlm.nih.gov/