EC Dental Science

Aesthetic rehabilitation is one of the objectives of prosthodontic practice, which is complemented by advances in implantology. While implant techniques have provided solutions to most clinical scenarios, the loss of bone over targeted implant sites presents important challenges to restorative attempts [1]. In the case presented here, a 55-year old with a longstanding anterior maxillary tooth loss is found to need extraction of adjacent teeth numbers 12 and 21, followed by placement of implants. However, longstanding bone resorption resulted in insufficient bone over the implant site, calling for bone augmentation and delayed implant placement [5]. In addition, a combination of severe orthodontic disorders, parafunctional habits, and high expectations threated the predicted performance and acceptability of the implants. The multidisciplinary approach adopted to overcome these challenges entailed orthodontic intervention, two-stage bone grafting using a guided bone reaeration technique that utilized platelet rich fibrin, and delayed implant placement. The assessment of bone volume was complemented by cone beam CT scans, which allowed for optimal timing of implant placement and confirmed structural adequacy of the implants.

Keywords: Multidisciplinary Management; Anterior Teeth Loss; Maxilla; Aesthetic Rehabilitation

1. Ali Syed Parveez and Jyoti Gupta. "Cone Beam Computed Tomography in Oral Implants". National Journal of Maxillofacial Surgery1 (2013): 2-6.
2. Al-Maawi Sarah., et al. “Efficacy of Platelet-Rich Fibrin In Promoting The Healing Of Extraction Sockets: A Systematic Review". International Journal of Implant Dentistry1 (2021): 1-27.
3. Buser Daniel., et al. “Early Implant Placement with Simultaneous Guided Bone Regeneration Following Single-Tooth Extraction in the Esthetic Zone: 12-Month Results of A Prospective Study With 20 Consecutive Patients". Journal of Periodontology1 (2009): 152-162.
4. Castro Ana., et al. “Characterization of the Leukocyte- And Platelet-Rich Fibrin Block: Release of Growth Factors, Cellular Content, And Structure". The International Journal of Oral and Maxillofacial Implants4 (2019): 855-864.
5. Chiapasco Matteo., et al. “Bone Augmentation Procedures in Implant Dentistry”. International Journal of Oral and Maxillofacial Implants 24 (2021): 237-259.
6. Cortese Antonio., et al. “Platelet-Rich Fibrin (PRF) In Implant Dentistry in Combination with New Bone Regenerative Technique in Elderly Patients". International Journal of Surgery Case Reports 28 (2016): 52-56.
7. Dam Van Viet., et al. “Bone Augmentation for Implant Placement: Recent Advances". International Journal of Dentistry (2022): 1-7.
8. De Groot RJ., et al. “Bone Augmentation Followed by Implant Surgery in The Edentulous Mandible: A Systematic Review". Journal of Oral Rehabilitation4 (2018): 334-343.
9. Dohan David M., et al. “Platelet-Rich Fibrin (PRF): A Second-Generation Platelet Concentrate. Part I: Technological Concepts and Evolution". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 3 (2006): e37-e44.
10. Elgali Ibrahim., et al. “Guided Bone Regeneration: Materials and Biological Mechanisms Revisited". European Journal of Oral Sciences5 (2017): 315-337.
11. Ghanaati Shahram., et al. “Advanced Platelet-Rich Fibrin: A New Concept For Cell-Based Tissue Engineering By Means Of Inflammatory Cells". Journal of Oral Implantology6 (2014): 679-689.
12. Hansson Stig and Anders Halldin. "Alveolar Ridge Resorption After Tooth Extraction: A Consequence of a Fundamental Principle of Bone Physiology". Journal of Dental Biomechanics1 (2012): 1-8.
13. Jallad Walid Al. "Restoration of Missing Upper Anterior Teeth Using Dental Implant Simultaneous with Bone Grafting- A Case Report". Journal of Dentistry and Oral Health1 (2014): 1-8.
14. Jiman Paula Argentina., et al. “New and Recovered Temporary Anchorage Devices, In Vitro Assessment of Structural and Surface Properties". Materials21 (2021): 1-14.
15. Jo You-Young and Ji-Hyeon Oh. "New Resorbable Membrane Materials for Guided Bone Regeneration". Applied Sciences11 (2018): 1-8.
16. Jonasson Grethe., et al. “The Rise and Fall of the Alveolar Process: Dependency of Teeth and Metabolic Aspects". Archives of Oral Biology 96 (2018): 195-200.
17. Karayürek Fatih., et al. “Combining Platelet Rich Fibrin with Different Bone Graft Materials: An Experimental Study on The Histopathological and Immunohistochemical Aspects of Bone Healing". Journal Of Cranio-Maxillofacial Surgery5 (2019): 815-825.
18. Lin Hsi Kuei., et al. “Prevention of Bone Resorption By HA/Β-TCP + Collagen Composite After Tooth Extraction: A Case Series". International Journal Of Environmental Research and Public Health23 (2019): 4616.
19. Liu Jie and David G Kerns. "Mechanisms Of Guided Bone Regeneration: A Review". The Open Dentistry Journal1 (2014): 56-65.
20. Liu Yiping., et al. “Platelet-Rich Fibrin As A Bone Graft Material In Oral And Maxillofacial Bone Regeneration: Classification And Summary For Better Application". Biomed Research International (2019): 1-16.
21. Mahesh Lanka., et al. “Guided Bone Regeneration in Anterior Maxillary Zone: A 3-Year Case Report". Journal Of Interdisciplinary Dentistry1 (2011): 28-32.
22. Pagni Giorgio., et al. “Postextraction Alveolar Ridge Preservation: Biological Basis and Treatments". International Journal of Dentistry (2012): 1-13.
23. Rabelo Gustavo Davi., et al. “Retrospective Study of Bone Grafting Procedures Before Implant Placement". Implant Dentistry4 (2010): 342-350.
24. Reda Riham., et al. “Evaluation of Injectable Platelet Rich Fibrin (I-PRF) With Bone Graft Around Immediate Dental Implant in Esthetic Zone". Al-Azhar Dental Journal for Girls3 (2021): 471-482.
25. Retzepi Maria and N Donos. "Guided Bone Regeneration: Biological Principle and Therapeutic Applications". Clinical Oral Implants Research6 (2010): 567-576.
26. Simonpieri Alain., et al. “Current Knowledge and Perspectives for the Use of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) in Oral and Maxillofacial Surgery Part 2: Bone Graft, Implant and Reconstructive Surgery". Current Pharmaceutical Biotechnology7 (2012): 1231-1256.
27. Singh Kamlesh., et al. “Temporary Anchorage Devices -Mini-Implants". National Journal of Maxillofacial Surgery1 (2010): 30-35.
28. Zhao Rusin., et al. “Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments". Molecules10 (2021): 1-27.