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A, Periapical radiograph showing bone loss, endodontic treatment, and a metal ceramic crown. However, sufficient bone height for initial stability of the implant was present. B–E, Atraumatic extraction of a hopeless tooth to preserve the osseous contour.
Source publication
Objective
The aim of this clinical report was to reestablish the buccal bone wall after immediate implant placement. The socket defect was corrected with autogenous bone, and a connective tissue graft was removed from the maxillary tuberosity to increase the thickness, height, and width of the buccal bone and gingival tissue followed by immediate p...
Contexts in source publication
Context 1
... examination revealed a left central incisor with signs of class I tooth mobility, 5 mm of probing depth, and absence of buccal bone wall creating a functional defect requiring bone augmentation ( Figure 1A-D). Periapical radiography showed a porcelain-fused-to-metal crown, localized vertical bone resorption on the buccal region, and endodontic treatment ( Figure 2A). Bone height above the root apex was 8 mm. ...
Context 2
... maxillary left central incisor was atraumatically extracted by a flapless technique under local anesthesia (mepivacaine 2% and epinephrine 1:100.000-Mepiadre®, DFL, Rio de Janeiro, RJ, Brazil) using a periotome, with pendular movements performed in the mesiodistal direction (Nobel Biocare, Yorba Linda, CA, USA) to preserve the remaining buccal bone architecture and the osseous structures as well as the papillae ( Figure 2B-E). Thereafter, a careful curettage of the socket was performed to remove all granulation tissue. ...
Similar publications
The present article reports the treatment of a 7-year-old girl with maxillary hypoplasia associated with multiple tooth agenesis through maxillary protraction with skeletal anchorage and pterygomaxillary separation. Two titanium mini-plates were placed in the lateral region of the nasal cavity and used as anchorage for maxillary protraction with a...
Citations
... No que se refere à engenharia de tecidos, esse campo de estudo classificou três fatores necessários à regeneração tecidual, a saber: a existência de um arcabouço, moléculas de sinalização que mobilizam células progenitoras mesenquimais, conhecidas como proteínas morfogenéticas ósseas, e células osteogênicas (Bydlowski et al., 2009;De Molon et al., 2015). ...
... Relativo à opção da área doadora e o modo de coleta do enxerto, sem irrigação, em bloco (cortical) e particulado (medular), potencializa o número e a viabilidade das células al., 2023), minimizando custos e tempo operatório, na medida em que reduz o número de procedimentos associados à reabilitação (De Molon et al., 2015). ...
... Dessa forma, fica observado que, para alcançar uma excelente estética, resultado funcional e estabilidade com a RDI em alvéolos comprometidos, cuidados nos procedimentos cirúrgicos e protéticos devem ser seguidos. Logo, para otimizar a função e a estética, preservar os tecidos peri-implantares duros e moles remanescentes é mandatório, sendo essencial a execução de cuidados especiais no manejo do enxerto e na remoção do elemento dentário a ser substituído(De Molon et al., 2015). Posto isto, o uso de protocolos cirúrgicos consolidados devem ser seguidos para mitigar traumas durante a fase da exodontia, assim como na remoção do enxerto no leito doador e a implantação do fragmento ósseo no sítio receptor.Não se pode negligenciar, também, a técnica de fresagem do alvéolo cirúrgico. ...
No presente relato de caso, descrevemos a substituição de um dente anterior perdido por um implante, utilizando a técnica de Restauração Dentoalveolar Imediata (RDI) proposta pelo Prof. Dr. José Carlos Martins da Rosa. Como também, realizamos no pós-operatório a avaliação tomográfica das regiões doadora e receptora do enxerto. Nosso objetivo foi executar um implante dentário no elemento 21 e reabilitá-lo cirurgicamente e proteticamente de forma segura e previsível, buscando a restituição da função e da estética dos tecidos moles e duros. Relato de caso: paciente do sexo masculino, 46 anos, apresentou queixa de mobilidade e extrusão do elemento 21, o que foi comprovado ao exame clínico, radiográfico e tomográfico. Após planejamento do caso, propusemos a execução do implante cone morse (Avantt®, Systhex®, Curitiba, Brasil) com provisionalização imediata usando um munhão cimentado e enxertia com um fragmento retirado do tuber (RDI, restauracao dento alveolar imediata). Avaliamos a região de túber de maxila e comprovamos a disponibilidade óssea para realizarmos a técnica escolhida. Resultados: acompanhamos o paciente quinzenalmente e observamos uma ótima estabilidade do conjunto implante-provisório, bem como dos tecidos moles. Isso possibilitou a finalização da reabilitação com a cimentação da prótese do 21, construída com subestrutura de zircônia e recobrimento em cerâmica feldspática (NORITAKE®, Japão). Dessa forma, alcançamos o resultado estético e funcional acima das expectativas. Conclusões: Conclusões: Este relato demonstra que a técnica RDI é segura e cumpre os objetivos propostos pelo seu autor, na medida em que permite a reabilitação protética e cirúrgica em seção única e com material autógeno, o que minimiza custos e propicia resultados, os quais atendem ao alto grau de expectativa do profissional e do paciente.
... Due to advanced resorption of the alveolar crest, a mucoperiosteal flap was raised exposing the entire bone area, followed by the immediate placement of the implants. Then, reconstruction of the bone walls was performed using xenogenous bone graft to increase the bone width around the implant, followed by the placement of a collagen membrane [33][34][35]. This approach stimulates bone growth in the implant region, promoting optimal support for osseointe-gration and long-term implant stability. ...
Congenital dental agenesis, particularly in younger adults, can have a profound impact on aesthetics and overall quality of life. The scientific literature offers various management strategies for this condition, with orthodontic movement and implant-supported rehabilitation being central to treatment. However, achieving predictable and successful outcomes necessitates a comprehensive multidisciplinary approach. Such an approach integrates diverse professional perspectives to ensure accurate diagnosis, prognosis, and treatment planning, ultimately aiming to restore dental function and address aesthetic concerns effectively. In this case report, we present the successful rehabilitation of a young patient with congenital agenesis of the mandibular central incisors. The treatment strategy combined oral surgery (extraction of deciduous teeth and autogenous bone graft), orthodontic movement (opening spaces to allow implant installation), periodontics (connective tissue graft), implantology, and prosthetic planning. We detail the specific surgical approaches employed and discuss how their integration contributed to the overall success of the case. This multidisciplinary treatment approach not only restored dental function but also met the patient’s aesthetic expectations and enhanced the patient’s quality of life, highlighting the importance of a coordinated approach in managing complex dental conditions.
... Several approaches can be used for implant rehabilitation in the atrophic maxilla and/or mandible areas. These include: (a) bone grafting (autogenous, homogenous, xenogenous and alloplastic) [6][7][8][9][10][11] (b) short dental implants (measuring less than 8 mm in length) [12][13][14], (c) bone reconstruction with a vascularized free flap [3] (d) alveolar distraction [15,16] and (e) guided bone regeneration (GBR) [6][7][8]. ...
... Several approaches can be used for implant rehabilitation in the atrophic maxilla and/or mandible areas. These include: (a) bone grafting (autogenous, homogenous, xenogenous and alloplastic) [6][7][8][9][10][11] (b) short dental implants (measuring less than 8 mm in length) [12][13][14], (c) bone reconstruction with a vascularized free flap [3] (d) alveolar distraction [15,16] and (e) guided bone regeneration (GBR) [6][7][8]. ...
Dental rehabilitation following single tooth extraction in the esthetic zone is one of the most challenging clinical scenarios due to the high patient expectations and elevated level of technical skills needed. In contemporary dentistry, efforts have focused on improving both aesthetics and biological function for single tooth replacement with dental implants. This is achieved through advancements in implant materials, minimally invasive surgical techniques, and varies regenerative approaches combining different bone substitute materials. This article presents a comprehensive multidisciplinary treatment plan to address the complex challenges encountered after single tooth loss in the esthetic region. It explores strategies for implant rehabilitation in atrophic areas, including guided bone regeneration techniques for alveolar ridge preservation. Emphasis is placed on the versatility of xenogeneic bone grafts highlighting their crucial role in ensuring predictable and high-quality results aiming at restore the lost alveolar bone tissue. Additionally, the importance of autogenous connective tissue grafts is underscored for achieving superior aesthetic outcomes and promoting peri-implant health. Through a detailed case report, we illustrate how the application of these techniques led to successful oral rehabilitation in a patient with alveolar ridge atrophy for single tooth replacement. Moreover, this case highlights the clinical relevance and practical applicability of the chosen approaches that might help the clinicians to choose the best treatment option for similar cases. This reports provides valuable insights for professionals pursuing for satisfactory functional and esthetical outcomes in single implant-supported rehabilitation.
... In order to obtain long-term functional, biological, and esthetic outcomes with immediate dental implants in fresh extraction sockets, a proper surgical and prosthetic planning should be carefully considered taking into consideration the minimal surgical invasiveness, higher outcome predictability, and decreased treatment time and morbidity to the patient. In light of the scientific improvements related to surgical techniques, biomaterials, and implant surfaces, the clinicians are now able to recommend surgical and prosthetic treatments with increased soft and bone tissue long-term stability, short treatment period, and enhanced functional and esthetic outcomes [5][6][7]. ...
... Immediate dentoalveolar restoration (IDR), a surgical technique first described by da Rosa et al. [12] in 2013 is designated as a one-stage approach that permits atraumatic tooth removal, instant installation of implants, reconstruction of the buccal bone wall with autogenous graft and connective tissue graft, and, finally, provisional restoration at the same operatory time [4,[11][12][13]. IDR has been shown to have several advantages compared to the conventional protocol as follows: (a) lower overall treatment time; (b) reduced bone resorption; (c) immediate esthetically acceptable restoration; (d) greater patient acceptance; (e) faster return of function; (f) improvements in soft tissue profile; (g) stability of the soft and bone tissues; and (h) no need for removable prosthesis [2,5,6,12,14]. On the other hand, IDR has also some drawbacks mainly related to unpredictability of site morphology, limited amount of autogenous soft and bone tissue available, and the remaining bone defect between the bone wall and the implant [15][16][17]. ...
... To obtain successful outcomes using the IDR technique, it is necessary to perform atraumatic tooth extraction without vertical or horizontal incision (flapless surgery) to preserve the reminiscent soft and hard tissue prior to bone reconstruction and implant placement [6]. Raising a fullthickness flap in the IDR technique is not preconized since the elevation of the periosteum would probably result in bone loss in the long-term follow-up and might result in migration of the gingival margin due to soft tissue manipulation and detachment of interdental papilla. ...
Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient’s expectations.
... [3][4][5][6] İyi bir estetiği sağlamak için, interdisipliner bir tedavi planlanması klinik başarıda önemli bir rol oynar. [7][8][9] Diş kaynaklı Sınıf 3 maloklüzyonunun tedavisinde ortodontik tedavi yaklaşımları yeterli olabilirken, iskeletsel Sınıf 3 maloklüzyonu olan durumlarda ortodontik tedaviye ek olarak cerrahi prosedürlerin uygulanması gerekebilir. 10 Sınıf 3 iskeletsel maloklüzyonu olan kişilerde cerrahi yaklaşım olarak: mandibular geriletme, maksiller ilerletme veya bu ikisinin birlikte yapılması şeklindedir. ...
... In the literature, the added value of CBCT during orthodontic treatment has been well described [16,18] for the evaluation of detrimental effects on the supporting alveolar bone after orthodontic treatment and rapid maxillary expansion. In periodontics, CBCT images are important to evaluate buccal bone thickness before and after reconstruction of the buccal bone wall [16,19]. Moreover, the buccal cortical bone regions are often evaluated to avoid the risk of resorption of cortical bone margin in case of immediate implant placement [16]. ...
Background:
The use of cone beam computed tomography (CBCT) in dentistry started in the maxillofacial field, where it was used for complex and comprehensive treatment planning. Due to the use of reduced radiation dose compared to a computed tomography (CT) scan, CBCT has become a frequently used diagnostic tool in dental practice. However, published data on the accuracy of CBCT in the diagnosis of buccal bone level is lacking. The aim of this study was to compare the accuracy of intra-oral radiography (IOR) and CBCT in the diagnosis of the extent of buccal bone loss.
Methods:
A dry skull was used to create a buccal bone defect at the most coronal level of a first premolar; the defect was enlarged apically in steps of 1 mm. After each step, IOR and CBCT were taken. Based on the CBCT data, two observers jointly selected three axial slices at different levels of the buccal bone, as well as one transverse slice. Six dentists participated in the radiographic observations. First, all observers received the 10 intra-oral radiographs, and each observer was asked to rank the intra-oral radiographs on the extent of the buccal bone defect. Afterwards, the procedure was repeated with the CBCT scans based on a combination of axial and transverse information. For the second part of the study, each observer was asked to evaluate the axial and transverse CBCT slices on the presence or absence of a buccal bone defect.
Results:
The percentage of buccal bone defect progression rankings that were within 1 of the true rank was 32% for IOR and 42% for CBCT. On average, kappa values increased by 0.384 for CBCT compared to intra-oral radiography. The overall sensitivity and specificity of CBCT in the diagnosis of the presence or absence of a buccal bone defect was 0.89 and 0.85, respectively. The average area under the curve (AUC) of the receiver operating curve (ROC) was 0.892 for all observers.
Conclusion:
When CBCT images are available for justified indications, other than bone level assessment, such 3D images are more accurate and thus preferred to 2D images to assess periodontal buccal bone. For other clinical applications, intra-oral radiography remains the standard method for radiographic evaluation.
... 15 However, few case reports have described the use of this procedure for bone regeneration in localized bone defects. 15,17,18,[19][20][21][22] The aim of this paper was to describe the clinical applications of the maxillary tuberosity block autograft in small and moderate localized defects of the alveolar process around implants and teeth. ...
Objective:
Autogenous bone grafts are considered the gold standard due to their compatibility and osteogenic potential to induce new bone formation through osteogenesis, osteoinduction, and osteoconduction. The aim of this paper was to describe clinical applications of the maxillary tuberosity block autograft in small and moderate localized defects of the alveolar process around implants and teeth.
Clinical considerations:
Maxillary tuberosity is often used as a particulate graft for augmentation of deficient alveolar ridge or maxillary sinus prior to or simultaneously with implant insertion, but not as a bone block graft. The maxillary tuberosity block autograft may also provide a valuable bone source for challenging situations such as immediate implant placement into types II and III extraction sockets, treatment of horizontal and vertical bone defects with simultaneous implantation, reconstruction of circumferential defects around implants, and preservation of alveolar ridge.
Conclusions:
The advantages of the maxillary tuberosity include intraoral corticocancellous autogenous graft with fewer intraoperative difficulties, no need for donor site restoration, less morbidity, and an excellent correction of localized alveolar ridge defects.
Clinical significance:
Within the limitations of the presented case reports, the use of maxillary tuberosity block autograft has shown to be successful in alveolar ridges augmentation that lack both width and height.
... A similar protocol was also assessed by various authors with favorable results [37][38][39]. The chamber concept explained by Degidi et al. included immediate provisionalization of implants placed in fresh extraction sockets using a definitive abutment [37]. ...
... In that paper, ten patients were treated with immediate flapless extraction, implant placement, grafting with bone substitutes into the gap between the inner surface of the buccal wall and the implant surface, and the provisional crown was placed on the standard abutment [37]. De Molon et al., in 2015 [38], evaluated results of reconstruction of the alveolar buccal bone plate in compromised fresh socket after immediate implant placement followed by immediate provisionalization [38]. De Molon et al., in that case report in 2013, reported a hopeless maxillary left central incisor with loss of the buccal bone wall, which was treated with flapless extraction, immediate implant placement, and immediate reconstruction of the buccal bone plate using the tuberosity as the donor site (to obtain block bone and connective tissue grafts, as well as particulate bone). ...
... In that paper, ten patients were treated with immediate flapless extraction, implant placement, grafting with bone substitutes into the gap between the inner surface of the buccal wall and the implant surface, and the provisional crown was placed on the standard abutment [37]. De Molon et al., in 2015 [38], evaluated results of reconstruction of the alveolar buccal bone plate in compromised fresh socket after immediate implant placement followed by immediate provisionalization [38]. De Molon et al., in that case report in 2013, reported a hopeless maxillary left central incisor with loss of the buccal bone wall, which was treated with flapless extraction, immediate implant placement, and immediate reconstruction of the buccal bone plate using the tuberosity as the donor site (to obtain block bone and connective tissue grafts, as well as particulate bone). ...
Background:
Augmentation of the edentulous atrophic anterior region is a challenging situation. The purpose of this article was to evaluate the effectiveness of a collagenated cortical bone lamina of porcine origin for horizontal ridge augmentation in patients with inadequate alveolar ridge width undergoing immediate post-extraction implantation in the anterior sites, and to report on implant survival rates/complications.
Materials and methods:
The cases were extracted electronically from a large database according to these specific inclusion criteria: patients with inadequate alveolar ridge width in the anterior maxilla or mandible, who underwent immediate post-extraction implant placement and simultaneous alveolar bone reconstruction using xenogeneic cortical bone lamina. An additional layer of palatal connective tissue graft was inserted between lamina and the vestibular mucosa, for improving soft tissue healing. A collagenated bone substitute was additionally placed in the gap between the lamina and implant surface in all patients. The main outcomes were implant survival and complications.
Results:
Forty-nine patients with 65 implants were included. Patients' mean age at the time of implant surgery was 60.0 ± 13.6 years. The mean follow-up was 60.5 ± 26.6 months after implant placement. The implant survival was 100%. Four postoperative complications occurred in four patients. No specific factor was found to be associated with complication occurrence.
Conclusion:
The use of collagenated cortical bone lamina can be considered as a successful option for alveolar reconstruction in immediate post-extraction implant insertion procedures in anterior regions with inadequate alveolar ridge width.
... This is of great clinical relevance: As reported in a recent clinical study in which a total of 53 teeth were extracted in 30 patients, 28% of the sites presented some degree of buccal bone dehiscence, and 4% exhibited complete buccal plate loss in spite of applying minimally traumatic extraction measures. 5 Only a handful of clinical studies and case reports have provided information regarding the outcomes of different clinical protocols for the management of extraction sites presenting large bone dehiscences, regardless of whether immediate implant placement is performed [6][7][8][9] or not. [10][11][12] While most of these studies reported favorable horizontal and vertical bone gains, implant survival, and esthetic outcomes, with the exception of the only randomized clinical trial (RCT) conducted to date, 10 none of them provided data on important parameters such as volumetric alveolar bone and ridge contour changes, histomorphometric outcomes, or patient-reported outcome measures (PROMs). ...
... Adult subjects with tooth-bound single-rooted teeth (not including mandibular incisors) indicated for extraction who also presented with a large dehiscence defect affecting at least the coronal third of the buccal bone were eligible to participate in the study. The exclusion criteria were as follows: (1) any periodontal attachment loss > 1 mm affecting the interproximal sites of neighboring teeth; (2) current heavy tobacco use, defined as > 10 cigarettes per day; (3) uncontrolled diabetes mellitus, defined as HbA1c > 7.0; (4) severe hematologic disorders; (5) organ failure; (6) uncontrolled or severe metabolic bone diseases or disorders; (7) previous head and neck radiotherapy or chemotherapy within the past 12 months; (8) intake of medications known to largely influence bone metabolism; (9) pregnancy at the time of screening or trying to conceive; and (10) mental disabilities that may interfere with reading, understanding, and signing the informed consent and/or with following study-related instructions. In the screening visit, candidates were informed of the purpose, design, and timeline of the study, as well as expected benefits and possible risks associated with their participation. ...
This study evaluated a panel of clinical, dimensional, volumetric, implant-related, histomorphometric and patient-reported outcomes (PROMs) following reconstruction of dehiscence defects in extraction sockets with a minimally invasive technique using a particulate bone allograft and a non-absorbable dense polytetrafluoroethylene (dPTFE) membrane. Subjects (n=17) presenting severe buccal dehiscence defects at the time of single-rooted tooth extraction participated in the study. The mean vertical dimension of the dehiscence defects at baseline was 5.76±4.23mm. Subjects were followed up at 1, 2, 5 and 20 weeks postoperatively. The dPTFE barrier was gently removed at 5 weeks. CBCT and an intraoral scans were obtained at baseline and at 20 weeks. A bone core biopsy was harvested at 24 weeks before implant placement. Linear radiographic measurements revealed a mean increase in buccal bone height from baseline to 20 weeks of 5.66±5.1mm (p<0.0001). A total alveolar bone volume gain of 9.12% (p=0.075) was observed, while the ridge contour volume was reduced 10.83% (p=0.002). Although approximately half of the sites required some degree of additional bone augmentation at the time of implant placement, all implants could be placed in a favorable restorative position with adequate primary stability. Histomorphometric analyses revealed a mean mineralized tissue area of 31.04±15.22%, while the proportion of residual allograft particles and non-mineralized tissue were 16.23±10.63% and 52.71±9.53%, respectively. All implants survived up to 12 months after placement. PROMs were compatible with minimal discomfort at different postoperative stages and a high level of overall satisfaction upon study completion. This study demonstrated that the reconstructive procedure employed was successful and predictable in treating large, postextraction alveolar ridge deformities to optimize tooth replacement therapy with implant-supported prostheses.
... In this context, several approaches have been used to rehabilitate atrophic areas in the maxilla with dental implants. Among the various techniques used for rehabilitation of atrophic jaw, some of them can be highlighted: guided bone regeneration with rhBMP-2 [7][8][9]; osteogenesis by alveolar distraction [10,11]; autogenous, homogenous, and xenogenous bone graft [7][8][9][12][13][14]; bone reconstruction with vascularized free flap [15]; and the use of short dental implants (dental implants with less than 8 mm in length) [2,[16][17][18]. The use of autogenous bone graft is still the gold standard to rehabilitate atrophic jaws due to its osteogenic, osteoin-ductive, and osteoconductive properties [19]. ...
... In this context, several approaches have been used to rehabilitate atrophic areas in the maxilla with dental implants. Among the various techniques used for rehabilitation of atrophic jaw, some of them can be highlighted: guided bone regeneration with rhBMP-2 [7][8][9]; osteogenesis by alveolar distraction [10,11]; autogenous, homogenous, and xenogenous bone graft [7][8][9][12][13][14]; bone reconstruction with vascularized free flap [15]; and the use of short dental implants (dental implants with less than 8 mm in length) [2,[16][17][18]. The use of autogenous bone graft is still the gold standard to rehabilitate atrophic jaws due to its osteogenic, osteoin-ductive, and osteoconductive properties [19]. ...
Rehabilitation of atrophic maxilla with dental implants is still a challenge in clinical practice especially in cases of alveolar bone resorption due to peri-implantitis and pneumatization of the maxillary sinuses. Several surgical approaches have been employed to reconstruct the lost tissues allowing the proper tridimensional position of the implants. In this context, the aim of this case report is to describe a surgical and prosthetic approach to fully rehabilitate the atrophic maxilla with dental implants. The patient presented with unsatisfactory functional and esthetical implant-supported prosthesis with some of the implants already lost by peri-implantitis. The remaining three implants were also affected by peri-implantitis. Reversal prosthetic planning was performed, and a provisional prosthesis was fabricated and anchored in two short implants. Sinus floor augmentation procedure and onlay bone graft were then accomplished. After a healing period of 8 months, digital-guided surgery approach was performed to place the implants. Finally, a definitive prosthesis was installed. One-year follow-up has revealed stabilization of the bone tissue level, successful osseointegration, and a pleasant esthetic and functional result. A proper diagnosis and careful planning play an important role to enhance precision and to achieve patient esthetic and functional outcomes.
