Treatment of severe compromised tooth in the maxillary anterior area still poses great challenge to the clinicians. Several treatment modalities have been proposed to restore the function and aesthetics in teeth with advanced periodontal disease. The present study aims to report a case of traumatic injury of a left-maxillary central incisor with ridge preservation, orthodontic movement, and implant therapy. A 45-year-old woman underwent the proposed treatment for her left central incisor: basic periodontal therapy, xenogenous bone graft, and guided bone regeneration (GBR). Six months after the graft procedure, orthodontic movement by means of alignment and leveling was made and a coronal displacement of the gingival margin and vertical bone apposition could be observed after 13 months of active movement. Afterwards, a dental implant was placed followed by a connective tissue graft and immediate provisionalization of the crown. In conclusion, orthodontic movement was effective to improve the gingival tissue and alveolar bone prior to implant placement favoring the aesthetic results. Six years postoperatively, the results revealed height and width alveolar bone gain indicating that the treatment proposed was able to restore all the functional and aesthetic parameters. 1. Introduction Single implant therapy is a predictable treatment and has high success rates, at least when adequate bone volume is present. However, severe compromised tooth in the maxillary aesthetic region poses a great challenge to implant therapy. A correct diagnosis, absence of systemic conditions such as diabetes mellitus [1], an adequate treatment plan, improvement of surgical techniques, and multidisciplinary team planning play an important role in the success of complex cases [2]. According to Savi et al. [3] to achieve an adequate aesthetic result in anterior upper regions with dental implants, favorable periodontal tissue and bone conditions should be present. There are several treatment options to restore the aesthetic and function of a compromised anterior tooth. Different treatment modalities to hard and soft tissue formation at the site of tooth extraction are used, including forced orthodontic eruption [4, 5], ridge augmentation by means of bone and connective tissue graft [2], guided bone regeneration (GBR), immediate or delayed implant placement, and a combination of those [6]. Implant therapy can be complex due to numerous local anatomic or traumatic factors resulting in aesthetic commitment in the maxilla. These factors involve thin gingival biotype, thin buccal bone
References
[1]
R. S. de Molon, J. A. N. D. Morais-Camilo, M. H. A. Verzola, R. S. Faeda, M. T. Pepato, and E. Marcantonio, “Impact of diabetes mellitus and metabolic control on bone healing around osseointegrated implants: removal torque and histomorphometric analysis in rats,” Clinical Oral Implants Research, vol. 24, no. 7, pp. 831–837, 2013.
[2]
E. D. de Avila, R. S. de Molon, F. de Assis Mollo Jr., et al., “Multidisciplinary approach for the aesthetic treatment of maxillary lateral incisors agenesis: thinking about implants?” Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, vol. 114, no. 5, pp. e22–e28, 2012.
[3]
A. Savi, O. Turillazzi, S. Pizzi, M. Bonanini, and M. Manfredi, “Therapeutic management for post-traumatic treatment of the anterior dental region: a case report with long-term follow up,” Dental Traumatology, vol. 29, no. 3, pp. 234–237, 2013.
[4]
L. A. de Barros, M. de Almeida Cardoso, E. D. de Avila, et al., “Six-year follow-up of maxillary anterior rehabilitation with forced orthodontic extrusion: achieving esthetic excellence with a multidisciplinary approach,” American Journal of Orthodontics and Dentofacial Orthopedics, vol. 144, no. 4, pp. 607–615, 2013.
[5]
R. S. de Molon, E. D. de Avila, J. A. de Souza, et al., “Forced orthodontic eruption for augmentation of soft and hard tissue prior to implant placement,” Contemporary Clinical Dentistry, vol. 4, no. 2, pp. 243–247, 2013.
[6]
R. S. de Molon, E. D. Avila, J. A. Cirelli, et al., “A combined approach for the treatment of resorbed fresh sockets allowing immediate implant restoration. A 2-year follow-up,” Journal of Oral Implantology, 2013.
[7]
R. V. Abou-Arraj, N. C. Geurs, and A. H. Romanos, “Autogenous options for soft tissue management of extraction sockets in the anterior maxilla,” Clinical Advances in Periodontics, vol. 3, no. 4, pp. 259–268, 2013.
[8]
J. M. Lasella, H. Greenwell, R. L. Miller et al., “Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans,” Journal of Periodontology, vol. 74, no. 7, pp. 990–999, 2003.
[9]
R. S. de Molon, E. D. de Avila, J. A. de Souza, A. V. Nogueira, C. C. Cirelli, and J. A. Cirelli, “Combination of orthodontic movement and periodontal therapy for full root coverage in a Miller class III recession: a case report with 12 years of follow-up,” Brazilian Dental Journal, vol. 23, no. 6, pp. 758–763, 2012.
[10]
R. S. de Molon, E. D. de Avila, A. V. Nogueira, et al., “Evaluation of the host response in various models of induced periodontal disease in mice,” Journal of Periodontology, 2013.
[11]
R. S. de Molon, E. D. de Avila, and J. A. Cirelli, “Host responses induced by different animal models of periodontal disease: a literature review,” Journal of Investigative and Clinical Dentistry, vol. 4, no. 4, pp. 211–218, 2012.
[12]
L. Schropp, A. Wenzel, L. Kostopoulos, and T. Karring, “Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study,” The International Journal of Periodontics & Restorative Dentistry, vol. 23, no. 4, pp. 313–323, 2003.
[13]
N. A. Frost, A. A. Banjar, P. B. Galloway, G. Huynh-Ba, and B. L. Mealey, “The decision-making process for ridge preservation procedures following tooth extraction,” Clinical Advances in Periodontics, 2013.
[14]
M. Esposito, M. G. Grusovin, I. P. Polyzos, P. Felice, and H. V. Worthington, “Timing of implant placement after tooth extraction: immediate, immediate-delayed or delayed implants? A Cochrane systematic review,” European Journal of Oral Implantology, vol. 3, no. 3, pp. 189–205, 2010.
[15]
C. Nemcovsky, L. Beny, S. Shanberger, S. Feldman-Herman, and A. Vardimon, “Bone apposition in surgical bony defects following orthodontic movement: a comparative histomorphometric study between root- and periodontal ligament-damaged and periodontally intact rat molars,” Journal of Periodontology, vol. 75, no. 7, pp. 1013–1019, 2004.
[16]
C. E. Nemcovsky, M. Sasson, L. Beny, M. Weinreb, and A. D. Vardimon, “Periodontal healing following orthodontic movement of rat molars with intact versus damaged periodontia towards a bony defect,” European Journal of Orthodontics, vol. 29, no. 4, pp. 338–344, 2007.
[17]
F. Vignoletti, P. Matesanz, D. Rodrigo, E. Figuero, C. Martin, and M. Sanz, “Surgical protocols for ridge preservation after tooth extraction. A systematic review,” Clinical Oral Implants Research, vol. 23, supplement 5, pp. 22–38, 2012.
[18]
M. Lorenzoni, C. Pertl, K. Zhang, G. Wimmer, and W. A. Wegscheider, “Immediate loading of single-tooth implants in the anterior maxilla. Preliminary results after one year,” Clinical Oral Implants Research, vol. 14, no. 2, pp. 180–187, 2003.
[19]
E. Mijiritsky, O. Mardinger, Z. Mazor, and G. Chaushu, “Immediate provisionalization of single-tooth implants in fresh-extraction sites at the maxillary esthetic zone: up to 6 years of follow-Up,” Implant Dentistry, vol. 18, no. 4, pp. 326–333, 2009.
