Rehabilitation of Surgically Relocated Integrated Dental Implants With and Without Bone Morphogenesis Protein-2
In the following case report, three osseointegrated implants placed in a dysfunctional and nonaesthetic position were successfully relocated with innovative surgical techniques were followed by a comprehensive dental rehabilitation. The goal of this report is to communicate the surgical techniques used to successfully relocate dental implants rather than replace them. Two techniques were used for these implants relocation. One technique consisted of displacing the integrated implant with some similarity to the alveolar distraction osteogenesis but without using the distraction device. The second surgical technique involved the displacement of the 2 adjacent implants, similarly to the first approach, except that an osseoinductive molecule, recombinant human bone morphogenetic protein-2, was used for guided bone growth. It was possible to relocate dental implants within bone blocs and rehabilitate them to adopt new dental abilities by complying with bone regeneration parameters. However, advanced treatment planning with computerized tomography scans, parametric software, and stereolithography models as well as guided surgery and bone regeneration products were used.
Patient's complaints: tooth #8 up into her palate causes speech impediment; poor aesthetics of teeth #9 and 10.
Computerized tomography scan with parametric software reveals proximity of implant #8 to the nasal cavity floor. Buccal bone plates of all maxillary implants are dehiscent, covering one-half to two-thirds of the implant surface.
Figure 3. Acellular dermis collagen membrane installed through tunnelization. Therapeutic goal was to increase soft tissue thickness and stimulate vascularization where the operation will take place. Figure 4. Stereolithographic model with coloration of implants #7–10 is developed for the surgery. An osteotomy surgical guide was prepared based on the stereolithographic model. Purpose was to locate osteotomy lines, reduce the iatrogenic risks, and increase the surgical prognosis. Figure 5. Implants #9 and 10 very close to one another; the soft tissue surrounding the implants is deficient. Note the absence of keratinized tissue between implants #9 and 10. These implants are apical with regard to the alignment of the teeth. Figure 6. Based on the alignment and aesthetics required for the creation of new crowns cemented to the implant, a model is prepared with the repositioning of the abutment of implant #8. Afterward, an abutment repositioning guide will serve to relocate the implant during surgery. Figure 7. The osteotomy surgical guide is placed on the relevant site. Guide stability confirms its position on the sought site. Figure 8. The bone bloc is separated and relocated with the implant abutment positioning guide. Figure 9. Second relocation surgery of implants #9 and 10. The implants are relocated with the repositioning guide and secured with external fixation screws. Note the significant implant relocation and the slight bone residue around the implants. Figure 10. A physical barrier made with a titanium mesh maintains a space between the bone near the operated site and the soft tissue. The recombinant human bone morphogenetic protein-2 collagen support is placed between the titanium mesh and the bone. Figure 11. A free gingival soft tissue autograft is placed where there is complication.
Figure 12. Complete dental rehabilitation. The dental implants restored with 2 sections of matching crowns. Given the week ratio crown/implant #10, the occlusion is adjusted on this implant, as if crown #10 was a cantilever. Figure 13. Frontal view; significant improvement of the implant-supported crown aesthetic profile. Figure 14. Smile view. The occlusal line harmony and the incisor elongation translate into a more harmonious smile.
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