Soft-Tissue Enhancement Combined With Biologically Oriented Preparation Technique to Correct Volumetric Bone Defects: A Clinical Case Report
The aim of the present case report was to illustrate how to obtain an ideal alveolar ridge contour by means of peri-implant soft-tissue management combined with the prosthetic approach of the biologically oriented preparation technique (BOPT). A patient presenting a moderate vertical and horizontal bone loss in the posterior maxilla was treated with sinus floor elevation and simultaneous implant placement. During the reentry procedure, the horizontal defect was corrected with an apically repositioned flap combined with a connective tissue graft. To increase the volume of the interimplant papillae, a pedunculated flap originating from the primary flap was turned within the interimplant space. BOPT one-time abutments have been employed to maximize the space available for the papilla-like tissues. A focused and combined surgical and prosthetic procedure has permitted enhancement of both peri-implant esthetics and function without the need for further invasive and costly bone regeneration techniques.
Figure 1. Clinical view before surgery of patients who showed edentulism and jawbone atrophies. Figure 2. Computed tomography dental scan showed moderate vertical and horizontal bone loss in the posterior maxilla.
Figure 3. Sinus floor elevation and contextual implant placement. Figure 4. Clinical view of the upper maxilla soft-tissue defect after implant placement. Figure 5. Connective tissue graft. Figure 6. Second-stage surgery consisted of a split-thickness apically repositioned flap combined with a subepithelial connective tissue graft. Figure 7. Semilunar incisions were made in the flap, and the tissue was then rotated toward the palate to create a papilla between the implant.
Figure 8. Occlusal soft-tissue view of the 2 healing screws. A horizontal augmentation is evidenced because of the connective tissue graft placed. Figure 9. Mesial and distal releasing incisions and the pedicle flap were fixed with a 6-0 suture. Collagen sponges were positioned in the donor site and sutured with cross-stitches. Figure 10. Occlusal view 3 weeks from the reentry procedure. Figure 11. A particular view of the reentry procedure. The abutments were screwed to the implants and used for impression.
Figure 12. Snap-fit impression with polyether material. Figure 13. Definitive abutments were prepared by the dental technician with the same emergency profile as the healing screw.They have been left in position during all the subsequent phases up to the delivery of the final crowns. Figure 14. Provisional resin crowns were prepared by the dental technician and enclosed a circular landmark with a previously determined diameter. Figure 15. Occlusal view after a 6-month period of soft-tissue maturation. Figure 16. Clinical view of the finished case with gold-ceramic definitive crowns. Figure 17. A colorimetric map elaborated by the software in which the color varied from blue, where the gingival thickness was decreased, to red, where the thickness was augmented.
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