González David, Olmos Gema, Cabello Gustavo, Saavedra Carlos, García-Adámez Ramón
Int J Esthet Dent. 2020;15(1):68-91.
Periimplantitis in a malpositioned maxillary anterior implant is one of the most challenging situations in implant dentistry. Since the regenerative treatment can often be unpredictable and have esthetic consequences such as soft tissue recession due to flap raising, extraction is sometimes recommended. In order to place a new implant after extraction, a bone regeneration procedure must be carried out. This implies raising a flap and therefore the risk of further interproximal gingival recession. In the case presented in this article, a hopeless implant at position 11 presented severe periimplantitis and soft tissue recession, which also affected the mesial part of tooth 12. Tooth 21 had a root canal treatment and a crown. After the implant extraction, a minimally invasive simultaneous bone regeneration and soft tissue graft procedure was performed to reconstruct the remaining ridge using xenograft, a collagen membrane, and a connective tissue graft (CTG). Ten months later, in order to improve the ridge profile, an augmentation procedure was carried out using a CTG. Three months later, an implant was placed and immediately loaded. Three months after loading, the right lateral incisor that still presented a mesial gingival recession was slowly extruded by orthodontic treatment until the papilla was symmetrical to the contralateral one. At the end of the orthodontic extrusion, an implant-supported crown was placed at position 11 and a tooth-supported crown delivered in place of tooth 21. A composite restoration was performed on tooth 12. One year later, the soft tissue level was almost symmetrical at incisor level and the periimplant bone level at implant 11 was stable.
上颌前牙种植体位置不佳导致的种植体周围炎是种植牙科中最具挑战性的情况之一。由于再生治疗往往不可预测，且会产生美学后果，如翻瓣导致软组织退缩，有时会建议拔牙。为了在拔牙后植入新的种植体，必须进行骨再生程序。这意味着要翻瓣，因此存在进一步导致邻间牙龈退缩的风险。在本文介绍的病例中，11号位置的一颗无望保留的种植体出现了严重的种植体周围炎和软组织退缩，这也影响到了12号牙的近中部分。21号牙进行了根管治疗并戴了牙冠。在种植体拔除后，采用异种骨移植材料、胶原膜和结缔组织移植（CTG）进行了微创同步骨再生和软组织移植手术，以重建剩余的牙槽嵴。十个月后，为了改善牙槽嵴形态，使用CTG进行了增量手术。三个月后，植入了一枚种植体并立即进行加载。加载三个月后，仍存在近中牙龈退缩的右侧侧切牙通过正畸治疗缓慢伸出，直到龈乳头与对侧对称。在正畸伸出结束时，在11号位置放置了一枚种植体支持的牙冠，并交付了一枚牙支持的牙冠来替代21号牙。对12号牙进行了复合树脂修复。一年后，切牙水平的软组织水平几乎对称，11号种植体的种植体周围骨水平稳定。
