Subsequent tooth extraction, alveolar bone loss and structural changes of the soft tissues can be predicted. The numerous alterations in the alveolar process may lead to difficulties at the time of implant placement when a prosthetically driven implant position is required.¹

The challenge in treatment is when the buccal bone plate presents a dehiscence type defect. Elian et al. described a facial-palatal socket classification where risks could be potentially assessed in regard to potential midfacial recession depending upon the existing socket condition.² Type 1 sockets were classified as having the buccal bone plate and soft tissues completely intact; Type 2 where the soft tissue was present but a dehiscence bony defect existed, indicating the partial or complete absence of the labial bone plate; and Type 3 where a midfacial recession defect occurred, indicative of loss of the labial bone plate and soft tissues.

Motivated by the complexities of restore bone and function after loss of this structures, the aim of this article was to evaluate prosthodontic treatment and soft tissue stability in an extraction socket with advanced buccal bone resorption, through the use of implant-supported single fixed prosthesis.

The patient was a 29-year-old female, without systemic disease, completely dentate, with a thick-scalloped gingival biotype.³ The radiographic exam showed the presence of advanced buccal bone resorption secondary to a root infection of the maxillary right central incisor (Tooth 1.1) (Fig. 1- A) and a large osteolytic area on the buccal aspect of the root (Fig. 1-B). The patient’s main complaint was aesthetic.

Fig. 1

In a first surgical phase, the right central incisor was extracted using an atraumatic periotome technique (Fig. 2-A). Then, one implant was placed (Tapered Screw-Vent 3,7x13, Zimmer Biomet Dental, Palm Beach Gardens, FL) in the palatal plate of the socket with an average surgical torque of 40 Ncm. After this, a resorbable collagen membrane (BioMend Extend, Zimmer Biomet Dental, Palm Beach Gardens, Fl) (15mmx20mm) was adapted to the bone defect and placed in a position to recreate the buccal plate (Fig. 2-B). Subsequently, particulate cortical bone allograft (Puros Cortical Allograft Particulate, Zimmer Biomet Dental) (0,5 cc) was compacted into the site to fill the space between the collagen membrane and the dental implant (Fig. 2-C). Finally, a screw retained provisional restoration was performed using the extracted natural tooth (Fig. 2-D and 2-E). The emergency profile was established by simply adding composite (flowable), until the desired contours were achieved.

Fig. 2

Six months after the implant placement, osseointegration was clinically confirmed. Radiographic and clinical follow-up after 6 months showed a favorable evolution of the implant (Fig.3A). No mechanical or biological complications were seen throughout this observation period. The buccal gingival margin was in a correct position. The osteolytic zone was a follow-up with controls and, the decision of the patient wasn't submitted to invasive treatment.

Fig. 3

After several stages, the final restoration with a zirconium dioxide abutment and a full ceramic crown was obtained and cemented (Fig.3B).

The dual zone is divided into two regions: the tissue zone and bone zone. The tissue zone is the labial-palatal dimensional change of the vertical region of tissue defined as ranging from the free gingival margin (0 mm) to the labial crest of bone mid-facially. The bone zone is the tissue apical to the osseous crest.⁴

This case report describes the resolution of an implant-supported rehabilitation with advanced buccal bone resorption. This case shows that minimally invasive extraction and grafting techniques satisfied the critical requirements needed for socket type 2 repair. This is particularly important in the aesthetic zone.^4,5,6 The use of particulate bone graft and a resorbable collagen membrane is a predictable technique to manage the lack of the buccal plate in a thick-scalloped gingival biotype.⁷ Placing a bone graft into the residual gap around an immediate fresh-socket anterior implant with a screw-retained provisional restoration acting as a prosthetic socket seal device, allows to achieve predictable results in terms of implant success as well as soft and hard tissue new formation and stability. Others authors have had similar results with the same technique for reconstruction of the buccal plate. Sarnachiaro et al.⁸ reported a case series and demonstrates that placing a bone graft, absorbable membrane, and custom-healing abutment at the time of immediate postextraction implant placement results in radiographic reformation of the labial plate dehiscence defect at 6 to 9 months posttreatment. Several factors can influence the amount of labial plate thickness reconstruction such as the amount of labial plate loss, preoperative soft tissue inflammation, and periodontal phenotype.^8,9,10,11,12

The use of a natural teeth to build a temporary crown over a dental implant is a widely used technique. It has a several advantages like return the natural anatomy of the teeth and allows create a desire emerge crown profile. The extracted teeth was cleaned and conditioning with phosphoric acid 37 % , after of this hybridized with dental adhesive and adapted with composite resin (A3) and polymerized. These two characters are too important for patients because they can recognize like an Own tooth without an adaptation period and for dentists too because is a versatile and quick technique.

Further research is required to assess the long-term stability of reconstructed labial plates of Type 2 sockets on CBCT (Cone beam computed tomography) with a larger number of patients. Additionally, the histologic evaluation of the reconstructed buccal plate would be important, as this would provide both qualitative and quantitative data on the type of tissues regenerated.

This technique allowed predictable esthetics/functional results and soft tissue stability in a thick-scalloped gingival biotype using a single fixed prosthesis.