Clinical case description:

Introduction:

one of the consequences of tooth loss is the atrophy of alveolar ridge. Bone loss due to tooth extraction can jeopardize rehabilitation with dental implants. Immediate implant installation and/or guided bone regeneration are feasible strategies to overcome alveolar ridge horizontal bone loss. Titanium mashes in combination with bone substitutes may be employed when vertical and horizontal reconstruction is needed.

Objective:

the aim of this case report is to illustrate a bone reconstructive technique of a severe vertical and horizontal bone loss at the anterior superior alveolar ridge using titanium screw, inorganic bovine bone mineral, L-PRF and allogeneic membrane to perform a guided bone regeneration.

Materials and Methods:

a female caucasian 55 years, with no systemic involvement, was refered to the Postgraduate service in implantology at the University of Ribeirão Preto - UNAERP for rehabilitation with dental implants. A computed tomography showed a thin alveolar ridge of the maxilla, indicating the need of a reconstructive of bone previously to implant placement. Therefore, it was performed a reconstructive procedure with bone substitute (Geistlich Bio-Oss^®, Geistlich Pharma AG, Wolhusen, Switzerland) covered with a perforated L-PRF (plasma rich in fibrin and leucocytes) membrane, covered with a titanium mesh fixed with screws, and subsequent placement of a collagen membrane. After eight months without exposition of the titanium mesh and an appropriate plaque control, it was requested another computed tomography to verify treatment results.

Results:

the tomographic images showed an evident bone improvement in the vertical and horizontal dimensions, with a radiopaque area similar to bone tissue, compared with the severe bone resorption. During the removal procedure of titanium mesh, a significant bone gain, compatible with mineralized tissue was observed, in accordance to the previous tomographic findings.