A 45 year old woman patient arrives at the clinic due to an abscess. During the clinical control a horizontal root fracture of the 12 is noted which had undergone an endodontic treatment. A treatment providing the element avulsion and an immediate implant insertion are suggested, since the socket is intact, and a temporary prosthesis through a fibreglass bridge which adheres to the adjacent teeth and guides the growth of the emergence profile. During the X-ray analysis an intact vestibular cortical and a sufficient apical bone volume are noted at
the 12 which allowing the immediate implant insertion. The root fracture is subgingival but supracrestal. The fractured fragments are avulsed, a Kohno implant of 3.80 x 11.5 mm without lifting the flaps is inserted and the gap is filled with a mix of heterologous and autologous bone collected during the drilling. In this case there is no need to use a connective graft. Finally a fibreglass and composite bridge is manufactured for a perfect camouflage in harmony with the other elements present in the mouth. At the 7 day follow-up a positive evolution of the fistula, which is disappearing, is noted and the tissues are adapting to the shape of the temporary bridge. However, after 4 months of osseointegration of the implant, even though any flap was not lifted, the avulsion was performed scrupulously and the gap has been filled with bio-material, a large vestibular bone resorption occurred to the implant leaving a concavity. The peri-implant tissues will not generate a long term stability to our rehabilitation and represent a limit for the achievement of a natural aesthetic. At the removal of the temporary and the healing abutment, from an occlusal point of view the defect is even more evident. Therefore a connective tissue graft from the palate is decided to be inserted, which gives long term volume and health to our treatment. After the operation you can observe how the aspect is improved and the prognosis is more favourable. In the end, from the 7 month image the proper growth and integration of the restoration and the peri-implant tissues can be appreciated.
