CLINICAL FINDINGS
  • Horizontally fractured left central incisor
  • Apically positioned facial gingival height of contour at left central and adjacent lateral incisor
  • Multiple recession defects throughout oral cavity
  • Deficient gingival contours in esthetic zone

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    Pretreatment panoramic radiograph showed fractured left central incisor planned for extraction and implant replacement.

    PP
    Dr. Paul Petrungaro
    Moderator · IML CaseRounds™
  • Importance of attached keratinized tissue for periodontal and implant health
  • Comparison between autogenous connective tissue grafts and acellular dermal matrix grafts
  • Advantages of acellular dermal matrix:
    • No palatal donor site morbidity
    • Unlimited graft availability
    • Reduced surgical trauma
    • Improved esthetics and patient acceptance
  • Role of thick soft tissue biotype in implant success
  • Immediate implant placement with simultaneous soft tissue augmentation
  • Use of PRP to enhance healing and graft integration

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    Surgical

    TOPIC A- SOFT TISSUE REPAIR and MANAGEMENT

    Fractured left central incisor requiring replacement with an implant while maintaining esthetics and avoiding damage to adjacent teeth.
    PATIENT SUMMARY
    AGE / SEX
    24
    CHIEF COMPLAINT
    Fractured left central incisor requiring replacement with an implant while maintaining esthetics and avoiding damage to adjacent teeth.
    ASA CLASS
    Class I
    SMOKING
    Non-smoker
    KEY MEDICATIONS
    WORKING DIAGNOSIS
  • Horizontally fractured maxillary left central incisor
  • Gingival recession with deficient keratinized tissue and soft tissue asymmetry in the esthetic zone
  • Thin/deficient soft tissue biotype requiring augmentation prior to definitive prosthetics

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    DR. PAUL'S TREATMENT PLAN
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    1. Atraumatic extraction of fractured left central incisor
    2. Immediate implant placement
    3. Bone grafting with mineralized cancellous chips and platelet-rich plasma
    4. Immediate provisional restoration
    5. Simultaneous soft tissue augmentation using acellular dermal matrix graft (AlloDerm)
    6. Tunnel grafting technique with coronally advanced pouch
    7. Frenectomy with Nd:YAG laser to facilitate coronal advancement of tissues