Case presentation :
A 48-year old female patient was referred to the Outpatient and
Implantology department of the University Dental Clinic of Monastir -
Tunisia for an implant rehabilitation. She was non-smoker and the
medical history did not reveal any significant systemic diseases.
Clinically, she presented two edentulous sites ; the first one was
located in the right maxilla (tooth 16 and 17), while the second was
located in the right mandible (tooth 47). Only the management of the
mandibular site will be described in this paper.
A dental panoramic radiograph (OPG) was prescribed and showed a
radiopaque lobular lesion in the site of tooth 47. Later, the CBCT’s
coronal sections enabled a better vizualisation of the lesion. The
findings of the radiological examination were attributable to focal COD.
(Figure 1, Figure 2).
The patient was informed of all the prosthetic solutions and the
possible complications, and still requested an implant rehabilitation.
An informed consent was signed prior to the procedure.
The implant surgery was performed in 3 steps to minimize the risk of
infection :
- 1st stage: After local anesthesia, a crestal incision completed with 2
partial intra-sulcular incisions on the adjacent teeth were performed.
Then, a full-thickness flap was elevated and the drilling sequence was
carried out. Afterwards, tooth 48 was extracted because of dental decay
and the flap was repositioned and sutured. (Figures 3,4,5,6,7,8).
Despite the prescription of an association of antibiotics
(amoxicillin-clavulanic acid) after the first surgery, the 7-day
check-up revealed signs of infection such as pain and local swelling.
The abscess was drained and a betadine wash was performed to control the
infection. (Figure 9).
- 2nd stage : 3 weeks afterwards: the flap was re-opened, an implant
(4.2 mm x 10 mm, Kontact®, Biotech dental, France) was placed into the
prepared site and the cover screw was put in place. Finally, the flap
was sutured. (Figures 10, 11, 12).
- 3rd stage : 3 months after the 2nd stage : the cover screw was
replaced by the healing abutement. (Figure 13).