Use of a 2-Piece Small Diameter Implant in the Esthetic Zone in a Site of Chronic Residual Periapical Lesion: A Case Report with 1-Year Follow-Up and Histopathological Examination

Abstract

BACKGROUND Replacing missing teeth in the anterior region of the jaw can be challenging due to the limited available interdental space. Improper selection or inadequate placement of a dental implant in this situation can affect the adjacent anatomical structures negatively. What if, in addition, a residual intraosseous chronic inflammatory lesion was present? The objective of this case report is to demonstrate the step-by-step surgical procedures of replacing a maxillary lateral incisor in a patient with a residual lesion with a satisfactory outcome. CASE REPORT A 63-year-old female patient with an extracted maxillary lateral incisor presented for implant placement. Radiographically, a residual periapical lesion with mild atrophy of the alveolar bone and fairly low density with sparse trabeculation was noted. Owing to the limited restorative space, a Straumann Bone Level Tapered Implant Ø2.9 mm (Small Cross-Fit connection, Roxolid, SLActive) was placed. Histopathological evaluation revealed a definitive diagnosis of periapical granuloma. After 1 year, the clinical examination revealed a successful outcome, and the patient was satisfied with the result. CONCLUSIONS This case report shows a successful clinical and radiographical outcome after 1 year of a 2-piece small diameter dental implant, the Straumann Bone Level Tapered Implant, diameter 2.9 mm, replacing a missing maxillary lateral incisor after enucleating the lesion with histopathological examination.

Figure 1.

Intraoral photographs and a periapical radiograph, showing the missing maxillary lateral incisor space.

Figure 2.

The bony fenestration detected at the area of tooth #12 upon reflecting the flap.

Figure 3.

Access to the intraosseous lesion created through the alveolar bone.

Figure 4.

Intraoral photograph and a periapical radiograph showing the tooth-supported surgical guide.

Figure 5.

Position indicator placed in the implant bed to confirm positioning and angulation.

Figure 6.

The intraosseous lesion filled with particulate bone graft, Straumann 2.9 mm Bone Level Tapered Implant placed, covered by healing abutment, with additional particulate bone graft added at the buccal side to be covered by resorbable collagen membrane.

Figure 7.

The repositioned and sutured mucoperiosteal flap with periapical radiograph obtained after implant placement at the day of the surgery.

Figure 8.

Temporary Essix retainer to replace the missing maxillary lateral incisor during the healing period.

Figure 9.

Hematoxylin and eosin staining of the specimen revealed dense fibrous connective tissue with patchy chronic inflammatory infiltrate, blood capillaries and interspersed fibroblasts. Numerous cholesterol clefts with associated multinucleated giant cells, extravasated red blood cells and reactive bone spicules (left: ×10, right: ×100 magnification).

Figure 10.

Intraoral photograph and a periapical radiograph of the implant supported prosthesis replacing maxillary lateral incisor tooth #12 after 1 year.