and 1 other(s)
Background Iatrogenic procedures can cause alveolar bone loss. Arsenic trioxide was used to devitalize pulp tissue. Its prolonged leakage leads to toxic effects with necrosis of the periodontium. Treatment of alveolar defects Siebert III is to provide bony ridge to allow maxillary arch continuity. Staged reconstructive grafting may treat such defects. Complications can result from harvesting bone graft. Different surgical techniques have been proposed to treat deficient ridge, including Ti-Mesh. Aim The purpose of this report is to describe the treatment of an iatrogenically induced cleft like defect using Ti Mesh and graft material. Materials and Methods A 65-year-old Caucasian female presented with a chief complaint of tooth #21 mobile. Radiographic examination revealed congenitally missing #12 and #13 to #23 with incomplete endodontic treatment previously done with arsenic trioxide. #21 had pocket depth deeper than 10 mm, with “grade 3” mobility, and recession. Endodontic retreatment was done for teeth #12 to #23. Endodontic surgical treatment was performed on #21, leading to more scar tissue and tooth extraction. Six weeks later CBCT was taken. Bone resorption extended to the base of the nasal bone and between buccal and palatal plates. Facial and palatal flaps were raised. Decortication was done. A Ti-mesh was secured with screws to protect allograft, a collagen membrane was placed. Primary closure achieved. Laser was used to stimulate healing. After 2 weeks the Ti-mesh was partially exposed in the palate and removed 6 weeks later. The dehiscence reduced progressively. After 5 months a CBCT was taken. Results. The site had gained a large amount of bone, to close the buccal-palatal cleft. Clinically the ridge was broad buccopalatally. A slight concavity in the soft tissue was noticed, which will be managed with soft tissue graft at 2nd surgery. Conclusion and Clinical Implication. Ridge reconstruction of maxillary defect cleft-like using Ti mesh and particulate bone can be achieved. Severe bone defects in the anterior maxilla can be repaired with membranes and bone grafting without the using of more invasive techniques.
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