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11/10/2021

Alveolar Filling of Posterior Element with Fracture Associated with Amalgam Restoration

Author: Thiago Roberto Gemeli

Large amalgam restorations are commonly associated with dental fractures, which can sometimes compromise the permanence of these working elements. When the replacement of a dental element by an implant becomes necessary and possible, a series of local assessments are carried out to make the result more assertive and predictable.

In addition to the detailed anatomical investigation of the region, it is up to the surgeon to plan the type, size, shape of the implant and the timing of its placement. Not infrequently, bone regeneration of the alveolus may be necessary beforehand in order to obtain better aesthetic and functional results.

Alveolar grafts help maintain three-dimensional space, providing strength to bone remodeling, intrinsic to tooth-dependent bone loss. Following the principle of occupying space long enough to select a slow degradative biomaterial seems to be the best decision.

Case report

The patient came to the private clinic reporting a tooth fracture of element 47 that had occurred approximately one year ago (Fig 1). The clinical and tomographic evaluation concluded that maintaining it was unfeasible, and the extraction was performed.

Condição clínica inicial do elemento 47

Fig 1 - Initial clinical condition of element 47.

Elemento 47 extraído, evidenciando extensa fratura associada à restauração de amálgama

Fig 2 – Element 47 extracted, showing extensive fracture associated with amalgam restoration.

Alvéolo do elemento 47 previamente ao preenchimento alveolar

Fig 3 – Alveolus of element 47 prior to alveolar filling.

The alveolus was completely filled with biphasic bioceramic (fig 4). Sixty days later, despite knowledge of temporal precocity and tissue immaturity, a 4.3x5 Arcsys (FGM) implant was placed in the region. And, 90 days after this procedure, surgical reopening was performed, with the aim of placing a prosthetic component.

Preenchimento alveolar com Nanosynt (1000-2000)

Fig 4 – Alveolar filling with Nanosynt (1000-2000).

The period between alveolar filling and reopening for prosthetic purposes was 150 days, sufficient to, in this case, allow the formation of bone tissue concomitant with the degradation of the biomaterial (fig 5).

Aspecto clínico do nanosynt após 150 dias. Observe a competente substituição óssea possibilitada pelo biomaterial

Fig 5 – Clinical appearance of Nanosynt after 150 days. Note the successful bone replacement made possible by the biomaterial.

A prosthetic component was attached to the implant and on top of it, a PEEK multifunctional transfer (Fig 6). Personalization of the transfer allows practicality, clinical versatility and savings, benefitting the case’s management as a whole. The objective of this procedure is to prepare the peri-implant tissues so that the final prosthesis fits without interference and also promotes greater aesthetic harmony and naturalness.

Personalização do transferente multifuncional em PEEK com resina composta tipo flow

Fig 6 – Personalization of the PEEK multifunctional transfer with flow type composite resin.

Resultado clínico da personalização customizada. Observe o adequado perfil de emergência obtido

Fig 7 – Clinical result of customized personalization. Observe the appropriate emergence profile obtained.

After the transfer impression, a ceramic crown was cemented over a frictional coping and fitted over the cement-retained abutment. In this way, a satisfactory result was obtained, allowing the aesthetic-functional rehabilitation of the element 47 region.

Instalação da coroa protética

Fig 8 – Placement of the prosthetic crown.