Single-stage management of a longitudinal root fracture associated with extensive bone resorption in the esthetic zone

a case report of immediate implant placement, guided bone regeneration,and immediate provisionalization

Abstract

Longitudinal fractures in endodontically treated teeth, especially after trauma, often present an unfavorable prognosis, associated with pain, fistula, and bone resorption. Immediate implant placement associated with regenerative techniques and immediate loading can offer a predictable solution for esthetic and functional restoration. Case report: A 35-year-old female patient presented with longitudinal fracture of tooth #12 with periapical lesion and fistula. Careful extraction, curettage, and socket decontamination with active oxygen gel (blue®m) were performed. A Helix Acqua GM Neodent implant (3.5 × 16 mm) with 60 N·cm insertion torque was placed, positioned 3 mm subcrestal. A universal abutment torqued at 20 N·cm was adapted, followed by placement of a provisional tooth previously milled in PMMA. The bone defect was filled with bone graft (Straumann® cerabone®)) and covered with a resorbable membrane (Straumann® Jason® membrane), associated with a de-epithelialized connective tissue graft from the palate. Clinical and radiographic follow-up demonstrated fistula resolution, provisional stability, preservation of peri-implant tissues, and favorable esthetic contour. Conclusion: Single-stage treatment combining immediate implant placement, immediate loading, bone grafting, connective tissue grafting, and active oxygen gel proved to be an effective alternative for root fracture cases in the esthetic zone, providing predictable rehabilitation with satisfactory clinical and esthetic results.