Initial Situation

A 66 year old healthy female patient presented at the dental office (no periodontal disease, non-smoker). On the 2nd of February 2021 a vertically fractured tooth number 2.5 (Figure 1) was diagnosed. A CBCT confirmed the clinical diagnosis. In addition, loss of the buccal plate was evident on the x-ray (Figure 2).

Treatment Planning

Based on the clinical diagnosis the decision was made to extract the unrestorable tooth and a socket preservation technique, i.e. Ice Cream Cone Technique (Elian et al. 2007), was proposed to the patient in order to recreate the missing bone and avoid the triangular aspect of the alveolus at the time of implant insertion.

Surgical and Prosthetic Procedure

The patient underwent an atraumatic extraction of tooth number 2.5 under local anesthesia (Figures 3 and 4), and a permamem® membrane cut in shape of an ice cream cone with “ice scoop” was inserted, with the cone part placed between the periosteum and the residual buccal plate (Figure 5). cerabone® plus was then placed into the alveolus (Figure 6). The round part of the membrane was used as a trap door to close the surgical site. A figure eight resorbable suture was used to hold the membrane in place and to stabilize the treated site (Figure 7). Finally, an immediate post-operative x-ray was performed (Figure 8).

On the 17th of March 2021 the membrane became loose and was gently removed (Funakoshi et al. 2007) (Figures 9 and 10). On the 30th of June a new CBCT was taken to verify the healing of the site (Figure 11). On the 15th of July 2021 a BLX implant was inserted with a flapless approach, the insertion torque was over
35 Ncm (Figures 12 – 14). On the 11th of October 2021 a final restoration was delivered (Figures 15 – 17).

Final Score

The result was very satisfactory for both the patient and the clinicians.

Conclusion

This approach avoided major GBR after a complete healing of the socket. With a minimally invasive approach an excellent result was achieved. The unconventional use of a permamem® in this case demonstrates that such a membrane is a versatile one and should be part of the armamentarium of any clinicians.

References
Elian N, Cho SC, Froum S, Smith RB, Tarnow DP. A simplified socket classification and repair technique. Pract Proced Aesthet Dent. 2007 Mar;19(2):99-104; quiz 106. PMID: 17491484.
Funakoshi E, Yamashita M, Maki K, Kage W, Ishikawa Y,  Shinichiro H Guided Bone Regeneration with Open Barrier Membrane Technique. 2007, AO 22nd Annual Meeting.