Tridimensional Reconstruction of a Complex Iatrogenic Defect Using Orthodontic Forced Eruption and Minimally Invasive...

As the use of dental implants has become more common, so has the frequency of complications and unforeseen outcomes. This article describes the treatment of a complex iatrogenic defect secondary to a failed implant (No. 7) and multiple bone-grafting attempts in the maxillary anterior region. The patient's revealing smile line and high-risk circumstances demanded the use of an interdisciplinary treatment approach with high potential for predictable esthetic results. Forced eruption was performed to restore the alveolar height deficit and develop the compromised hard and soft tissues around teeth Nos. 6 and 8. The subperiosteal minimally invasive (a)esthetic ridge-augmentation technique (SMART) was subsequently used to provide horizontal bone augmentation while preserving the soft-tissue architecture. After bone-graft integration, immediate postextraction implants were placed at Nos. 6 and 8 using a flapless approach, and a screwretained long-term polymethylmethacrylate provisional prosthesis was delivered during the same appointment. The synergy of these combined therapies resulted in a complete tridimensional reconstruction of the defect. Gingival and alveolar volumes and gingival margin levels were successfully restored.