Immediate dental implant with guided surgery and connective tissue graft – a clinical case report after 5 years of follow-up

DOI: https://doi.org/10.71440/2675-5610.11.1.26.40-45.art

Luis Paulo Diniz Barreto
Doutorando em Odontologia – Uerj; Professor adjunto da Faculdade de Odontologia – Unigranrio-Afya
ORCID: https://orcid.org/ 0000-0001-8381-8366

Plinio Mendes Senna
Professor associado da Faculdade de Odontologia – Uerj.
ORCID: https://orcid.org/ 0000-0003-0743-5376

 Marcela Melo dos Santos
Professora adjunta da Faculdade de Odontologia – Unigranrio-Afya
ORCID: https://orcid.org/ 0000-0002-9805-3260

RESUMO

Neste relato de caso, uma paciente saudável com 25 anos de idade apresentou-se ao atendimento com mobilidade grau II e comprometimento estético do dente 11. O exame clínico e radiográfico apontou uma fratura, lesão periapical e reabsorção radicular extensa, confirmadas pela tomografia computadorizada de feixe cônico (TCFC). Foi realizado o planejamento virtual do implante dentário para geração de um guia cirúrgico fabricado pela prototipagem, seguido de uma manobra de exodontia atraumática, instalação imediata de implante cone-morse e preenchimento do alvéolo com osso xenógeno. Após seis meses, um enxerto de tecido conjuntivo foi coletado e posicionado com técnica de tunelização. A reabilitação protética foi finalizada com uma coroa em óxido de zircônia sobre o implante dentário e uma faceta em porcelana feldspática no dente adjacente. O acompanhamento depois de cinco anos demonstrou excelente resposta tecidual e alto grau de satisfação da paciente. A combinação de planejamento digital, cirurgia guiada e manipulação tecidual com enxertos conjuntivos favorece a previsibilidade estética, o selamento biológico e a manutenção do volume gengival em regiões críticas. A abordagem interdisciplinar com cirurgia guiada e enxerto de tecido conjuntivo mostrou-se eficaz, segura e reprodutível na reabilitação estética anterior com implante imediato.

Palavras-chave – Implantes dentários; Cirurgia guiada; Estética dentária; Tecido conjuntivo; Reabilitação oral.

ABSTRACT

In this case report, a 25 years-old, healthy patient presented to the clinics with grade 2 tooth mobility and aesthetic compromise at the tooth 11. Clinical and radiographic local exams pointed to tooth fracture, periapical lesion, and external root resorption, later confirmed by cone beam computed tomography (CBCT). In this way, the virtual dental implant planning was made to generate a prototyped surgical guide, followed by atraumatic tooth extraction, the immediate placement of a Morse taper dental implant, and the use of xenogeneic bone as the socket grafting material. After six months, a connective tissue graft was harvested and inserted according to the tunneling technique. The prosthetic rehabilitation was completed with a zirconium oxide crown at the dental implant and a feldspathic porcelain veneer at the adjacent tooth. Five years later, the follow-up appointment showed excellent tissue response and a high level of patient satisfaction. The combination of digital planning, guided surgery, and soft tissue manipulation with connective tissue grafts enhances aesthetic predictability, biological sealing, and gingival volume maintenance in critical areas. The interdisciplinary approach using guided surgery and connective tissue graft proved to be effective, safe, and reproducible for aesthetic anterior rehabilitation with immediate implant placement.

 Keywords – Dental implants; Guided surgery; Dental esthetics; Connective tissue; Oral rehabilitation.

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