Using an Incidental Separated Segment of the Socket Wall as an Autogenous Block: A Lesson Learned Case Report of Three-Dimensional Bone Reconstruction in the Anterior Maxilla.

Abstract

This case report discusses a patient who was referred for the right maxillary central incisor extraction, with subsequent plans for implant replacement and reconstruction of the lateral incisor site. During the extraction of the tooth, a fragment of the distal wall of the socket was fractured. Given that the fractured piece resembled an autogenous block and was amenable to being screwed, it was subsequently positioned to address the coronal defect in the lateral incisor area following the implant placement. Small-sized cortical allograft powder was utilized to fill the area beneath the block, followed by coverage with a barrier membrane before closing the flap. After 4 months of reconstruction, clinical observations indicated successful bone reconstruction in both horizontal and vertical dimensions. Furthermore, the tooth socket, which had previously lost its distal portion, demonstrated promising and satisfactory reconstruction. The implant placed in the central incisor successfully osseointegrated without any complications. Due to the restricted space for the placement of two implants, the patient has been referred for further treatment plan involves a fixed prosthesis supported by implants in the central area, complemented by cantilevers in the lateral incisor site. The presented case demonstrates that when the bone dimensions of the incidentally separated fragments obtained during tooth extraction are adequate, and their suitability for screw fixation is confirmed, these fragments can effectively serve as autogenous blocks, even in vertical reconstruction.