São Leopoldo Mandic Clinic - CPO SL-Mandic, Campinas, São Paulo, in the Master's degree in periodontics in 2006.
Female, 28 years old patient with melanodermia and significant bilateral bone loss located between canine and the upper right and left first premolars (Fig. 1 and 2) complaining of aesthetically compromised smile.
Usually the cosmetic rehabilitation of the site is performed by the practitioner through the use of connective tissue graft, the donor area being the palate to increase the tissue volume; this technique has the disadvantage of a longer surgical time, increased morbidity, and significant postsurgical discomfort.
The technique proposed in the present case was the use of alloplastic material, specifically hydroxyapatite HAP-91 Ravioli (Fig. 3) due to its texture and weaving; such material being scientifically proven for the regularization of bone volume.
After being properly clarified on the procedure, the patient agreed to the procedure, being properly medicated.
After being anesthetized, a cul-de-sac incision and two relaxing incisions are performed, Newman technique (Fig. 4), moving the tissue along with the periosteum and causing a total loosening of the tissue, exposing the maxillary bone (fig. 5). Then it was made a matrix with suture paper (sterile) to cut the ravioli of hydroxyapatite in the required size (fig. 6). After decorticalizing the maxillary bone for blood supply of the graft (Figure 7), it was positioned the ravioli of hydroxyapatite (HAP-91) (fig. 8 and 9). Once confirmed the correct position and volumes, suture with 5-0 Vycril thread was performed (fig. 10).
For the preservation of the surgical bed, the patient was asked to avoid compression of the region as well as to maintain hygiene and gentle brushing.
The correction of bone defect showed satisfactory results after 5 months (right side fig. 11) (left side fig. 13), and after 11 months (right side fig. 12) (left side figure 14). We avoided the use of a donor area, in this case the palatal tissue, thereby causing less morbidity and significantly reducing the surgical time with a less complicated post-surgery.