With the emergence of new technologies, we make more accurate diagnoses that allow us to combine classic reconstructive techniques in the resolution of cases that have periapical lesions that compromise not only the dental organs but also the alveolar process. In this case, we present a 45-year-old female patient with systemic compromise of controlled type I diabetes mellitus, who has suffered from moderate-severe periodontal disease, accompanied by chronic periapical processes exacerbated over time.

All the interdisciplinary planning and management by disciplines were carried out to decide the best treatment plan for our case, taking into consideration that due to the extent of the lesion and compromise of the alveolar bone, it would not be possible to offer the application of an immediate loading protocol. Considering solving it in 3 different phases, beginning with a first phase of Surgery that includes: The extraction of the anteroinferior group, enucleation of the periapical lesion, bone curettage and the possibility of immediate reconstruction with the application of the 50:50 guided bone regeneration protocol combining autologous grafting of the ascending ramus of the mandible combined with bovine-type xenograft, combined with matrices of APRF+ (Choukroun protocol). Covering all the biomaterial with a collagen membrane made from slowly reabsorbing porcine dermis. With a resorption time between 6 and 9 months, this provides high stability in maintaining the space for new bone formation. In a second phase, the controls and planning are carried out with a new CBCT, to place 03 Neobiotech dental implants. Looking for the increase of vestibular keratinized tissue with connective tissue grafts, around the healing screws. In the third phase of treatment we decided to start the fixed implant-supported rehabilitation phase, achieving an acceptable functional aesthetic result.