Reconstruction of bone damage of teeth has been done for many years with

varying degrees of success (Feuillet, Keller, & Agossa, 2018). If the procedureis done

with a full understanding of the applicable biological principles and if the proper clinical

techniques are used, it can be very successful (Davis et al., 2020).

symptoms occur, multiple traumas are very difficult to overcome. Intraoral examination,

checking for bleeding and swelling are also mucosal tissue and gingival lacerations, when

it is covered with blood clots and suction clean with tampons alone (Hogrefe, 2020).

Abnormality such as tooth shape regardless of the socket, fracture crack too. Shakiness

of teeth horizontally and vertically by moving the fingers slowly assessed course,

percussion and pressure checks are very hurt (Natterson-Horowitz & Bowers, 2020).

Orofacial trauma causes great damage to the tissue structures supporting the teeth

(Pigg et al., 2021). To repair the damage/loss of tissue structures supporting the teeth, we

can do the restoration/remodeling tissue structures supporting the teeth (Hernández-

Monjaraz, Santiago-Osorio, Monroy-García, Ledesma-Martínez, & Mendoza-Núñez,

vascularization as well as the fixation stability of the bone construction (Dalisson et al.,

2021).

Bone is a dynamic tissue that undergoes a process of continuous remodeling in

stable condition and there is a balance between the processes of bone resorption and

deposition (Sykes, Bradfield, & Naidu, 2021). Remodeling process begins with the

activation phase which is described by the displacement of osteoclast precursors into the

bone area that will resorp and the occurrence of cell attachment and fusion of osteoclast

precursor cells into multinucleated osteoclasts (Jann, Gascon, Roux, & Faucheux, 2020).

The second phase is the phase of resorption, bone by osteoclasts resorption possibly

helped by the existence of mononuclear phagocytes to the resorption area (Sivaraj et al.,

mineralized.

Hydroxyapatite polyurethane sponge is a alloplast - bone graft material that has

the ability and osteoconduction and osteoinduction (Bajuri, Selvanathan, Dzeidee Schaff,

Abdul Suki, & Ng, 2021). Presence of bone morphogenic proteins (BMPs) to bone graft

material will alter the cells - the cells into osteoblasts around, helping mesenchymal cell

migration, adhesion and osteogenesis in intraboni damage. In the histological study of

this material showed the regeneration of cementum, periodontal ligament and alveolar

bone, in humans the presence of new attachment apparatus. Clinical studies have also

demonstrated an increase in probing depth and significant clinical attachment level.

mobility is present in the mandibular teeth, inflammation is present, and the patient has

difficulty chewing food.

Diagnose ; Cases of chronic periodontitis stage IV grade C, is a condition of periodontal

disease caused by gram negative bacteria for a long time, which results in alveolar bone

destruction >5 mm and affecting >5 teeth. Usually, acquired due to trauma, thereis a

fractured bone defect, and 20 remaining teeth are in the mouth, the condition is

exacerbated if the patient has systemic disease, poor oral hygiene, and is a heavy smoker.

Picturte 1. Flap gingiva lower jaw and wire splint

Picture 2. Bone graft

Picture 4. Flag gingiva upper jaw

solution of 3% peroxide. Enter hydroxyapatite polyurethane sponge - alloplast bone graft

material to the brim on the socket, reconstruction of the bone and teeth. Fit splinting on

tooth implant and its neighbors, fixasi must be strong to fight the force of gravity so that

may change as airline pilots do. Note the dental occlusion and articulation time of

implantation. Splinting using wires 0.4 mm. Tailoring gingiva toward the teeth crown

bridge should also be considered. Install the pack on the area of periodontal surgery well,

it will remain attached to 10 days.

The patient is given antibiotics metronidazole 500 mg 2x a day for 3 days, clindamycin

300 mg 2x a day for 6 days, the rapid reaction of sodium diclofenac 50 mg three times

daily until 6 days, mefenamic acid 500 mg 2 times daily until 6 days.Day 10th

3 months post-surgery, there is no bleeding on probing, probing depth of 3 mm,

2 mm. Patients are advised to do a re-entry operations.

Bajuri, Mohd Yazid, Selvanathan, Nanchappan, Dzeidee Schaff, Fatin Nadira, Abdul

Dalisson, Benjamin, Charbonnier, Baptiste, Aoude, Ahmed, Gilardino, Mirko, Harvey,

Davis, Karen D., Aghaeepour, Nima, Ahn, Andrew H., Angst, Martin S., Borsook, David,