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Journal of Oral Science & Rehabilitation No. 4, 2016

Journal of Oral Science & Rehabilitation Volume 2 | Issue 4/2016 21 O p e n h e a l i n g : A r e t r o s p e c t i v e a n a l y s i s ofthe surgicalareas. In 13.1%, ridge preservation was combined with bone augmentation. The ice-creamconetechniquewasusedin14%ofthe surgicalareas (26% ofallareas undergoing ridge preservation).In1.25%ofthesurgicalareas,bone defects were treated owing to implant removal. Atotalof32.5%ofthesurgicalareasincluded an extraction site in which immediate implant placement was performed. In 10.6% of the sur- gical areas, implants were placed into healed bonesimultaneouslywiththeaugmentationpro- cedure. Healing was uneventful in 90.6% of the sur- gical areas. Complications during healing occur- redin15areas(9.4%;Table4).Fiveoftheseareas had undergone ridge preservation, three areas ridgepreservationcombinedwithboneaugmen- tationandsevenareasaugmentationprocedures. The complications included premature mem- brane resorption (five areas: four covered with NBCM; one covered with JM), hematoma (three areas:twocoveredwithNBCM;onecoveredwith JM)andmembraneloosenedbytongue(onearea covered with NBCM). One patient developed an abscess (area coveredwithJM), one implantwas lost (area covered with NBCM) and another pa- tient complained about pain six weeks after sur- gery(area coveredwith NBCM).The patientwas successfullytreatedwith antibiotics. Othercom- plications were an exposed titanium mesh (one area covered with NBCM), wound dehiscence (one area covered with NBCM) and a fractured boneplateduringtheaugmentationsurgery(one area covered with NBCM). The graft was parti- ally lost in three surgical areas (1.9%; one area coveredwithJM;twoareascoveredwithNBCM). Thenumberofcomplicationsperdefectmor- phology type is given in Table 5. The number of morphology categories was too large to test for a correlation between the number of present bone walls and frequency of healing complica- tions. When only the two most frequent defect morphologies, that is, three- and four-wall de- fects, were compared with each other, no clear indication of a correlation was found. In both morphology types, the percentage of healing problems was very similar. When defect mor- phologywascodedasafigure(e.g.,2–3was2.5), a rank correlation of -0.052 was calculated. This indicated that defects with a higher number of bone walls slightlytended to have fewer healing complications. Healing complications occurred in 9.52% of the surgical areas covered with NBCM and in 8.82% of the areas covered with a different membrane type. The data did not indi- cate any correlation between membrane type and healing complications. I m p l a n t a t i o n o r s e c o n d a r y a u g m e n t a t i o n The average healing phase until implantation and/or secondary augmentation was 5.2 ± 8.1 months (0–58 months). Implants could be in- serted as planned in atwo-stage procedure in all but one surgical area. Flapless implantation was possible in 58.8% of the surgical areas. In86.88%ofthesurgicalareas,nosecondary augmentation was necessary (Table 6). Se- condary augmentation procedures were per- formed accordingtothetreatment plan in 12.5% of the surgical areas. They ranged from minor to extensive interventions and included sinus floor augmentation in nine surgical areas (three inter- nal sinus lifts), bone spreading in three and bone splitting intwo.Therewas onlyone surgicalarea in which an abscess required an unplanned re-augmentation and implant insertion was therefore not possible as planned. Discussion In this analysis, different collagen membranes and matrices, as well as tissue glue, were used in ridge preservation and augmentation proce- dures in an open-healing approach in avarietyof indications and defect types. The clinical out- comes were evaluated retrospectively. The pri- mary outcome parameter was the necessity to perform unplanned augmentation sincethiswas regardedtobeapartialfailureoftheregenerative treatment. The treatment was judged to be suc- cessful if no re-augmentation had to be per- formed or if an additional bone augmentation could be performed as planned at the time point of the first intervention. There was just one case in which an unplanned re-augmentation had to be performed owing to an abscess. Therefore, the surgical approach using open healing was successful according to the criterion of no unplanned re-augmentation being required in 99.4% of the surgical areas. However, owing to the retrospective and un- controlled nature of this study, it is not known whether a closed-healing approach might have resulted in improved bone regeneration ormight have reduced the extent of a planned secondary augmentation. Exposure of resorbable mem- branes maybe associatedwith premature mem- Volume 2 | Issue 4/201621

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