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Italian EditionAnno IV n. 2 - Maggio 2010 1. Tallgren A The continuing reduction of the residual al- veolar ridges in complete denture wearers: a mixed- longitudinal study covering 25 years. 1972. J Prosthet Dent 2003;89:427-35. 2. Araújo MG, Sukekava F, Wennström JL, Lindhe J Ridge alterations following implant placement in fresh extraction sockets: an expe- rimental study in the dog. J Clin Periodontol 2005; 32:645-52. 3. Barone A, Aldini N, Fini M, Giardino R, Calvo Guira- do JL, Covani U. Xenograft verss extraction alone for rid- ge preservation after tooth removal: a clinical and hi- stomorphometric study. J Pe- riodontol. 2008;79:1370-1377. 4. Chen ST, Wilson TG Jr, Hämmerle CH Immediate or early placement of im- plants following tooth ex- traction: review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants 2004; 19 Suppl:12-25. 5. Brkovic BMB, Prasad HS, Konandreas G, Milan R, Antunovic D, Sandor GKB, Rohrer MD. 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A report of two cases. Clin Oral Implants Res 2001;12:379–84. 18. Zerbo IR, Bronckers AL, de Lange G, Burger EH. Localisation of osteogenic cells and osteoplastic cells in porous beta-tricalcium phosphate particles used for human maxillary sinus flo- or elevation. Biomaterials 2005;26:1445-51. 19. AboElsaad NS, Soory M, Ga- dalla LM, Ragab LI, Dunne S, Zalata KR, Louca C. Effect of soft laser and bioactive glass on bone regeneration in the treatment of infra-bony defects (a clinical study). La- sers Med Sci 2009;24:387-95. 20. Ando Y, Aoki A, Watanabe H, & Ishikawa I. Bactericidal effect of Erbium YAG Laser on periodontopathic bacte- ria. Lasers in Surgery and Medicine.1996;19: 190-200. 21. Henry CA, Dyer B, Wagner M, Judy M & Matthewa, JL Phototoxicity of argon laser irradiation on Porphyromo- nas and Prevotella species. J Photochem Photobiol 1996; 34: 123-128. 22. Coffelt DW, Cobb CM, Mac- Neill S, Rapley JW, Killoy WJ Determination of energy density for laser ablation of bacteria. 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Photomed Laser Surg. 2006; 24:169-78. 28. Pinheiro AL, Martinez Ger- bi ME, de Assis Limeira F Jr, Carneiro Ponzi EA, Marques AM, Carvalho CM, de Car- neiro Santos R, Oliveira PC, Nóia M, Ramalho LM. Bone repair following bone graf- ting hydroxyapatite guided bone regeneration and infra- red laser photobiomodula- tion: a histological study in a rodent model. Lasers Med Sci.2009; 24:234-40. Bibliografia IT pagina 25 Il Tissucol è stato diluito 1:10 e miscelato con ß-TCP fino ad ot- tenere una consistenza sabbiosa. L’impasto è stata portata nell’al- veolo in piccole quantità con una siringa sterile e condensato con un compattatore manuale (Fig. 5). Dopo 1/2 minuti, l’innesto di- venta duro e stabile permettendo il riposizionamento coronale del lembo, che deve risultare passivo e privo di tensioni e con totale copertura del difetto. Dopo tre mesi la radiografia di controllo effettuata evidenzia una comple- ta ricostruzione del difetto con mantenimento dei picchi ossei interprossimali (Fig. 6). Alla ri- apertura si evidenzia la ricostru- zione della parete ossea vestibo- lare (Fig. 7) e, mediante tecnica piezo-espansiva, si inserisce un impianto di diametro 4,3 mm e lunghezza 13 mm. La radiografia di controllo conferma l’avvenuta integrazione dell’impianto (Fig. 8). Alla scopertura si evidenzia il soddisfacente rimodellamen- to dei tessuti e la stabilità della ricostruzione ossea ottenuta in senso vestibolo-palatale (Fig. 9). Secondo caso Paziente di sesso femmini- le di quarantacinque anni con atrofia crestale di 12 e 13 (Fig. 10). Dopo aver eseguito lembo a spessore totale per l’esposizione del difetto si evidenzia la man- canza assoluta della bozza cani- na che impedisce l’inserimento contestuale di impianti (Fig. 11). Si procede quindi mediante tecnica espansiva a inserimen- to di impianto osteointegrato in posizione 12 e contestuale decontaminazione con laser a diodi e ricostruzione ossea con tecnica ROC seguendo il proto- collo precedentemente descritto (Fig. 12). Alla riapertura in de- cima settimana si evidenzia la completa ricostruzione dell’am- pio difetto osseo che permette l’inserimento di un impianto di adeguate dimensioni in sede 13 (Fig. 13). Conclusioni Il presente studio suggerisce che l’utilizzo di un innesto di ß- TCP e Tissucol, in sinergia con l’uso del laser a diodi 810 nm per decontaminare i siti trattati, può prevenire il riassorbimento crestale post-estrattivo ed essere una metodica semplice, sicura e predicibilediricostruzioneossea. Fig. 9 Fig. 12 Fig. 10 Fig. 13 Fig. 11 26 Speciale RegeneRation