international magazine of oral implantology

I case report _ edentulous sites Fig. 1a_Clinical view of tooth 12 prior treatment with similar recession on tooth 13. Distal papilla of 11 is missing. Fig. 1b_Standardized X-ray at base- line. The #12 tooth has a deep intra- bony defect on the mesial aspect. Fig. 2 & 3_Advanced periodontal breakdown at the upper right lateral incisor. The bony defect involves the buccal plate of bone. The neighbour- ing tooth has also intrabony periodontal defect. _Deep periodontal defects with advanced bone loss of the buccal cortical plate represent a challenge forperiodontaltreatmentintheupperfrontregion.Lit- eraturedatasuggestthatoneandtwo-wallperiodon- tal defects do not have tendency for complete peri- odontalregenerationandbonefill(Eickholzetal.1996, 1998,2000).Remainingresidualpocketscanalsojeop- ardize the long term result of periodontal treatment (Matuliene et al. 2008). Tooth extraction in the upper front region even without any periodontal defect will resultincertainamountoforo-vestibularandeventu- allyverticalshrinkageoftheoriginalsofttissuecontour (Schropp etal. 2003). Due to bone remodelling appro- priate implant placement cannot be achieved in most ofthecases.Socketpreservationanddifferentalveolar sitedevelopmentsareusedtooffsetthisunfavourable feature (Camargo & Lekovic, 2004; Lekovic & Kenney, 1997).Itisobviousthattheapplicationofoneofthese techniquescanbeofgreatimportancewhentoothex- traction is being considered at periodontally compro- misedteethwithadvancedbuccalplateinvolvement.It is not clear that ridge preservation procedures are ef- fective in limiting horizontal and vertical ridge alter- ations in postextraction sites. Comparing the clinical andhistologicalresultsobtainedbydifferentpreserva- tion techniques there is no literature data to support the superiority of one technique over another (Darby etal.,2009). Neverthelesseachpreservationtechnique provided better results than natural socket wound healing(Baroneetal.2008).Theeffectofextractionsite development on the changes of attachment level of neighbouringteethhasnotbeenclarifiedyet. While supraalveolar periodontal regeneration is still unpredictable (Sculean etal., 2004) vertical ridge augmentation has been successfully demonstrated in several publications (Barboza EP.,1999; Urban & Jo- vanovic, 2009; Merli & Lombardini, 2010; Beitlitum etal.,2010).Treatmentofverticalridgedeficienceshas been performed in edentulous areas without neigh- bouring teeth demonstrating advanced periodontitis. It was suggested that natural teeth with advanced periodontitis,mayimposeariskforaninfectionofthe augmented site and of membrane exposure originat- ingfromtheneighbouringperiodontallycompromised teeth (Karoussis et al., 2003; Hoffmann et al., 2007). Nevertheless in certain clinical situations, teeth pre- senting deep intrabony defects are located in close vicinityofthecompromisedalveolarridge. Intheseparticularcases,itisofclinicalinteresttosi- multaneously reconstruct both the intrabony peri- odontaldefectandtheresorbedalveolarridge,thusal- lowing proper insertion of dental implants. For those implantpatientshavingahistoryofchronicperiodon- titis it is inevitably important to reduce periodontal pocketsatnaturalteethto3mmandevenbelowtofa- cilitate proper individual plaque control and to reduce thechanceofperiodontalreinfection(Carnevaleetal., 2007). The importance of proper implant positioning Implant therapy of edentulous sites Authors_Balint Török, Istvan Gera, Agnes Meszaros & Peter Windisch, Hungary 32 I implants1_2011 Fig. 1a Fig. 1b Fig. 2 Fig. 3