international magazine of oral implantology

I case report _ edentulous sites Fig. 10_The horizontal dimension of the implant site is already satisfac- tory but its vertical dimension needs further augmentation. Fig. 11 & 12_Surgery 2: implantation with simultaneous hard tissue aug- mentation using a BioOss and titanium membrane. Fig. 13a–c_Radiological follow up of the augmented site development. a) Standardized X-way prior to im- plant placement. Radiographycal bone fill can be seen in intrabony de- fects of the neighbouring teeth. b) Radiological view after 9 months healing of implant placement and si- multaneous hard tissue augmenta- tion. c) The platform shifted abut- ment is fixed to the implant. cosalflap.Additionallytheoralflapattheearliertooth removal site was covered by a connective tissue graft withanepithelialcollar.Theperiodontaldefectandthe edentulous ridge were either filled and overfilled ver- tically and horizontally with BDX (Bio- Oss®, particle size 0.25 to 1.0 mm, Geistlich AG, Wolhusen, Switzer- land) (Case1and 3) or no bone grafting material was used(Case2).Aftergrafting,abiodegradablecollagen membrane of porcine origin (Bio-Gide®, Geistlich AG, Wolhusen, Switzerland) was trimmed and adapted over the graft (Case 1 and 3) . Finally the buccal mu- coperiosteal and the oral “CTG reinforced” flaps were re-positioned by avoiding any extra flap mobilizing procedure and closed with vertical mattress sutures (5.0 non-resorbable polyamide monofilament, Braun AG, Tuttlingen, Germany). Surgery2 Soft tissue augmentation Following the above mentioned procedures if the width of the keratinized soft tissue allowed proper coverage after augmentation procedure simultane- ous augmentation and implant placement was per- formed. If the thickness and the width of the alveolar mucosawerenotsufficienttoprovidepredictablepri- marywoundhealingduringhardtissueaugmentation procedure, soft tissue augmentation was performed priortoimplantplacementAfreeautogenoussofttis- sue graft or a xenograft (Alloderm®, BioHorizons, Birmingham, AL, USA) was used in order to gain enough keratinized gingiva and deepen the vestibule attheimplantareausingamodifiedtunneltechnique (Azzi etal. 2009). The tissue harvesting technique has already been described before. Surgery3 Implant placement with simultaneous hard tissue augmentation One implant (Straumann Bone Level, Straumann AG, Waldenburg, Switzerland, and Nobel Replace Ta- peredEffect,NobelBiocare,Gothenburg,Sweden)was inserted with simultaneous 3-D hard tissue augmen- tationusingBDXandanon-resorbablemembrane(Ti- tanium membrane—FRIOS® Boneshield; DENTSPLY Friadent®, Mannheim, Germany) or a slow resorbable membrane(ResolutAdaptLT2530,Gore-Tex®,Newark, DE, USA) was fixed over it. A tension free wound clo- sure was achieved in all cases resulting in primary woundhealing. Surgery4 Abutment connection with non resorbable membrane removal Thesamesplitthicknessflapdesignwasappliedfor non-resorbable membrane removal and abutment connection. After surgery patients were instructed to take an- tibiotics (Augmentin, 3 x 625 mg/day for 1 week). Post surgically mechanical plaque control was not per- formedinthesurgicalandadjacentareaandchemical plaquecontrolwasmaintainedwitha0.2%chlorhex- idine solution twice daily (Corsodyl, GlaxoSmithKline). Sutures were removed at 14 days after surgery. Addi- tional recall appointments including supragingival professional tooth cleaning were scheduled biweekly for the first 6 postoperative weeks. Prior tooth extrac- tion each patient received a resin bond prefabricated bridge to provide immediate provisional prosthodon- ticreconstructionaftertoothextraction.Finallyallpa- tientsreceivedfixedprosthodonticrestorationi.e.PFM crownsoneachimplant. _Case 1 (Figs.1–14) A51years-oldmalepatientwasreferredwithgen- eralizedperiodontitisforacomprehensiveperiodontal treatment. At the upper right lateral incisor an ad- 34 I implants1_2011 Fig. 11 Fig. 12Fig. 10 Fig. 13a Fig. 13b Fig. 13c