international magazine of oral implantology

I case report _ edentulous sites 36 I implants1_2011 vanced periodontal defect was registered with tooth mobilityIII(seethestandardisedX-ray,Fig.1a–b).Deep periodontal pocket depths were assessed on the adja- cent teeth. After flap elevation a two-wall crater-like defectwasfoundonthemesialaspectofthetoothwith amissingbuccalbonyplate(Fig.2&3).Aftertoothex- traction the previously described step-by-step tech- niquewascarriedout(Fig.4–7).Asaresultofsurgery1, completedwithasofttissueaugmentation,thealveo- larridgeconfigurationallowedtheimplantplacement with simultaneous further augmentation (Fig.8–12). During abutment connection the 3-D reconstruction of alveolar ridge was observed around the previously supracrestally placed implant. This surgical approach allowed a re-entry procedure of adjacent periodontal defects, they presented bone fill and complete regen- eration of earlier one-wall defects. After soft tissue healingascrewretainedtemporarycrownwasplaced in situ to form an ideal emergence profile for further three months. This situation was then transferred to thecasttomakethepermanentPFMcrown.Seethefi- nal restoration on Fig. 14. _Case 2 (Figs.15–17) A54years-oldmalepatientpresentedanadvanced vertical bony defect on the mesial aspect of the right upper central incisor with excessive tooth mobility (Fig. 15). After tooth extraction an alveolar site devel- opmentwasperformedinthesamewaylikedescribed before without any bone substitute material. The sec- ond surgical phase was the previously described soft tissue augmentation. During surgery 3 implant place- ment with simultaneous hard tissue augmentation was proceeded by. As an augmentation material BDX wasusedcoveredbyaslowresorbablemembrane.The width and height of the alveolar ridge became suffi- cient to promote long term stability for the implant bornerestoration(Fig.16a&b,17). _Case 3 (Figs.18–20) The third case is a 49 years-old male patient who presented the left upper lateral incisor with an ad- vancedhorizonto-verticalbonydefectonitsmesialas- pect (Fig. 18). Following tooth extraction an alveolar ridge preservation was performed and implant place- ment with simultaneous augmentation as described before.TheaugmentationmaterialwasBDXcoveredby atitaniummembrane(Fig.19).Thefinalsofttissueaug- mentationwasfollowedbytheprosthodonticrehabil- itation,aPFMcrownwasestablished(Fig.20). _Results Afterthecauserelatedperiodontaltherapythepa- tients developed proper individual oral hygiene meas- ures.Eachpatients’gingivalandplaqueindexwasun- der 20%, the mean of PI was 7,7%, and 12,7% of GI, respectively.AtbaselinethemeanperiodontalPDofthe neighbouring teeth was 3,97mm, GR 0,88mm and CAL 4,78mm. After the healing of the 3rd stage the neighbouring teeth’s PD was 2,55, GR 2,13 and CAL 4,58. The clinical parameters showed slight improve- mentalthoughthenumberofcasesdoesnotofferany statistical analysis. The intrabony component of the adjacentteethisbeingeliminatedclinicallyandradio- logicallyandduringre-entry.Optimalhardandsofttis- sueconditionswerefoundaroundimplants. _Discussion The long term success of implant therapy depends on the adequate volume of bone around the implant site. The lack of mineralized tissue is an unfavourable condition for a predictable implant therapy (Lekholm et al., 1986). Another key factor for maintaining the alveolar crest level around implant is the quantity and morphologyofthecoveringsofttissues.Implantther- apy in the aesthetic zone needs a comprehensive con- siderationofseveralcontributingfactors.Inperiodon- tal patients implant placement is even more challeng- ing. Periodontally compromised teeth often show dis- advantageous bone loss, especially if the buccal bony plate is missing. For achieving predictable healthy pe- riodontal conditions tooth extraction cannot be avoided. Several techniques and materials have re- cently been developed for the purpose of extraction socketpreservation.Therearecontroversialdatainthe literatureconcerningthepossibleroleofbonefillersin alveolar socket preservation. Several different tech- niques have been described to achieve this goal. There is a substantial ambiguity in the literature regarding the predictability of these kind of techniques. Several Fig. 14a & b_Post treatment view of the final PFM crown in place surrounded by optimal and harmo- nious soft tissues. Fig. 15_The tooth 11 has got a deep one-wall bony defect that after extraction would cause tissue collapse influencing also the periodontal status of the neighbouring teeth. Fig. 15 Fig. 14bFig. 14a