international magazine of oral implantology

I case report _ edentulous sites 38 I implants1_2011 Fig. 16_The optimally positioned implant in 3-D regenerated bone. Fig. 17_The final result. Fig. 18_The morphology of the osseous defect after flap elevation. Fig. 19_The optimally positioned Ti-membrane covering the aug- mented area. Fig. 20_The final prosthetic rehabilitation. authors report positive findings on the effect of bone substitutes(Froumetal.,2002).Differentanimalstud- ies (Araújo & Lindhe, 2009; Fickl et al., 2009) suggest that bone filler materials can to a certain extent retard or modify the resorption of the buccal bone. It is also thematterofdiscussionwhetherthesegraftingmate- rialsinthealveolihaveanactiveroleinthemodulation ofalveolarboneformationortheyonlyslowdownthe vestibular bone resorption (Araújo & Lindhe, 2009). Other studies suggest the utilization of membranes. The biodegradable membranes have recently been in- creasingly applied because of its incorporation in the hosttissuesandprovidingbettersofttissuehealing.If it is exposed to the oral cavity the healing is less com- promisedandtheriskofinfectionislow(Lekovicetal., 1997, 1998). Tooth extraction always presents condi- tionswhereacompletewoundclosureisquestionable. If the membrane is not able to maintain enough space for regeneration it should be supported with some grafting material (Case 3). Similar ridge configuration was achieved when using bone fillers (see our Case 1) or without any bone substitute (see our Case 2) (Chia- pascoetal.,2006). The use of non-resorbable membrane became the gold standard for GBR with a need of 3-D reconstruc- tion of the edentulous ridge (Simion etal., 2007). One of the disadvantages of this technique that the gingi- valflapsshouldbesuturedoverthemembraneinaway that a primary wound healing without any flap dehis- cencecouldbeachieved.Membraneexposuremayse- verely compromise wound healing and also the con- secutive regeneration and final treatment outcomes (Hämmerle et al., 1998). The soft tissue coverage is a prerequisite for the management of hard tissue aug- mentation and for the final aesthetics of the implant borne restoration. The three demonstrated clinical cases showed favourable hard and soft tissue alter- ation during the third surgery. During this step-wise surgicalapproachwemanagedtodevelopanideal im- plant position in all the three dimensions covered by the required amount of hard and soft tissues (Buser et al.,2004).Literaturedatasuggestthatsurvivalandsuc- cess rate of implants partially or fully placed into aug- mentedboneiscomparabletoimplantsplacedintonon regeneratedalveolarridges(Mayfieldetal.,1998;Zitz- mann et al., 2001b). The biological mechanism of the alveolar regeneration is not fully investigated and un- derstood and the role of this issue in the healing of neighbouring teeth’s periodontal intrabony defects evenneedsfurtherexamination. _Conclusion Thisstepwiseseriesofsurgicaltechniquescouldbe successfully applied for correcting sever ridge defi- ciencies and also can facilitate the comprehensive re- generative therapy of periodontal defects at adjacent teeth._ Editorial note: A list of references is available from the publisher. Dr Peter Windisch DMD,PhDAssociate professor Departement of Periodontology Semmelweis University,Budapest 1088 Budapest,Szentkiralyi u 47,Hungary Phone/Fax:+36 1 267 4907 peter.windisch@gmail.com _contact implants Fig. 16b Fig. 17Fig. 16a Fig. 19 Fig. 20Fig. 18