implants - international magazine of oral implantology

I user report _ augmentation Fig. 10_Insertion of the implant in region #14. Fig. 11_After stabilisation of the Schneiderian membrane, the Bio-Gide membrane is raised by the introduction of Bio-Oss granules (Geistlich), blood from the operation area and mixed with autologous bone chips of the patient. Fig. 12_Another gentle introduction of the augmentation in the Bio-Gide membrane before insertion of the dental implant in region #16. autologous transplant patients and bone defect of the patient’s blood. The implant survival rate with the use of xeno- geneic grafts is statistically equivalent to the use of particulated autogenous bone grafts. Del Fabbro et al. conducted studies on various bone replacement materials in 2004. Aghaloo and Moy 2007 found a survivalrateof88%inpureautologoustransplants, 92% in mixed grafts with autologous bone, 81% in pure alloplastic grafts, 93.3% in pure allogeneic grafts and 95.6% in pure xenogeneic grafts was found. These figures are encouraging for dentists and indicate a positive long-term prognosis for implant treatment in the distal maxilla. However, in aesthetically challenging zones, an implant inser- tion without augmentation procedures is almost impossible to achieve, for only connective soft tissueaidedbyboneorgraftmaterialcancontribute to aesthetically satisfying results. _Placement of grafts and implants The graft material should be inserted starting from the areas that are the most difficult to reach andcontactwiththebonewallsmustbeensuredto improve the healing of bone. If the sinus membrane (Schneiderian membrane) is very thin, it should be protectedandstabilisedwithacollagenmembrane. Therecessesarefirstfilledanteriorlyandposteriorly, andthereaftertheareaofthemedialsinuswallwas filled too. The graft should not raise the membrane further and must not be compressed too much, as then vascularisation particularly with biomaterial will be hampered. The implants are then succes- sively inserted into the prepared implant cavities. This achieves compaction of the loose cancellous tissue of the maxillary bone after the actual pilot holewithpoorbonequalityisachievedbymeansof bone-condensing instruments. This is also a useful andeffectivewaytoimproveprimarystability.After the insertion of the implants from the lateral side, the graft material is placed on the implants, all intermediate space and cavities are filled and the bonewindowiscoveredwithasmallcollagenmem- brane. The size of the collagen membrane should correspond to the existing bone window. The attachmentcantakeplacewithouttheuseofpinsor absorbable sutures under the mucoperiosteal flap. Newstudieshaveshownthattherearenodiffer- ences between the results with the use of collagen- membranesandthosewithmembranesmadeofex- panded polytetrafluoroethylene (ePTFE, GORE-TEX; Wallace et al. 2005). Since collagen-membranes stick, they can be installed without screws or pins and,becauseoftheirabsorbability,theydonothave to be removed in a later procedure. _Suturing and wound care For the final wound care, the defect is covered passively with the lobes. For this purpose, releasing incisions in the periosteal area are necessary. This method, however, is usually only necessary with simultaneous maxillary bone augmentation (for widening) because pure sinus floor augmentation doesnotchangetheridgecontour.Thethreadthick- ness can be specified from 4.0 to 6.0mm with non- absorbable monofilament. _Summary It is generally in the interest of the patient to weighthebenefitsofpureautologousgraftsorsome combinationofautologousboneandtheincorpora- tion of synthetic bone materials and/or xenogeneic bone substitute materials. The use of foreign mate- rial leads to conservation of the patient’s own bone and avoids a second opening at a donor site, which creates an additional wound. In principle, in treatment planning and advising patients must respect the patient’s desire that all surgicalproceduresproceedassmoothly,efficiently and, ultimately, as successfully as possible. It is throughthecombinationofautologousbonegrafts and foreign material, depending on the case and necessary use of membranes, that the long-term success of implant treatments is predictable. Oper- 38 I implants2_2011 Fig. 11 Fig. 12Fig. 10