implants - international magazine of oral implantology

support with a natural-looking temporary restoration. Augmentation is usually performed at the same time as immediate implantation. This applies both to imme- diate temporisation and to transgingival or closed healing. If the tissue deficit is small, minor controlled tissue regeneration is sufficient. This can be achieved, for example,withthehelpofaslowlyabsorbedbonereplacementmaterialandamem- brane. However, for larger defects this can be technically challenging owing, espe- cially, to the frequent lack of soft-tissue volume.1 In such a case, a two-session pro- cedure is recommended with socket preservation and implantation in the aug- mented alveolar ridge or simultaneous implantation using suitable soft-tissue techniques to cover the implant cleanly.2 A requirement for successful immediate implantation with immediate tempori- sation is a largely intact bony alveolus, particularly an intact and sufficiently thick buccal lamella. Even with the use of 3-D radiology techniques, this cannot be de- termined with certainty until after extraction. Another requirement for the success of immediate implants is adequate primary stability of at least 35 Ncm.3 During the process of osseointegration, the bone is able to convert mechanical forces into bi- ological stimuli. In this context, the degree of bone expansion under force plays a key role. It is absolutely essential to avoid micro-trauma that could overstrain the interface between the implant and bone.4 Moreover, the risk of recession appears to be less in patients with thick gingival tissue than in patients with thin tissue.5, 6 This can be easily determined with a PA probe inserted vestibularly into the sulcus. If the metal is visible through the tissue, the patient has a ‘thin’ gingival phenotype, otherwise a ‘thick’ one.7 Finally, the choice of treatment also depends on extraneous factors such as the patient’s laugh line, as well as his/her expectations with regard to aesthetics, cost and treatment time. According to recent studies, if all these factors are taken into account, immedi- ate temporisation—also in conjunction with immediate implantation—can achieve hard- and soft-tissue results that are just as stable as those obtained with conven- tional loading after three to six months.8–12 The bone contact rate at the implant in- terfacealsoappearscomparableforimmediateandlateprotocols.11 However,inthe case of immediate temporisation static and functional contact points should be avoided if possible. The risk of integrating the final restoration immediately is too great owing to unpredictable tissue changes during the healing phase. _Case report In a 66-year-old male patient, the crown of tooth #22 was fractured (Fig. 1). The tooth had been endodontically treated with insertion of an abutment post and crown about 15 years previously. The patient had no pain and there were no peri- apicalabnormalities.However,inviewoftheslenderroot,anewpostandcrowndid not appear advisable (Fig. 2). Because the patient did not want the neighbouring teethground(“Iwantanewlateralincisor.Icertainlydon’twantthehealthyneigh- bouring teeth ground”), only an implant came into consideration. The panoramic radiograph showed incomplete filling of the root remnants, a generalised horizontal bone defect and endodontic and dental restorations in all four quadrants (Fig. 2). The pocket depth was neither unremarkable at 3 to 3.5 mm, norwastherebleedingonprobing.Theperiodontitiswasevidentlyaccompaniedby tissue recession, largely without pocket formation or acute inflammation. The soft tissue was somewhat rough and was classified as belonging to the ‘thick’ pheno- type. Other findings were periodontitis originating from the pulp of tooth #45, an implantatposition44,tooth#37inclinedstronglyintogap36andaretainedtooth #38. There were no functional abnormalities. The patient did not smoke and, apart from pharmacologically controlled hypertension, was healthy. As a manager of an bionicstickygranules easy-graft® CRYSTAL Degradable Solutions AG Wagistrasse 23 CH-8952 Schlieren Phone: +41 43 433 62 60 www.degradable.ch dental@degradable.ch Ingenious: Simple handling and accelerated osteocon- duction for long-term volume preservation. Order your free test sample over the internet! AD