Dental Tribune United Kingdom Edition

January 16-22, 201218 Implant Tribune United Kingdom Edition page 17DTß can be achieved, for example, with the help of a slowly ab- sorbed bone replacement ma- terial and a membrane. How- ever, for larger defects this can be technically challenging ow- ing, especially, to the frequent lack of soft-tissue volume.1 In such a case, a two-session pro- cedure is recommended with socket preservation and im- plantation in the augmented alveolar ridge or simultaneous implantation using suitable soft-tissue techniques to cover the implant cleanly.2 A requirement for suc- cessful immediate implanta- tion 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 determined with certainty until after extraction. Another requirement for the success of immediate implants is adequate primary stability of at least 35Ncm.3 During the process of osseointegration, the bone is able to convert mechanical forces into bio- logical 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 over- strain the interface between the implant and bone.4 Moreover, the risk of re- cession appears to be less in patients with thick gingival tissue than in patients with thin tissue.5, 6 This can be eas- ily 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 Final- ly, 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, immediate temporisa- tion—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 interface also appears comparable for immediate and late protocols.11 However, in the case of im- mediate temporisation static and functional contact points should be avoided if possible. The risk of integrating the final Fig 3 The remnants of root 22 were removed with a periotome, while sparing the buccal lamella and soft tissue. Fig. 4 Probing of the extraction socket showed intact bony walls, especially the buccal walls. ‘The choice of treat- ment also depends on extraneous fac- tors such as the patient’s laugh line, as well as his/ her expectations with regard to aesthetics, cost and treatment time’ Fig. 5 The implant (Replace Select Ta- pered, Nobel Biocare) is relatively short owing to the horizontal bone defect (10 mm with diameter 4.3 mm). The planned vertical apical position approximately corresponded to that of the extracted dental root. Fig 6 The shoulder of the primarily sta- ble (35 Ncm) inserted implant is located approximately 1 mm apical to the buccal crestal bone edge. The transverse posi- tion is approximately 1 mm palatal for optimum distance to the buccal lamella. The buccal orientation of one of the three internal channels can be clearly seen. The Art of Perfection LEADING REGENERATION The natural collagen structure of Geistlich Bio-Gide® > provides high therapy safety > leads to less dehiscence > underlies the perfect aesthetic outcome Covering the augmentation with Geistlich Bio-Gide® . (PD Dr. R. Jung, University Zurich) Excellent soft-tissue healing and a perfect aesthetic outcome. (PD Dr. R. Jung, University Zurich) Geistlich Biomaterials Geistlich Sons Limited Tel. + ( ) Fax + ( ) info@geistlich.co.uk www.geistlich.co.uk Cross-linked collagen membraneGeistlich Bio-Gide® Casesin . . Complication-free healing Soft-tissue dehiscence Based on Tal et al. .