Dental Tribune United Kingdom Edition

May 7-13, 2012United Kingdom Edition CAD/CAM SYSTEMS | INSTRUMENTS | HYGIENE SYSTEMS TREATMENT CENTRES | IMAGING SYSTEMS Relaxed patients. Easy treatment. Improved post-operative healing. Is this all just wishful thinking? Actually, it’s stress-free – and at your fingertips. Both the SIROLaser Advance and the upgrade-ready SIROLaser Xtend offer you all the benefits of modern laser denitistry. For periodontology, endodontics, surgery … the list goes on! Enjoy every day. With Sirona. T h e D e n t a l C o m p a n y Telephone: 0845 0715040 e-mail: info@sironadental.co.uk www.sironadental.co.uk Sirona Dental Systems Lakeside House 1 Furzeground Way Stockley Park Heathrow London UB11 1BD Newcomers welcome. The new SIROLaser Xtend deproteinized bovine bone [90 per cent] and porcine collagen fibres [10 per cent]; Bio-Oss collagen, Geistlich) and a double layer of resorbable collagen membrane (BioGide, Geistlich; Figs. 5 & 6). The flaps were replaced and were sutured with GORE-TEX without obtaining complete socket cov- erage. Thus, the membrane re- mained exposed (Fig. 7). Post-operative care The patient was given 600mg ibuprofen every eight hours for the first four days and 500mg amoxicillin every eight hours for the first seven days and 10ml 0.20 per cent chlorhexidine gluconate rinses for 30 seconds twice a day (1-0-1) from the day of the opera- tion until day 14 after surgery was prescribed. A toothbrush with extra soft bristles was recom- mended from the second week. The patient was advised to avoid chewing on the operated side, and refrain from consuming hot food and drinks for two weeks. A follow-up visit was scheduled for seven days post-treatment, and the sutures were removed after 14 days. Surgical re-entry for implant placement (at six months follow- ing ridge preservation, Figs 8 & 9) Following local anaesthesia as described above, a crestal incision was done and a full-thickness flap was raised in preparation for im- plant placement (Fig 10). A bone biopsy specimen was harvested in the area previously regener- ated using a bone trephine drill. Following the biopsy, the planned implant was placed (Figs 11–13). The specimen was fixed in a so- lution of 10 per cent neutral buff- ered formalin, then dehydrated in ethanol and embedded in methyl- methacrylate resin. Finally, the section was stained with basic fuchsine and toluidine blue, and was observed with an optical mi- croscope at 200 x and 400 x mag- nification. Clinical and histological anal- ysis (Figs 14 & 15) Clinically, xenograft particles were well integrated into the al- veolus, and the regenerated area was easily distinguishable from the original bone tissue. The new bone formed was firmly attached to the particles of xenograft. The histological analysis revealed no inflammatory response or fi- brous encapsulation of particles of the graft material. All sam- ples showed new bone forma- tion with the newly formed bone strongly adherent to the bone graft particles. Discussion The aim of this case report is to evaluate guided bone regenera- tion after tooth extraction with a xenograft material. The use of a bone substitute can avoid bone harvesting from a donor site, thus reducing patient discomfort post- operatively. In a randomised clinical study, Barone et al. (2008) compared extraction-only treatment to ridge preservation with xenograft (cortico-cancellous porcine bone) and collagen membrane. Seven months after tooth extraction, a greater horizontal width reduc- tion of the residual alveolar ridge (8.1mm versus 6.3mm) in the ex- traction-only group was observed. Areductionofverticalridgeheight was also observed. These findings were in agreement with previ- ous studies (Iasella et al. 2003). Deproteinised bovine bone has proven to be a highly biocompat- ible and osteo-conductive mate- rial that acts as a natural scaffold for bone formation, and has a low page 22DTà Fig 7 Fig 8 Fig 9 Fig 10 Fig 11 Fig 12 Fig 14 Fig 13 Fig 7_The flaps were replaced and were sutured without obtaining complete socket coverage Figs 8 & 9_Clinical and radiographic view at six months following ridge preservation Fig. 10_Surgical re-entry for implant placement. Clinically, xenograft particles were well integrated into the alveolus, and the regenerated area is easily distin- guished from the original bone tissue Figs 11 & 12_A bone biopsy specimen was harvested in the area previously regener- ated using a bone trephine drill Fig. 13_Implant placement Fig 15 Figs 14 & 15_All samples show new bone formation with the newly formed bone strongly adherent to the bone graft particles ‘The use of a bone substitute can avoid bone harvesting from a donor site, thus re- ducing patient discomfort post-operatively’