implants the journal of oral implantology United Kingdom Edition

40 I I case study _ Implant therapy implants2_2012 technique over another (Darby et al., 2009). Nevertheless each preservation technique provided better results than natural socket wound healing (Barone et al.2008). The effect of extraction site development on the changes of attach- ment level of neighbouring teeth has not been clarified yet. While supraalveolar periodontal re- generation is still unpredictable (Sculean et al., 2004) vertical ridge augmentation has been successfully demonstrated in several publications (Barboza EP.,1999; Urban & Jovanovic, 2009; Merli & Lom- bardini, 2010; Beitlitum et al., 2010). Treatment of vertical ridge deficiences has been performed in edentulous areas without neighbouring teeth demon- strating advanced periodontitis. It was suggested that natural teeth with ad- vanced periodontitis, may impose a risk for an infection of the augmented site and of membrane exposure originating from the neighbouring periodontally compromised teeth (Karoussis et al., 2003; Hoffmann et al., 2007). Neverthe- less in certain clinical situations, teeth presenting deep intrabony defects are located in close vicinity of the compro- mised alveolar ridge. In these particular cases, it is of clini- cal interest to simultaneously recon- struct both the intrabony periodontal defect and the resorbed alveolar ridge, thus allowing proper insertion of den- tal implants. For those implant patients having a history of chronic periodonti- tis it is inevitably important to reduce periodontal pockets at natural teeth to 3mm and even below to facilitate proper individual plaque control and to reduce the chance of periodontal rein- fection (Carnevale et al., 2007). The importance of proper implant positioning and adequate amount and quality of periimplant hard and soft tis- sues have to be considered to maintain long term stability around implants. Therefore, the aim of the present cases was to evaluate the effect of a new step- by-step surgical technique designed to simultaneously reconstruct resorbed al- veolar ridge and the adjacently located intrabony defect to achieve a predict- able clinical outcome and adequate peri-implant tissue stability. Three patients exhibiting chronic periodontitis with localised advanced periodontal bone loss were referred to the Department of Periodontology, Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig 4_Clinical situation immediately after tooth extraction. Fig 5&6_A long term biodegradable membrane is fixed on the buccal aspect with titanium pins. Then the defect was filled with bovine derived xenograft (BDX) (BioOss) and covered with collagen membrane. Fig. 7_Tension-free wound closure after alveolar socket preservation. Fig. 8_The reentry revealed that the intrabony defect of the neighbouring tooth has also been filled with new bone. Fig. 9_The horizontal dimension of the implant site is already satisfactory but its vertical dimension needs further augmentation.