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implants the journal of oral implantology United Kingdom Edition

Semmelweis University, Budapest, for comprehensive periodontal therapy. All three patients were middle aged Cau- casian males (51, 50 and 49 years-old), systemically healthy and had never been smokers. Each patient presented at least one deep advanced periodontal bony defect in the upper front region. After initial therapy teeth were considered to be hopeless because of their disad- vantageous pathomorphology. Before tooth extraction each patient had com- pleted basic cause related periodon- tal therapy including full mouth scal- ing and root planing and oral hygiene training. Before surgery all exhibited high standards of oral hygiene. Treat- ment plan consisted of tooth removal followed by extraction site development (Surgery 1), and soft tissue augmenta- tion (Surgery 2), and implant placement with simultaneous ridge augmentation (Surgery 3) and abutment connection with non resorbable membrane removal (Surgery 4). The following parameters were measured at baseline, immedi- ately before augmentation procedure and 11–20 months after implant place- ment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), prob- ing depths (PD) around the neighbour- ing teeth at six sites, gingival recession (GR), clinical attachment level (CAL) with a millimetre calibrated periodontal probe (PCPUNC 15, Hu-Friedy, Chicago, IL, USA) and also intrasurgical direct measurements: the level of periodontal bone of neighbouring teeth, the width and height of the alveolar ridge. Stan- dardised radiographs were taken with the long cone parallel technique preop- eratively, between surgeries and post- operatively; for qualitative assessment of bone height. Surgery 1- Tooth extraction with ex- traction site development Following tooth removal a full thick- ness flap was raised up to the mucogin- gival line and beyond a partial thickness flap was mobilised with a horizontal extension thus allowing a tension free soft tissue management and wound closure. This flap design let the operator to evaluate and treat the periodontal defects around the neighbouring teeth. A combined alveolar site preservation technique was used with a slow resorb- able membrane (Resolut Adapt LT 2530, Gore- Tex®, Newark, DE, USA) fixed with titanium pins (Tipins; DENTSPLY Fria- dent, Mannheim, Germany) to cover the missing part of the buccal plate and to maintain the original form of the earlier arch. Following an appropriate- sized connective tissue graft was re- moved from the palatal mucosa by us- ing the Hürzeler technique (Hürzeler & Weng, 1999). The harvested tissue was trimmed and sutured (5.0 non-absorb- able polyamide monofilament, Braun AG, Tuttlingen, Germany) to the inner surface of the partial thickness. Surgery 2- Soft tissue augmentation Following the above mentioned pro- cedures if the width of the keratinised soft tissue allowed proper coverage af- ter augmentation procedure simultane- 41 case study _ Implant therapy I implants2_2012 Fig. 10 Fig. 11 Fig. 12 Fig 10_The horizontal dimension of the implant site is already satisfactory but its vertical dimension needs further augmentation. Fig 11&12_Surgery 2: implantation with simultaneous hard tissue augmentation using a BioOss and titanium membrane.