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implants the journal of oral implantology United Kingdom Edition

42 I I case study _ Implant therapy implants2_2012 ous augmentation and implant place- ment was performed. If the thickness and the width of the alveolar mucosa were not sufficient to provide predict- able primary wound healing during hard tissue augmentation procedure, soft tissue augmentation was performed prior to implant placement A free au- togenous soft tissue graft or a xeno- graft (Alloderm®, BioHorizons, Birming- ham, AL, USA) was used in order to gain enough keratinised gingiva and deepen the vestibule at the implant area using a modified tunnel technique (Azzi et al. 2009). The tissue harvesting technique has already been described before. Surgery 3 - Implant placement with simultaneous hard tissue augmentation One implant (Straumann Bone Level, Straumann AG, Waldenburg, Switzer- land, and Nobel Replace Tapered Effect, Nobel Biocare, Gothenburg, Sweden) was inserted with simultaneous 3-D hard tissue augmentation using BDX and a non-resorbable membrane (Tita- nium membrane—FRIOS® Boneshield; DENTSPLY Friadent®, Mannheim, Ger- many) or a slow resorbable membrane (Resolut Adapt LT 2530, Gore-Tex®, Newark, DE, USA) was fixed over it. A tension free wound closure was achieved in all cases resulting in pri- mary wound healing. _Surgery 4- Abutment connection with non resorbable membrane removal The same split thickness flap design was applied for non-resorbable mem- brane removal and abutment connec- tion. After surgery patients were in- structed to take antibiotics (Augmentin, 3x625 mg/day for one week). Post sur- gically mechanical plaque control was not performed in the surgical and ad- jacent area and chemical plaque con- trol was maintained with a 0.2 per cent chlorhexidine solution twice daily (Cor- sodyl, GlaxoSmithKline). Sutures were removed at 14 days after surgery. Ad- ditional recall appointments including supragingival professional tooth clean- Fig. 13c Fig. 14b Fig. 15 Fig 13a-c_Radiological follow up of the augmented site development a) Standardised X-way prior to implant placement. Radiographical bone fill can be seen in intrabony defects of the neighbouring teeth b) Radiological view after nine months healing of implant placement and simultaneous hard tissue augmentation c) The platform shifted abutment is fixed to the implant. Fig 14 a&b_Post treatment view of the final PFM crown in place surrounded by optimal and harmonious soft tissues. Fig 15_The tooth 11 has got a deep one-wall bony defect that after extraction would cause tissue collapse influencing also the periodontal status of the neighbouring teeth. Fig. 13a Fig. 13b Fig. 14a