implants the journal of oral implantology United Kingdom Edition

44 I I case study _ Implant therapy implants2_2012 alveolar ridge preservation was per- formed and implant placement with si- multaneous augmentation as described before. The augmentation material was BDX covered by a titanium membrane. The final soft tissue augmentation was followed by the prosthodontic rehabili- tation, a PFM crown was established. After the cause related periodontal therapy the patients developed proper individual oral hygiene measures. Each patients’ gingival and plaque index was under 20 per cent, the mean of PI was 7.7 per cent, and 12.7 per cent of GI, respectively. At baseline the mean peri- odontal PD of the neighbouring teeth was 3.97mm, GR 0.88mm and CAL 4,78 mm. After the healing of the third stage the neighbouring teeth’s PD was 2.55, GR 2.13 and CAL 4.58. The clinical pa- rameters showed slight improvement although the number of cases does not offer any statistical analysis. The intrabony component of the adjacent teeth is being eliminated clinically and radiologically and during re-entry. Op- timal hard and soft tissue conditions were found around implants. _Discussion The long term success of implant therapy depends on the adequate vol- ume of bone around the implant site. The lack of mineralised tissue is an un- favourable condition for a predictable implant therapy (Lekholm et al., 1986). Another key factor for maintaining the alveolar crest level around implant is the quantity and morphology of the cover- ing soft tissues. Implant therapy in the aesthetic zone needs a comprehensive consideration of several contributing factors. In periodontal patients implant placement is even more challenging. Periodontally compromised teeth often show disadvantageous bone loss, espe- cially if the buccal bony plate is miss- ing. For achieving predictable healthy periodontal conditions tooth extraction cannot be avoided. Several techniques and materials have recently been de- veloped for the purpose of extraction socket preservation. There are contro- versial data in the literature concerning the possible role of bone fillers in alveo- lar socket preservation. Several differ- ent techniques have been described to achieve this goal. There is a substantial ambiguity in the literature regarding the predictability of these kind of tech- niques. Several authors report positive findings on the effect of bone substi- tutes (Froum et al., 2002). Different animal studies (Araújo & Lindhe, 2009; Fickl et al., 2009) suggest that bone filler materials can to a certain extent retard Fig. 17 Fig. 18 Fig 17_The final result. Fig 18_The morphology of the osseous defect after flap elevation.