implants the journal of oral implantology United Kingdom Edition

46 I I case study _ Implant therapy implants2_2012 or modify the resorption of the buccal bone. It is also the matter of discussion whether these grafting materials in the alveoli have an active role in the modu- lation of alveolar bone formation or they only slow down the vestibular bone re- sorption (Araújo & Lindhe, 2009). Other studies suggest the utilisation of mem- branes. The biodegradable membranes have recently been increasingly applied because of its incorporation in the host tissues and providing better soft tissue healing. If it is exposed to the oral cav- ity the healing is less compromised and the risk of infection is low (Lekovic et al., 1997, 1998). Tooth extraction al- ways presents conditions where a com- plete wound closure is questionable. If the membrane is not able to maintain enough space for regeneration it should be supported with some grafting mate- rial (Case 3). Similar ridge configuration was achieved when using bone fillers (see our Case 1) or without any bone substitute (see our Case 2) (Chiapasco et al., 2006). The use of non-resorbable membrane became the gold standard for GBR with a need of 3-D reconstruc- tion of the edentulous ridge (Simion et al., 2007). One of the disadvantages of this technique that the gingival flaps should be sutured over the membrane in a way that a primary wound healing without any flap dehiscence could be achieved. Membrane exposure may se- verely compromise wound healing and also the consecutive regeneration and final treatment outcomes (Hämmerle et al., 1998). The soft tissue coverage is a prerequisite for the management of hard tissue augmentation and for the final aesthetics of the implant borne restoration. The three demonstrated clinical cases showed favourable hard and soft tissue alteration during the third surgery. During this step-wise surgical approach we managed to de- velop an ideal implant position in all the three dimensions covered by the required amount of hard and soft tis- sues (Buser et al.,2004). Literature data suggest that survival and success rate of implants partially or fully placed into augmented bone is comparable to implants placed into non regenerated alveolar ridges (Mayfield et al., 1998; Zitzmann et al., 2001b). The biological mechanism of the alveolar regeneration is not fully investigated and understood and the role of this issue in the heal- ing of neighbouring teeth’s periodontal intrabony defects even needs further examination._ Dr Peter Windisch Phone/Fax: +36 1 267 4907 peter.windisch@gmail.com implants_contact info Fig. 19 Fig. 20 Fig 19_The optimally positioned Ti-membrane covering the augmented area. Fig 20_The final prosthetic rehabilitation.