implants - international magazine of oral implantology

I research 12 I implants1_2013 11, 21, 22 are no longer conservable. They showed mobility grades of I–II, high circular probing depths and bleeding on probing. After a removable interim prosthesis 12–22 was produced,thefourteethintheanteriormaxillawere extracted gently and the periradicular granulation tissue was also removed as non-traumatically as possible. The wound was closed with four collagen membranes and cone units; they were fitted to the alveolus by resizing the collagen part. The mem- brane part facing the oral cavity was adapted to the edges of the wound to enable a tight closure with suture material. Four weeks after extraction of the teeth, the former tooth area 12–22 was non-irri- tated with good remaining structure and volume. ITI implants were inserted in areas 12–22 which werefittedwithafixedbridgeaftertwelveweeksof healing. Case 2: Free-end situation in the right half of the maxilla The free-end situation in the right half of the maxilla that occurred 31 years ago had been fitted with a disto-cantilever bridge 16-15-14 BM-KM- KM.Atalatertime,bothofthetwopremolars(abut- ment teeth) received endodontic treatment and a root filling. Both teeth fractured so unfavourably that they were non-conservable. The patient re- quested “the same treatment, but with implants in- stead of teeth”. Topreventfurtherfracturesoftheteeththathad fracturedonthesubgingivallevel,theremainingtwo root portions were extracted gently and carefully. Two collagen-cone units were customised with a scalpel (collagen part) and scissors (membrane) in such a way that they were flush with and filled the formeralveolusinadditiontoprovidingafinish.The final closure was achieved by way of intraosseous sutures.Adelayedimmediateimplantationwasalso carried out after about four weeks; two implants were inserted in areas 14, 15, which were again fit- tedwithacantileverbridge(16asapremolarpontic) after several weeks of osseointegration. Case3:Replacementofperiodontallyseverelydam- agedteeth11,21 The patient in her mid-thirties had already lost severalteethinthelateraldentalareaofthemaxilla. The fact that she is a heavy smoker was certainly a considerable co-factor in this unpleasant situation. A trauma of the front teeth (a fall at home) that had occurred many years ago had required splinting of the two upper central incisors which now, only ten years after the procedure, showed a high degree of mobility. The patient also complained of pain when biting. Aftertheproductionofaclip-freeinterimpartial prosthesis, the two upper central incisors were ex- tracted, taking care to avoid any traumatisation. A collagen membrane cone unit was also used for treatingbothofthetwoalveoli.Sincethepatientwas notpreparedtostopsmoking,maintainingstructure andvolumewasjustasimportantasachievingafast and tight closure by using the collagen membrane and cone unit. After four weeks of primary healing time, two implants were inserted in areas 11, 21, which then received two crowns as a supra-con- struction after eight weeks. _Evaluation The procedure presented here is definitely not a substituteforaproventreatmentscheme,butitcan serve to simplify it. If the alveolus is largely intact, which must be defined as the precondition for exe- cuting the treatment steps described here, a GBR procedurecanbeperformedquicklyandwithoutany further trauma to the tissue. The goal is to conserve as much volume of the former tooth socket as pos- sible, thus creating favourable preconditions for a delayedimmediateimplantation.Theprocedurehas obvious limitations in cases where the former tooth socket has been largely destroyed (due to a compli- cated extraction or previous procedures resulting in alossofmostofthebuccalbonelamella),wherethe non-conservabletoothshowsaprofoundinfection, and in situations where the patient does not want the use of materials of animal origin. Information regarding the employed collagen product: Absorbable collagen membrane-cone – PARASORB-Sombrero® – Absorbable local hemo- staticagentwithmembraneforguidedboneregen- eration of equine origin. Manufacturer: RESORBA (Germany)._ The authors hereby confirm that there is no conflict of interest. Dr Georg Bach Oral surgery specialist Rathausgasse 36 79098 Freiburg/Breisgau,Germany doc.bach@t-online.de Christian Müller Master DentalTechnician Christian Müller Dental-Technik Carl-Kistner-Straße 21 79115 Freiburg/Breisgau,Germany _contact implants