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Cosmetic dentistry beauty & science

I case report _ delayed immediate implantation 34 I cosmeticdentistry 3_2013 were extracted gently and the periradicular gran- ulation tissue was also removed as non-traumati- cally 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 membrane part facing the oral cavity was adaptedtotheedgesofthewoundtoenableatight closure with suture material. Four weeks after ex- traction of the teeth, the former tooth area 12–22 was non-irritated with good remaining structure and volume. ITI implants were inserted in areas 12–22 which were fitted with a fixed bridge after twelve weeks of 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. At a later time, both of the two premolars (abutment teeth) received endodontic treatment and a root filling. Both teeth fractured so un- favourably that they were non-conservable. The patient requested “the same treatment, but with implants instead of teeth”. To prevent further fractures of the teeth that had fractured on the subgingival level, the re- maining two root portions were extracted gently and carefully. Two collagen-cone units were cus- tomised with a scalpel (collagen part) and scissors (membrane) in such a way that they were flush with and filled the former alveolus in addition to providing a finish. The final closure was achieved bywayofintraosseoussutures.Adelayedimmedi- ate implantation was also carried out after about fourweeks;twoimplantswereinsertedinareas14, 15,whichwereagainfittedwithacantileverbridge (16 as a premolar pontic) after several weeks of osseointegration. Case 3: Replacement of periodontally severely damagedteeth11,21 The patient in her mid-thirties had already lost several teeth in the lateral dental area of the max- illa. The fact that she is a heavy smoker was cer- tainly 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 re- quired 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. After the production of a clip-free interim par- tial prosthesis, the two upper central incisors were extracted,takingcaretoavoidanytraumatisation. A collagen membrane cone unit was also used for treating both of the two alveoli. Since the patient was not prepared to stop smoking, maintaining structure and volume was just as important as achieving a fast and tight closure by using the col- lagenmembraneandconeunit.Afterfourweeksof primary healing time, two implants were inserted in areas 11, 21, which then received two crowns as a supra-construction after eight weeks. _Evaluation The procedure presented here is definitely not a substitute for a proven treatment scheme, but it can serve to simplify it. If the alveolus is largely intact, which must be defined as the precondition for executing the treatment steps described here, a GBR procedure can be performed quickly and without any further trauma to the tissue. The goal is to conserve as much volume of the former tooth socket as possible, thus creating favourable pre- conditions for a delayed immediate implantation. The procedure has obvious limitations in cases where the former tooth socket has been largely destroyed (due to a complicated extraction or pre- vious procedures resulting in a loss of most of the buccal bone lamella), where the non-conservable tooth shows a profound infection, and in situa- tions 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 he- mostatic agent with membrane for guided bone regeneration 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 cosmeticdentistry