Please activate JavaScript!
Please install Adobe Flash Player, click here for download

implants - international magazine of oral implantology

I research 12 I implants3_2013 pointwereadequatebonethicknessdeveloped.Amicro reciprocating saw was used to cut through the cortex along the anterior border of the ramus medially to the external oblique ridge. The anterior vertical cut was madeinthemandibularbodyinthemolarregionwitha verticalsaw.Thelengthofthiscutwasdependentonthe sizerequirementsofthegraftandonthepositionofthe inferior alveolar canal. The posterior vertical cut was madeonthelateralaspectoftheramus,perpendicularly to the external oblique osteotomy. The inferior os- teotomyconnectingtheposteriorandanteriorvertical cuts was made with a straight saw. This was a shallow cut into the ramus to create a line of fracture (Fig. 5). A thinchiselwasgentlytappedalongtheentirelengthof the external oblique osteotomy, and care was taken to parallel the lateral surface of the ramus, so that a frac- ture would occur at a particular level. This level was modifiedtopredeterminethesizeofthecorticocancel- lousbonegraft.Thus,thesplittingofthegraftfromthe ramus was completed. The bone block was lifted care- fully to ensure that the inferior alveolar nerve was not trappedwithinthegraft.Thedonorareawasfilledwith acollagencottonspongeforlocalhaemostasis. The block grafts were then fixed with small-diam- etertitaniumosteosynthesisscrews(MatrixMidface, Synthes© 2011 NHS Supply Chain) after appropriate separationintosmallerparts(Figs.6&7).Corticocan- cellousbone,collectedwiththeSafescraper,wasthen usedtofillthesmallgapsbetweenthebonegraftand thealveolarcrest(Fig.8).Inallcases,acollagenmem- brane (Bio-Gide, Geistlich Biomaterials, Wolhusen, Switzerland) was cut appropriately and adapted to cover the defect and extended 2 to 3 mm sideways, being laid over the graft in a saddle configuration. It was tucked underneath the palatal or lingual flap to cover the ridge and buccal defect, moistened, and pressed gently to adapt to the underlying bone (Fig. 9). Periosteal releasing incisions were made when necessarytoachieveeasyclosureofthemucosalflaps on top of the grafts without tension (Fig. 10). An or- thopantomographic control was performed postop- erativelytoevaluatetheoutcomeofthesurgicalpro- cedure (Fig. 11). Postoperatively, patients were instructed to rinse their mouth with chlorhexidine 0.2% for two to three weekstwiceaday.Afterthisperiod,thesutureswerere- moved. Removable provisional prostheses were ad- justedgenerously.Patientswereinstructedtousetheir prostheses for cosmetic appearance and for eating ratherthanfunctionforthewholeperiodofhealing,i.e. threemonths.Atthattime,patientswerescheduledfor implant surgery. No antibiotic therapy was continued after surgery and patients were instructed to use non- steroidal anti-inflammatory drugs (Ibuprofen®, Docpharm® Arzneimittelvertrieb GmbH & Co. KGaA) onlyifpainwaspresent. Stage2surgery After a healing period varying between three to six months after the grafting procedure, clinical and radi- ographic evaluations were performed and implants were placed in a routine fashion using the special pro- gram for guided implant surgery CoDiagnostiX® (IVS SolutionsAG).AllpatientsunderwentCTscanbeforethe implant placement to assess new bone formation and plan the accuracy of the implant position. A crestal in- cisionandsubperiostealdissectionofthealveoluswere performed and the fixation screws were removed. Im- plant site preparation was performed with guidance fromthelaboratory-madesplintandtheimplantswere positioned(Figs.12–18). Weusedbone-leveltypetita- nium implants. The most common in use were Strau- mann® Bone Level implants (Institut Straumann AG, Switzerland), followed by Astra® (Astra Tech Inc.) and Camlog®(CAMLOGVertriebsGmbH,Germany).Intotal, 155implantswerepositioned,39inthemaxillaand116 inthemandible.Threetosixmonthslater,theprosthetic workwasstarted. Clinicalappointmentswereperformedaftersurgery toevaluateanycomplicationatthedonorandrecipient site,suchasdehiscence,infection,swelling,sensorydis- turbancesorhaemorrhage.Graftlossandgraftremoval weredefinedasfailure;swelling,wounddehiscence,in- cision line opening, infection with pus or temporary paresthesia were defined as complications. Buccal nervedamagefromincisionalongtheexternaloblique ridgeaswellasthedamageofinferioralveolarnerveis possible. Graft incorporation was evaluated following the removal of the fixation screws. Statistical analysis includeddescriptivestatisticsusingIBMSPSSSoftware forWindows.Thesignificancelevelofp≤0.05forallsta- tistictestswasdefinite.Theresidentsofourdepartment operatedandfolloweduponallpatients,andtheresults were analysed in percentage and presented in tables anddiagrams._ Disclosure The authors do not have any financial interests, either directly or indirectly,in the products listed in the study. Editorial note: To be continued in im- plants 4/2013 with results, an exten- sivediscussionandtables.Afulllistof references is available from the pub- lisher. Andreas Sakkas Oral Surgeon Department of Oral and Maxillofacial Surgery,Facial Plastic Surgery Military Hospital Ulm andAcademic Hospital University Ulm Ulm,Germany Tel.:+49 731 17101701 andreaszfc13@yahoo.gr _contact implants