cone beam international magazine of cone beam dentistry

ment (Fig. 6). Full template guidance has been made possible by the collaboration between den- tal implant manufacturers and interactive treat- mentplanningsoftwarecompanieswhohavecon- tinued to develop innovative solutions to treating our patients. _Bone volume preservation 3-D imaging technologies can identify areas withgreatclarityareasthathaveinsufficientbone volume for implant placement. It is well docu- mented that atrophy of the bone can occur once teeth have been removed from the jawbone. When a tooth needs to be extracted, preservation of the alveolarridgehasbecomeasignificantandpracti- cal procedure to prevent resorption and to provide enough bone volume for future dental implant placement. If there is not enough bone volume within a designated receptor site to place an im- plant, many options are now available to replace missing anatomy to create a sound foundation for future implant placement. The area of biologics has greatly expanded the choices for clinicians to determine the appropriate method and materials to rebuild lost soft- and hard-tissue anatomy. Demineralized bone, mineralized bone, bone putties, allografts (human cadaver bone), and zenografts (bovine bone), as well as combinations of partic- ulate and block graft materials, are available as scaffolds to increase volume and promote new bone growth. There are also a variety of different resorbable and nonresorbable membranes of vari- ous materials that can be used in conjunction with grafting procedures with and without tenting screws to preserve space as an aid to the remodel- ling process. The most popular membranes are made from different configurations of collagen matrices, and can be short-acting or long-acting depending on the desired usage. Use of autologous biomaterials has also been expanded since the development of platelet-rich plasma (PRP) many years ago. Natural bioactive membranes can be fabricated from the patient’s ownbloodforthepurposeofenhancinghard-and soft-tissue healing. PRP protocols are basically enhanced fibrin glues. Recent advances with platelet-rich fibrin (PRF) create a true fibrin-based biomaterial that can function as a membrane with its improved properties and incorporation of sig- nificant growth factors. As a completely autoge- nous material developed from the patient’s own blood, the membranes derived from this process are easy to handle and inexpensive to produce. These membranes can be used to cover surgical sites, mixed with bone grafting materials, acting as optimized blood clot (Fig. 7). Other biologics that have evolved include re- combinant human bone morphogenic proteins which have shown clinical efficacy, although they remain quite expensive, and thus have limited applications. _Sinus grafting Sinus augmentation procedures were intro- duced years ago to provide a new foundation for the placement of dental implants in the severely resorbed posterior maxilla. CBCT imaging allow for total inspection of the sinus to evaluate potentialpathologyaswellastoplanthegrafting procedure (Figs. 8a & b). New surgical techniques and instruments have significantly simplified maxillary sinus surgery, by decreasing the poten- tial of perforating the Schneiderian membrane through the selective cutting action of hard tis- sue and not soft tissue. Creating a piezoelectric bony window osteotomy can be accomplished without damaging the soft tissue, followed by Fig. 7_Autologous platelet-rich fibrin matrix (l-PRF) can be utilized to promote healing for various intra-oral applications. Figs. 8a & b_A cross-sectional view of the maxillary sinus revealing pathology (a). Total inspection of the sinus helps determine the type of access and amount of bone graft material required (b). I 13 special _ evolution of dental implantology I cone beam1_2014 Fig. 8bFig. 8aFig. 7 CBE0114_10-14_Ganz 31.01.14 15:50 Seite 3