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implants - international magazine of oral implantology International Edition

research I Fig. 14_Re-entry with healing abutments. Fig. 15_Three weeks after re-entry. Fig. 16_Papilla morphology after healing abutments. Fig. 17_Definite abutments try-in. Fig. 18_Final prosthetics. Fig. 19_Pseudopapilla formation after three months of loading. I 09implants1_2014 The implants placed feature micro grooves at the implant neck in a height of 1 mm. This laser manu- factureddesignimitatesbiologyandpromisesanim- proved cell adhesion on this surface. These modern designs, combined with the advantages of platform switching, result in high tech products. Modern cre- stalbonemaintenancefunctionsbecauseofthepro- tectionofthecrestalbone.Whenimplantsareplaced subcrestallyorcrestally,asofttissueringbuildsonthe platform and protects the bone beneath. When im- plantsareplacedsupracrestally,implantneckoptions secure the crestal bone beneath, through soft tissue fibreattachmentoftheirnecks.23,24 In cases in wich primary closure is not possible or mobilization of neighbouring soft tissue through other flap designs is not wanted, temporary pros- theticsareessential.Thesofttissuemanipulationbe- gins from the very first moment and decides about theaestheticoutcome.25-27 The clinical situation after three weeks with heal- ingabutmentsneededtobealteredbuccalyat11and 21 and manipulated 0.5 mm apically. This was achieved via individualized abutments with convex base and breadth of 1 mm. In contrast, the gingiva marginsatthelateralincisorsneededtobecorrected coronally. Therefore, we used narrow abutments to givesofttissuemorespacetoheadcoronally.13-15 The combination of the biomaterials belongs to ourstandardaugmentationprotocolandiswelldoc- umented.Theresultsofguidedboneregenerationare predictableandcanbeplanned,eveninmajordefects. Inadditiontothecombinedbiomaterials,theirstruc- ture is very important. Rocky and edgy particles help internalstabilisationattheaugmentationarea.Often isanexternalstabilizationwithpinsorscrewsunnec- essary.Theporosityoftheparticlesisdefinedthrough their biology. This is the reason why we prefer no al- loplasticbiomaterialsandtakeadvantageofthepros of combined allografts and xenografts. At the same time, these are the requirements of modern bio- matierials,accompaniedofcoursebyinductivityand conductivity. 28-30 Periodontal diseases are a regular limitationfactorinoralimplantology.Thus,thereare situationsinwhichperiodontaldiseaseposenocon- traindicationtoimplantology.Preconditionsforsim- ilar procedures are understanding and knowledge of biology, surgery and prosthetics. These procedures underlienoalgorithmsbutproperdiagnosis,analysis and planning of every individual patient and the choiceoftheappropriateimplantsystemandbioma- terials. Modern implantology provides all tools for successful implant treatment. Complications are, however, severe and can hardly be solved without compromises._ Editorialnote:Alistofreferencesisavailablefromthepub- lisher. Dr.Nikolaos Papagiannoulis Steigmann Institute Bahnhofstraße 64 69151 Neckargemünd Germany m.steigmann@t-online.de www.implantologie-heidelberg.de _contact implants Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19