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ePaper created 2014-07-29, 09:08:59 | version 1.30.01
I case report 34 I implants2_2014 Figs. 9 & 10_The Calc-i-oss™ particles were placed to fill the spaces between the blocks. Figs. 11, 12 & 13_Images of implant placement after 6 months. There was adequate neoformation in the areas where the Calc-i-oss™ (arrows) was inserted. areawasdiagnosed,whichpreventedtheplacementof a dental implant. The patient was advised to undergo a bone grafting procedure using autologous bone har- vestedfromthemandibularramusinconjunctionwith a synthetic biomaterial. Subsequently, implant place- mentandprosthesiswereplanned.Inthefirststep,the maxillary area was surgically prepared. Figs. 3 and 4 showthemassivebonelossinthisarea. Oncethedonor site was exposed (ramus mandibular), osteotomy was performed using a trephine and a saw of the Transfer- Controlkit(Hager&MesingerGmbH,Neuss,Germany) under abundant irrigation with sterile saline solution (Figs. 5 and 6); 3 bone blocks were removed from the mandibularramus,andtheseblockswerethenplacedin the recipient site and held in place with screws (Figs. 7 and 8). The spaces between the blocks were filled with synthetic calcium phosphate bone granules (Calc-i- oss™, Degradable Solutions AG, Switzerland) with par- ticlesizesaveragingat500-1000µm(Fig.9).Thegran- ules provide resorption protection and produce a smooth outline. The mucosa was sutured with 5-0 ny- lon. Sutures were removed on the 10th postoperative day, and a control radiograph was performed (Fig. 10). Clinically,therewasanormalinflammatoryreactionaf- tersurgeryinthisarea.Sixmonthsafteraugmentation ofthealveolarridge,aconicalimplant(4.0mmx13mm) withandinternalhexagonwasplaced(ImplacilDeBor- toli Ltda, São Paulo, Brazil) (Figs. 11, 12 and 13). Three months after implant placement, the site was re- opened and an immediate temporary crown was in- stalledtoconformthemucosa.Aftertissuehealing,the permanentcrownwasplaced.Thepatientwaseducated andmotivated,andthoroughoralhygieneinstructions were provided. Four years after the installation of the prosthesis, a control tomography to evaluate the be- haviorofthegraftedbonetissuewasperformed;thisal- lowedthemaintenanceofboneinthevestibularportion oftheimplanttobeevaluated(Figs.14and15). _Discussion The utilisation of dental implants sometimes re- quiresanincreaseintheamountofboneintheimplant site. The technique to be used when reconstructing a bonedefectislargelyatthesurgeon’sdiscretion;how- ever, certain situations demand particular techniques. Furthermore,theselectionofaminimallyinvasivetech- niquemustalwaysbeconsidered.Autologousbonehas beenconsideredthegoldstandardbiomaterialforbone grafts because its characteristics are similar to the lost boneanditistheonlybiomaterialwithosteogenic,os- teoinductive and osteoconductive properties.20 How- ever,itrequirestwosurgeries,oneforharvestingofthe bone and one for grafting, increasing the trauma and sometimes the cost of treatment. Although excellent clinical and histological outcomes have been demon- stratedwiththeuseofbonesubstitutematerialsassyn- theticscaffolds,21,22 sometypesofbonedefectscannot be repaired with these materials because of local me- chanicalinstabilityanddefectsize.Therefore,incasesin which large amounts of bone are required, autologous boneisconsideredthefirstchoiceandcanbeharvested from sites such as the iliac crest, tibia, skull or mandible.23–26 Incasesinwhichtherequiredincreasein Fig. 9 Fig. 10 Fig. 11 Fig. 12