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ePaper created 2014-11-07, 14:16:52 | version 1.30.01
I research _Late complications after prosthetic restoration Boneloss In an experiment on dogs, Berglund and Lindhe demonstrated that the thickness of peri-implant soft tissue influences the amount of bone resorp- tion that takes place after second-stage surgery to establish biologic width.26 In this process, a biologi- cal interface between the bone, soft tissue and im- plant is established, which is composed of the bar- rierepithelium(2mm)andtheconnectivetissueat- tachment (1–1.5 mm). These phenomena result in bone loss of up to 2 mm on a radiograph. A higher rate of bone loss may be of concern because it can be the result of mechanical overload or chronic in- flammation of the peri-implant soft tissue.5 Lossofattachedgingiva A loss of fixed gingiva is frequently observed around implant restorations. Bengazi et al. and Grunderreportedanaveragelossof0.5mmoffixed gingiva in the initial years after prosthetic restora- tion.27,28 In the mandible, vestibuloplasty and con- nective tissue grafts are suitable techniques to shape aesthetic and functional peri-implant soft tissue.5 _Treatment outcome of clinical complications Atraumaticulceraffectingtheoverlyingmucosa of a maxillary molar (Figs. 1a&b) was treated with a maxillary partial denture to maintain centric occlu- sion (Fig. 2), protecting the overlying mucosa and NanoBone block graft. After the treatment, a com- plete healing of the traumatic ulcer was observed (Fig.3).Duringthistreatment,theuseofachlorhex- idine solution several times a day was useful in re- ducing bacterial infiltration. An infection of the NanoBonegraft(Fig.4a)andFisiograft(Fig.4b)from the suture was treated by removing the suture (Figs.5a&b),prescribinganantibioticandamouth- wash, which in total lead to a complete healing (Figs. 6a & b). In the early healing stage, the screws have to re- maininplaceforproperstabilisationofthegraft.In four cases, a fixation screw had loosened and be- come exposed in the late stage of graft healing (Figs.7a&b).Thisscrewwasremovedtopreventin- fection of the graft (Figs. 8 a&b). In three cases, the soft-tissue perforation healed after several days (Fig. 9). In cases in which the area around the mini- plate and the second cover screw became inflamed (Figa. 10 & 11), we removed the remaining cover screw and mini-plate (Fig. 12), sutured the wound (Fig. 13), and the soft tissue healed after several days (Fig. 14). In a case in which the mesial part of the NanoBone graft had become exposed (Fig. 15), a mesial mucosal pedicle graft was performed to cover the exposed bone graft (Figs. 16a & b). After- wards, the wound was sutured (Figs. 17a & b). For the same case, the distal part of the graft had be- come exposed (Figs. 18a & b) and a distal mucosal pedicle graft was performed to cover the exposed graft (Figs. 19a & b), but the graft size markedly de- creased.Then,awoundsuturewasperformed(Figs. 20a & b). A decrease in augmentation size was noticed (Figs.21a&b).Oncethecoverscrews(Figs.22a&b) and mini-plate had been exposed but not loosened (Fig. 23) with partial exposure of the graft (Fig. 24), resuturing of the dehiscent area was performed (Fig.25)afterreducingthevolumeoftheNanoBone 22 I implants3_2014 Fig. 28 Fig. 29 Fig. 30 Fig. 31a Fig. 31b Fig. 32