Implant Tribune Italian Edition

20 Implant Tribune Italian Edition - Novembre 2014Speciale Regeneration SR << pagina 19 and the membrane is configured with small scissors to facilitate insertion under the marginal edg- es, while at the same time achiev- ing an ideal defect-congruent cov- erage. To achieve this, the dimensions of the membrane should be approxi- mately 1–2 mm wider than the di- ameter of the alveolus. 3. Insertion of collagen membrane and cone unit Using dry, anatomical, wide twee- zers, the collagen membrane and cone units are inserted into the alveolus and then pushed in deep with a moist swab. The membrane part should be seated exactly at the level of the marginal gingiva. Now the free and slightly oversized part of the membrane is pushed care- fully under the edges of the mar- ginal gingiva. 4. Protective measures A back-and-forth suture with a non-absorbable suture material will secure the position of the col- lagen membrane and cone unit in the alveolus and also adapt the free gingiva edges on the membrane. Case presentations The following three patient cases serve to illustrate and ultimately evaluate the procedure of a delayed immediate implantation using an absorbable collagen membrane and cone unit. Case 1: Four non-conservable teeth in the anterior maxilla Due to a trauma of the anterior teeth during adolescence, the pa- tient received endodontic treat- ment and crowns on the four front teeth, which — after recurring problems — resulted in apicoecto- mies. The second set of crowns at ten years after the first prosthetic treatment was followed immedi- ately by a second resection due to persistent discomfort. The patient is in her late thirties, and now the four front teeth 12, 11, 21, 22 are no longer conservable. They showed mobility grades of I–II, high circu- lar probing depths and bleeding on probing. After a removable interim prosthesis 12–22 was produced, the four teeth in the anterior maxilla were extracted gently and the per- iradicular granulation tissue was also removed as non-traumatically as possible. The wound was closed with four collagen membranes and cone units; they were fitted to the alveolus by resizing the collagen part. The membrane part facing the oral cavity was adapted to the edges of the wound to enable a tight closure with suture material. Four weeks after extraction of the teeth, the former tooth area 12–22 was non-irritated with good remaining structure and volume. ITI implants were inserted in areas 12–22 which were fitted with a fixed bridge after twelve weeks of healing. Case 2: Free-end situation in the right half of the maxilla The free-end situation in the right half of the maxilla that occurred 31 years ago had been fitted with a disto-cantilever bridge 16-15-14 BM-KMKM. At a later time, both of the two premolars (abutment teeth) received endodontic treat- ment and a root filling. Both teeth fractured so unfavourably that they were non-conservable. The patient requested “the same treat- ment, but with implants instead of teeth”. To prevent further fractures of the teeth that had fractured on the subgingival level, the remain- ing two root portions were extract- ed gently and carefully. Two colla- gen-cone units were customised with a scalpel (collagen part) and scissors (membrane) in such a way that they were flush with and filled the former alveolus in addition to providing a finish. The final closure was achieved by way of intraosse- ous sutures. A delayed immediate implantation was also carried out after about four weeks; two im- plants were inserted in areas 14, 15, which were again fitted with a cantilever bridge (16 as a premolar pontic) after several weeks of osse- ointegration. Case 3: Replacement of periodontally severely damaged teeth 11, 21 The patient in her mid-thirties had already lost several teeth in the lateral dental area of the max- illa. The fact that she is a heavy smoker was certainly a consider- able co-factor in this unpleasant situation. A trauma of the front teeth (a fall at home) that had occurred many years ago had re- quired splinting of the two upper central incisors which now, only ten years after the procedure, showed a high degree of mobili- ty. The patient also complained of pain when biting. After the production of a clip-free interim partial prosthesis, the two upper central incisors were extracted, taking care to avoid any traumati- sation. A collagen membrane cone unit was also used for treating both of the two alveoli. Since the patient was not prepared to stop smoking, maintaining structure and volume was just as important as achieving a fast and tight clo- sure by using the collagen mem- brane and cone unit. After four weeks of primary healing time, two implants were inserted in ar- eas 11, 21, which then received two crowns as a supra-construction after eight weeks. Evaluation The procedure presented here is defi- nitely not a substitute for a proven treatment scheme, but it can serve to simplify it. If the alveolus is largely intact, which must be defined as the precondition for executing the treat- ment steps described here, a GBR pro- cedure can be performed quickly and without any further trauma to the tissue. The goal is to conserve as much volume of the former tooth socket as possible, thus creating favourable preconditions for a delayed immedi- ate implantation. The procedure has obvious limitations in cases where the former tooth socket has been largely destroyed (due to a complicated ex- traction or previous procedures re- sulting in a loss of most of the buccal bone lamella), where the non-conserv- abletoothshowsaprofoundinfection, and in situations where the patient does not want the use of materials of animal origin. Information regard- ing the employed collagen product: Absorbable collagen membrane-cone — PARASORB-Sombrero® — Absorba- ble local hemostatic agent with mem- brane for guided bone regeneration of equine origin. Manufacturer: RESOR- BA (Germany). The authors hereby confirm that there is no conflict of interest. L’articolo è stato pubblicato per la prima volta su COSMETIC DENTISTRY International, vol.3 anno 2013. Case 3 - The teeth were marked by a severe previous periodontitis, and the two upper central incisors were damaged so severely (Fig. 3a) that they were considered non-conservable. After minimally invasive removal of the two upper central incisors (Fig. 3b), the alveoli of the incisors were found to be intact (Fig. 3c) so that, for the purpose of socket preservation, collagen cone and membrane units were inserted (Fig. 3d) and fixa- ted (Fig. 3e). Two implants (Fig. 3f) were inserted after primary healing of the soft tissue. Figure 3g shows the immediate postoperative status; Figure 3h shows the status after one week. The two implants were fitted with crowns upon completion of further eight weeks of healing time. Figure 3i shows the clinical findings after six months within the scope of a recall appointment.

Implant Tribune Italian Edition

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