Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-03-04, 10:43:31 | version 1.33.01
I case report 08 I implants1_2015 jor focus of treatment was on functional rehabilita- tion,aestheticsshouldnotbeunderestimatedinsuch cases. Once functionality has been obtained, the pa- tient’s attention turns to his or her appearance. The patient was to receive implants for teeth #12–23 in an immediate implantation with simultaneous guided bone regeneration. The implants were to be loaded immediately with a high-filler resin tempo- rary bridge. _Surgery Withawax-uponthesituationmodel,anoptimal formwascreatedtosupportandmanipulatesofttis- sue during the healing phase. At the same time, the temporary bridge functions as wound coverage if primary closure is not possible (Figs. 3–6).1–4 Inthenextstep,teeth#12–23wereextracted.The flap outline preserved the papillae of the adjacent teeth by an incision at the papilla base. Owing to the interproximal bone defects, papilla raising in this re- gion would have led to severe recession. The vertical bone defects were obvious after raising a full-thick- ness flap. A releasing incision was made only mesiodistally at tooth #12 and only in attached gin- giva to prevent scar formation through vertical cuts at the mucosa. The low vestibule made a split-thick- ness or periosteal pocket flap the less logical choice. Mobilisingsofttissuefromthelipstoo,throughother flap designs, would have caused functional limita- tions,suturetensionandasecondgingivalsurgeryto reposition the coronally transpositioned soft tissue. The wound margins were cut back to remove excess epitheliumandthebonedefectsfreedfromsoft-tis- sue ingrowth (Figs. 7–10). The horizontal bone loss was moderate. The im- plants were placed slightly sub-crestally. Although the gap between the implants and buccal plate was duetotheresorptionofapproximately1–1.5mmand the buccal plate thickness of less than 1 mm, we de- cidedon3.8mmimplants,leavinga1.5mmgapfrom the buccal plate.5–10 Theinter-implantspaceandthebuccalplatewere augmented with a combination of allograft and xenograftmaterials.Autologousboneobtainedwith a bone scraper was placed directly on the implant surface and covered with a mixture of allograft and xenograft materials. A pericardium membrane was used as barrier (Fig. 11). Fig. 3_Flap raising and implant insertion, showing the bone morphology after extraction. Fig. 4_Implant positioning, frontal view. Fig. 5_Guided bone regeneration: filling the gap to the buccal plate and the interproximal space. Fig. 6_Flap closure, coronal view. Fig. 7_Flap closure, frontal view. Fig. 8_Provisorium and temporary bridgework. Fig. 3 Fig. 4 Fig. 6Fig. 5 Fig. 8Fig. 7