Please activate JavaScript!
Please install Adobe Flash Player, click here for download

implants - international magazine of oral implantology

I case report 08 I implants2_2015 unphysiological force induction influences the pro- gressionofboneresorption.Toavoidfurthertraumati- sationofthehardandsofttissue,weremovedthegin- gival plate of the flipper and created a pontic-like de- sign for region #21 (Fig. 3). With the exception of the pronounced bone deficit in region 21, there were no negative findings during examination of the anterior toothregion(Fig.4). We took impressions of the situation, prepared models and performed articulations. Then all thera- peutic options were weighed against each other. We preparedabiologicalandfinancialcost-benefitanaly- sis for each solution.1, 2 We discussed all options in- depth with the patient. The justification for implanta- tion was that both adjacent teeth were free of caries and should not be ground. Knowing that a correctly placedimplantwouldpreventfurtherresorptionofthe jaw bone, we prepared the most suitable treatment planforthepatientinourview. The challenge of every treatment is the natural ap- pearanceoftherestoration.Theaestheticcharacteris- ticsproposedbyMagneandBelser3 arepartofourpre- prostheticplanningandarediscussedbytheteam.The focus is on the condition and colour of the gingiva, achievingclosedinterdentalspaces,abalancedprofile ofthegingiva,interdentalcontactpoints,theshapeof the teeth, characterisation of the teeth and their tex- ture,thealignmentandpositionoftheteeth,aswellas the symmetry of the smile. The design of the convex structure of the alveolar bone ridge and the reshaping of the jugae alveolaris in the “red” area are just as im- portantforanaturalappearanceastheperfect“white” crown reconstruction. Reconstruction of the bone deficit,bothverticallyandhorizontally,requiresabone blockgraft.Inordertoensurethesuccessofthesurgi- cal intervention for the 3-D placement of the implant, we opted for a two-stage procedure. In other words, the planned implant is inserted after regeneration of thebone. _Reconstruction of the bone defect After administering local anaesthetic in both the donor and the host regions, a mediocrestal incision with vertical relieving incisions was performed in the anteriormaxilla,distaltotheadjacentteeth.Inorderto allow sufficient mobilisation of the mucoperiosteal flapandtension-freeadaptationofthemargins,there- lievingincisionswereextendedoverthemucogingival margin. Care was also taken to ensure that the flap edgeswerepositionedonthelocalboneasthisiswhere the growth factors for marginal regeneration origi- nate.Themucoperiosteum/mucosalflapwasprepared. To ensure blood supply to the flap, this was opened 5mmapicaltothemucogingivalmargin.Thedegreeof bone deficit was demonstrated visually using a thread loop(Fig.5). A sufficiently large bone graft was harvested from the Corpus/Ramus mandibulae. This was preserved in physiologicalsolutionuntilthesofttissueatthedonor sitehadbeensutured(Figs.6&7).Wethenadaptedthe cortical bone block as precisely as possible to the host site. In order to achieve an aesthetic overall outcome, attentionwaspaidtotheshapingofthejugaalveolaris in the later implant region. The bone block was fixated withtwoosteosynthesisscrews(Fig.8).Theremaining autologous bone material was ground and then used to fill the spaces between the block graft and the local bone (Fig. 9). Bio Oss® was added around the graft to Fig. 5_A loop thread around the adjacent teeth illustrates the bone deficit. Fig. 6_The bone block was harvested in sufficient size from the Corpus/ Ramus mandibulae. Fig. 7_The bone graft was stored in physiological solution until further processing. Fig. 8_The autologous bone block was adapted to the shape of the host site. The focus was on the forming of the juga alveolaris. Fig. 9_The cavities were filled with ground autologous bone chips and Bio Oss® was applied to the bone edges to protect against resorption. Fig. 10_The X-ray control image shows the fixated bone block in the upper jaw and the donor site in the lower jaw. Fig. 8 Fig. 10Fig. 9 Fig. 5 Fig. 7Fig. 6

Pages Overview