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ePaper created 2015-09-15, 12:06:46 | version 1.38.0
I case report Fig. 6_Soft-tissue quality after complete socket healing at the time of second-stage surgery. Fig. 7_Additional augmentation procedures after complete healing of the socket (BC = bone collector; GBR = guided bone regeneration; CBG = cortical bone graft; CTG = connective tissue graft). Table 1_Bone quantity according to Cawood’s classification at the time of second-stage surgery in sound bony walls (SP) and sockets with osseous defects (RP) at the time of tooth extraction. ofthefirstsurgery.Statisticalanalysisincludedthe description of the percentage distribution of the above-mentioned data in comparison with the necessary augmentation steps in consideration of the region and progress. Surgicalprocedure The extremely thin buccal bone in the anterior region of the upper jaw most often undergoes re- sorption after tooth extraction. In order to min- imise the resorptive processes, atraumatic extrac- tion techniques with SP are essential. A significant reduction in alveolar ridge resorption has been noted with the aid of SP techniques.10 All of the teeth were extracted using special pe- riotomes and luxators (KLACK-Periotome, Weg- mann Dental). The periodontal tissue was exposed by straight slide-in movements, and the tooth was elevated. If extraction was not possible (post-en- dodontic treatment or ankylosis), further efforts with luxators were attempted. A flap was prepared without damaging the papillae and the tooth ex- tracted by gentle osteotomy. In total, 72 teeth, which were not conservable, were extracted. After the sockets had been cleaned thoroughly, they were filled with Geistlich Bio-Oss Collagen (Geistlich Pharma). The moistened combination of collagen and bone material can be easily shaped. Depending on the size of the osseous defect, 100 or 250 mg Bio-Oss blocks were used, with 100 mg being suitable for single-rooted sockets and 250 mg being suitable for the molar region. Bio- Oss Collagen was placed at the height of the cre- stal bone. Wound closure was performed by single sutures. ThequalityofthehardtissueaccordingtoMisch andthebiotypeofthesofttissueweredocumented after wound closure. The biotype was determined by probing the gingival margin with a WHO dental probe. The biotype was considered to be thin if the probeappearedtoshowthrough;ifnot,thebiotype was recorded as thick (concept by Dr Markus Schlee, Germany). The sockets healed by secondary intention. Wound healing lasted for a minimum of seven weeks. On the day of second-stage surgery, the quality11, 12 and quantity13 of the bone were docu- mented to clarify the condition of the soft tissue. Depending on the structure of the bone bed, either the implant was inserted or augmentation to opti- mise the bone range in the horizontal and vertical directions was performed beforehand. The implants (RatioPlant Implants, HumanTech Germany) were placed according to the manufac- turer’sprotocol.Incasesofminorboneloss,suchas filteringthroughofthethread,boneparticlesfrom abonecollector(BoneTrap,DENTSPLY)wereusedto augmentthedefect.Intheeventofalargerosseous defect (uncovered thread size of 2–4 mm), a modi- fiedguidedboneregeneration(GBR)procedureen- tailingtheapplicationofGeistlichBio-Ossgranules (Geistlich Pharma) mixed with autologous bone particles covered by a membrane (Geistlich Bio- Gide, Geistlich Pharma) was performed. Very large osseous defects required a two-stage procedure: first, a block graft from the angle of the mandible was fixed in the affected area, and the implants were then placed in the lower and upper jaws after three and four months, respectively. If required, a 30 I implants3_2015 Fig. 6 Fig. 7 Cawood classification SP (%) RP (%) I 0 0 II 0 0 III 60,9 24,5 IV 34,8 57,1 V 4,3 18,4 VI 0 0 I 00 II 00 III 60,924,5 IV 34,857,1 V 4,318,4 VI 00