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implants – international magazine of oral implantology

case report I connective tissue graft from the palate was trans- planted to the buccal site of the fixture. Thereferringdentistsfabricatedtheprostheses. Once the fixture exhibited good osseointegration both radiographically and clinically, the surgical implant therapy was deemed completed. _Results Overall, 72 % of the extraction sockets were lo- calised in the upper jaw, with 63% being in the an- terior regions of teeth #14 to 24 (Figs. 1a & b). One extraction socket was treated in 37 patients, two in 11, and three in three patients. A thin biotype was present in 60.9% of the patients treated with SP and 87.8% of the patients treated with RP. In the majorityofthepatients,thebuccalboneheightwas reduced by more than 30% owing to pre-existing defects or extraction trauma (Fig. 2). The buccal bone was considered satisfactory in 32% of the patients (resorption of < 30%). Antibiotics were administered postoperatively in 28.9% of the cases. The second stage of surgery was performed at 13–20 weeks in approximately 50% of the patients (Fig. 3). One patient became pregnant shortly after SP; therefore, the implant surgery was extremely delayed. The handling of the collagen blocks was rated “easy”bythesurgeonandtheamountofbonesub- stitute for the size of the sockets was always suffi- cient. Healing was uneventful in all of the patients. The sockets had healed completely at the time of the second surgical procedure, and 88.9% of the treatedsocketsexhibitedabonequalityofD2orD3 according to Misch (Fig. 4). No significant differences were observed be- tween the SP (D2 or D3 in 91.3%) and RP (D2 or D3 in 87.8%) groups. The bone quantity according to Cawood’sclassificationwasIIIorIVin86.6%inthe SP group (Fig. 5), whereas the RP group included a lower number of patients at the III and IV levels (Table 1). Thetextureofthesofttissuewasratedas“good” in the majority of cases (Fig. 6). The criteria for this rating included the absence of inflammation and a broadbandofkeratinisedandstippledgingiva.The criterionfor“fairquality”wasanarrowbandofker- atinised gingiva with a lack of stippling. The crite- rion for “poor quality” was a thin biotype with par- tial superficial redness that was sometimes caused by coverage with a temporary prosthesis (i.e. con- tact mucositis). Implant placement was not hin- dered in any of the cases. In 75 % of the sockets, complementary meas- ureswereundertakentoaugmentthehardorsoft tissue (Fig. 7). Mainly, hard-tissue augmentations were required (76.4 %). However, block grafts (with or without soft-tissue augmentation) had to be carried out in 14.8 % of the cases, and all of thesesocketsfeaturedbonedefects(RPgroup).In five of eight sockets, resorption was distinct with percentages of ≥ 70 %. In most cases, augmenta- tion using bone particles from the collector or performing GBR with Bio-Oss and a Bio-Gide Membranewassufficientfortreatingtheexisting defects. Combined augmentations of hard and softtissuewereundertakenin20.4 %ofthesock- ets. In the RP group, augmentation of the hard and soft tissue had to be performed more often than in the SP group (28.2 % compared with 6.3%; Table 2). In 77.8% of the treated sockets, implants could beplacedimmediately,whereasaboneblockhadto be grafted beforehand in 15.3% of the sockets. No dental fixtures were placed in 6.9% of the sockets. In sockets without relevant bone defects (SP), im- plantswereinsertedinalmostallthecases(95.7%) during the second-stage surgery. In contrast, only 69.4% of the sockets preserved by RP could un- dergo immediate implantation during the second- stage surgery. One of the patients underwent partial resection ofthetongueandfloorofthemouthwithadjuvant radiotherapy owing to squamous cell carcinoma. Although surgical preparation and wound closure were difficult owing to fibrosis, the patient suc- cessfullyreceivedimplants.Theprosthesishasbeen inplaceformorethansixyearswithouttrouble.The clinical progress and prosthetic outcomes are shown in Figures 8–18. Fig. 8_Planned SP in region #13 in a 70-year-old patient. Fig. 9_Radiograph of the non-conservable tooth #13. Fig. 10_Moistening of the Bio-Oss Collagen block (100 mg). Fig. 11_Gentle extraction of the fractured tooth. I 31implants3_2015 Fig. 8 Fig. 9 Fig. 10 Fig. 11

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