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implants – international magazine of oral implantology

I case report Table 2_Augmentation procedures at the time of second-stage surgery in sound bony walls (SP) and sockets with osseous defects (RP) at the time of tooth extraction. Fig. 12_Placement of a moistened Bio-Oss Collagen block (100 mg). Fig. 13_Pre-op radiograph (cone beam) after four months of healing. The former Bio-Oss Collagen block that supported the hard and soft tissue, averting the collapse of the tissue, is marked out. Fig. 14_Placement of three RatioPlant Avantgarde (HumanTech Germany) fixtures. Fig. 15_Placement of a Geistlich Mucograft matrix (Geistlich Pharma) to support the soft-tissue biotype. _Discussion In the present analysis, SP and RP were suc- cessfully carried out in 52 patients in order to im- prove the hard- and soft-tissue beds before im- plant placement. In these treated alveoli, dental fixturescouldbeinsertedasplannedinaone-step procedure without prior bone grafting. Existing bone defects were mostly of minor or moderate classificationandcouldbeaugmentedsimultane- ously by placing bone particles or through GBR. Only a few patients required additional connec- tivetissuegrafts.Inpatientswithpre-existingde- fects of the bony socket walls (RP), implantation had to be delayed, compared with patients with intact bony walls (SP). In addition, a greater num- ber of augmentations using bone particles and/or an artificial bone source were required in the RP group. The main region of treatment was the upper an- terior jaw. In addition to the functional aspects of implant treatment, the aesthetic perspective is just as crucial. In order to achieve optimal functional andaestheticresultswithimplanttherapy,thebuc- calwallshouldbe2mmwide.14,15 However,thebuc- cal wall is often less than 1 mm wide.16 Moreover, 52% of the width and 2–4 mm of the height of the buccal wall are lost in the first year after tooth ex- traction. The majority of such resorptions are knowntooccurinthefirstthreemonths.5 Ifsuchan occasion arises, extensive augmentation measures areinevitablyrequired.Elevationoftheperiosteum has been previously noted to lead to a median of 0.7 mm resorption at the buccal site. In the present study, SP achieved better results than RP, although resorptionofthevestibularbonecouldnotbeelim- inated completely. Currently, the focus is on preserving the bone volume and optimising soft-tissue conditions.6 In ordertoreduceoravoidthelossofbonevolumeaf- ter extraction, tooth extraction should be per- formed very carefully; the alveolus can be further treatedbySPorRPwithBio-OssCollagen.17, 18 Sub- sequently, hard- and soft-tissue volumes can be preserved to a large extent, and losses can be re- duced to simplify implantation. It should be noted that the process of resorption after extraction oc- curs in the crestal part of the tissue.1 It is not nec- essary to fill the socket completely to the apex with Bio-Oss Collagen. However, the apical void was confirmed to be well ossified by imaging using CBCT in this case series. Aesthetic outcomes were not assessed in this study, since many different referring dentists per- formed the prosthetic treatments. In addition, af- ter the incorporation of the crown or bridge, pa- tientswerenotcompliantregardingthetimeframe for prosthetic treatments. Therefore, patients were documented during standard treatment in our clinic. Consequently, no comparison with a group of patients without SP or RP was planned. There- fore, data analysis was performed on the basis of the quantity and method of augmentation needed to perform the standard procedure of tissue aug- mentation as described below: 1. If the primary stability of an implant has been achieved and the threads show through, bone particles gathered by a collector are used to widen the lateral wall by up to 2 mm. 2. If the primary stability of the implant has been achieved,buttheverticalbonedefectofthebuc- cal wall measures 2–4 mm, GBR with Geistlich Bio-Oss granules mixed with bone particles is performedandcoveredwithaGeistlichBio-Gide Membrane. 3. In the case of a larger bone defect in the vertical and horizontal directions (Cawood IV–V), a two- stage procedure must be performed, with bone blocksfromtheangleofthemandiblebeingused for augmentation. The lower and upper jaw im- plantsareplacedafterthreeandfourmonths,re- spectively. 32 I implants3_2015 SP (%) RP (%) Only hard tissue augmentation 87,5 71,8 Only soft tissue augmentation 6,25 0 Hard and soft tissue augmentation 6,25 28,2 Fig. 12 Fig. 13 Fig. 14 Fig. 15 87,571,8 6,250 6,2528,2

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