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ePaper created 2015-09-15, 12:06:46 | version 1.38.0
case report I The results of the analysis suggest that after SP inmostcases,aone-stageprocedure(Type1or2in the list shown above) could be chosen to provide a sufficient amount of hard tissue for the implant. In sockets with sound bony walls (SP), this rate was higher than that in sockets with a defect in the vestibular wall (RP). Similar results were obtained by Shakibaie in a prospective clinical study with 32 patients and 142 recently extracted sockets.19 On comparing the de- greeofpreservationinthreedimensionsafterthree to five months of healing without (control group) andwithSPorRP(testgroup),thecontrolgroupex- hibited a significantly higher rate of resorption (65%) than did the test group. Combining our subjective grading and the above-mentioned comparison with previous re- sults from our practice, we consider that the bone bedisimprovedbySPorRP,therebydecreasingthe number of cases that require block grafts. Bio- switching of the soft tissue after SP or RP with Bio- Oss Collagen is feasible. Connective tissue grafts were only required in a few cases in our study, re- sembling the results by Ackermann, who described comparable outcomes concerning soft tissue.17 SP and RP have certain advantages: these are straightforward procedures with little risk, involve no shift of the mucogingival junction, and lead to minimal trauma and shortened treatment time compared with cortical bone grafts, which may be considered avoidable.19 Curettage of the alveolus must be carried out diligently, since the obturation ofthesocketwithBio-OssCollagenposesagreater risk of the development of a residual cyst. _Conclusion In this consecutive case series, fresh extraction sockets were treated with SP or RP to improve the hard and soft tissue of the implantation bed in or- der to render the proposed implant placement eas- ier to perform. In larger augmentation procedures that require intricate surgical techniques and long treatmenttimes,withhigherrisksofcomplications and morbidity, SP or RP could positively influence the need for such complex augmentations, en- abling simpler procedures. This aim was well achieved in our patient population—more so in pa- tients with intact bony walls (SP) than in patients with osseous defects (RP). Most of our patients re- quired only small bone augmentations, which could be performed simultaneously with the im- plantation.Thisone-stageprocedurerepresenteda substantial clinical improvement compared with bone block transplantations. The probability of successful RP decreases with increasing loss of the lateral bony wall. In cases of high resorption of the buccal wall (70–100%), Bio- Oss Collagen acts like an expander for the soft tis- sue, but cannot help avoid a two-stage augmenta- tion procedure. Bio-Oss Collagen is very well suited for SP or RP, sinceitsupportshardandsofttissue,iseasytohan- dle,andpresentsonlyaminorriskofcomplications. SP or RP reduces the necessity of complex aug- mentations and is an ideal preconditioning regi- men for guided surgery cases. Based on our findings in these cases of SP or RP, the use of Bio-Oss Collagen is a reliable approach for simplifying and optimising implant therapy._ Fig. 16_Radiograph of the osseointegrated RatioPlant fixtures at four months after implantation. Figs. 17 & 18_Prosthetic crowns (upper jaw) and removable partial dentures (lower jaw) completed by Dr Katharina Dietz-Epple (Aalen, Germany). I 33implants3_2015 contact Praxisklinik-MKG Wetzgauer Str.62 73557 Mutlangen Germany sg-implant@praxisklinik-mkg.de Fig. 16 Fig. 18Fig. 17