Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-11-17, 15:11:47 | version 1.38.0
10 Volume 1 | Issue 1/2015 Journal of Oral Science & Rehabilitation S urgic a l pro to co l In allofthe patients,the same surgicalprotocol was followed. All of the patients received pro- phylactic antibiotic medication before and af- ter surgery. Infiltrative anesthesia was admin- istered and incisions were made to elevate a full-thickness flap (Fig. 1). Implant explanta- tion was carried out using an implant extrac- tion kit (BTI Biotechnology Institute, Vitoria, Spain).Aratchet was first engaged into the im- plant connection and the removal torque was exerted by a wrench in a counterclockwise di- rection, maintaining a perpendicular position of the assembly in relation to the implant plat- form (Fig. 1).1, 19 After implant removal, the explantation socket was carefully curetted to remove any granulationtissueandimmediateplacementofa new implant was performed only in those sock- ets in which the four bony walls were preserved (Fig. 1). Bone drilling for placement of the new implant was performed to remove only 0.2– 0.5mm of bone.An implant with a wider diame- ter than that of the failed implant was then placed using a surgical motor set at an insertion torque of 25N cm and the implant placement was then continued manually to finish (Fig. 1). Activatedfraction2ofplasmarichingrowthfac- tors (PRGF-Endoret; BTI Biotechnology Insti- tute, Vitoria, Spain) was placed in the socket be- fore implant placement. The surgical site was then coveredwith afibrin membrane beforeflap closure. In order to obtain plasma rich in growth fac- tors,20 peripheral blood was extracted by venipunctureintotwo9mlextractiontubescon- taining 3.8% sodium citrate (BTI Biotechnology Institute, Vitoria, Spain) and processed accord- ing to the manufacturer’s instructions. To acti- vate platelets and fibrin formation, 50μl of cal- cium chloride solution (PRGF Activator, BTI Biotechnology Institute, Vitoria, Spain) per milli- literofplasmawas employed.Activatedfraction 1 (platelet count comparable to the peripheral blood) was employed to prepare a fibrin mem- brane that was compressed (Fibrin compactor, BTI Biotechnology Institute, Vitoria, Spain) to provideathinandconsistentmembranetocover thesurgicalsitebeforeflaprepositioningandsu- turing with a 5-0 monofilament nylon suture. Activated fraction 2 (platelet count two to three times higherthan peripheral blood)was injected into the implant bed and was used to humidify the dental implants before placement. Follow- up visits were scheduled to remove sutures, detect any surgical complications and fabricate theimplant-supportedprosthesis. P eriim pla n titis : I m m edi ate i mplant re place me nt Fig. 2 Scanning electron micrographs of five implants removed owing to periimplantitis. All of the implants showed clear signs of bacterial contamination and plaque formation, accompanied by vertical bone loss. Full implant images have been reconstructed using three to five scanning electron micrographs. The areas where bone resorption around the implants occurred are highlighted (white line). A scale bar is indicated for every implant image. Fig. 2 a b c d e