Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-01-07, 12:59:38 | version 1.38.0
I case report 22 I implants4_2015 – Primaryclosureofthesurgicalsitetoenableundis- turbed and uninterrupted healing. – Completion of the best possible angiogenesis to provide the required vascularisation and undiffer- entiated mesenchymal cells. – Creation and maintenance of a space to facilitate bone formation inside this space. – Stabilisationofthesurgicalsitetoinducebloodclot formation and facilitate healing. – Thankstothecarefulchoiceofthehealingscrewor the implant abutment/temporary crown pair, these two entities with different regeneration potentials can be hermetically sealed, thereby avoiding cell competition, which we know contributes to the growth of epithelial cells which develop more rap- idly. _Case 1 Thepatientpresentedwithafractureofnumber16 (Fig. 3) and periapical cysts. With the patient's con- sent,thedecisionwasmadetoperformanextraction, debridement, socket decontamination and immedi- ate placement of a non-submerged implant (implant + healing screw) using Summers' method (crestal si- nus lift). The patient was on standard premedication with amoxicillin and corticosteroids. Tooth number 16 was carefully extracted by radicular separation to avoid bone fracture especially in the vestibule, where the cortical bone is very thin. The lamina dura, which enables the attachment of collagen and Sharpey's fi- bres, presents a high potential for contamination. Consequently, a light manual curettage of the socket wascarriedout,followedbyasuperficialdebridement (vaporisation)oftheentire“laminadura“,withanEr- bium laser (2,870 nm) followed by decontamination withadiodelaser(940nm).Thiswasaflaplesssurgery. Expansionosteotomywasperformedthroughthe inter-radicular septum. It was initiated with a very thin manual bone tap (pointed) and then an auto- matic mechanical osteotome (Figs. 4–5, Osteo Safe®, Anthogyr) was used. The use of convex inserts in the beginning enables lateral expansion of the native or Figs. 2a–d_a & b) Bone expansion through the septum with the use of osteotomes; c & d) choice of healing screw that enables primary closure of the soft tissue. Fig. 3_Preoperative clinical view: 16 fractured, infected. Fig. 4_Use of OsteoSafe® . Fig. 5_Complete OsteoSafe Kit. Figs. 6a–c_a) Bone expansion; b) positioning of the implant; c) choice of the healing screw. Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6a Fig. 6cFig. 6b a b c d