Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-09-14, 10:12:26 | version 1.38.0
| industry 30 implants 3 2016 gained enough bone volume for insertion of four standarddiameterimplants.Consideringthefactthat the fixation screws had to be removed, and with re- gard to a number of benefits of a delayed implant placementinaugmenteddeficientalveolarridges,we optedforatwo-stageprotocol.Eventhoughdelayed implantplacementwithflapelevationrequiredasec- ondsurgicalinterventionandthereforeanadditional burdenforthepatient,itcomprisedtheadditionalad- vantage of a visual and tactile assessment with re- spect to the osseointegration of the autograft in our patientcase.Anothercrucialadvantageofthestaged approach comprised inter alia the possibility for an implant placement in an ideal position for the later prosthetic restoration under visual control.5 Another reasonforopenaccessforimplantplacementwasthe use of non-resorbable microscrews for the stabilisa- tion of the bone graft. The decision to utilise non-re- sorbable titanium screws in favour to resorbable screws out of poly (D, L-lactide) acid, was supported bythefindingsofasystematicreviewoftheCochrane Collaboration.6 Thus, resorbable screws seem to have ahighsusceptibilityforfractureduringfixationofon- lay grafts. As the combination of autogenous grafts with guided bone regeneration (GBR) is apparently associatedwithsuperioroutcomes,wedecidedtouse a barrier membrane.9 With the additional application of a PRGF membrane, we aimed to utilise the benefi- cial effects of platelet-derived rich plasma for an ad- vanced wound therapy, and the reduced risk of post-operative infection.10 The vestibuloplasty with the Edlan-Mejchar method was performed for two purposes. Firstly it was done in order to create a suf- ficient amount of keratinised mucosa. According to findingsofasystematicreview,publishedbyLinetal., a lack of keratinised mucosa around implants fosters plaque accumulation, inflammation, and soft-tissue recession.11 Secondly we aimed to create enough space for the final overdenture. Conclusion Thestagedapproachwiththeuseofanautogenous bonegraft,harvestedfromthesurgicalsiteinthean- terior mandible, resulted in a significant horizontal bone gain, and took to a good osseointegration of both, autograft and implants. Obviously, the de- scribed grafting procedure has not been previously reported in literature. Despite the lack of any experi- encereports,ourmethodrevealednonethelessasuc- cessful rehabilitation with an implant-supported, screw-retainedprostheticrehabilitation,andisstillin functionwithoutanybiologicalortechnicalproblems after a three-year follow up._ Special thanks to Dr Pantelis Petrakakis. Editorial note: A list of references is available from thepublisher. Fig. 19 Fig. 21 Fig. 18 Fig. 20 contact Dr Marko Nikolic Dental Clinic Rident Franje Candeka 39 51000 Rijeka, Croatia Tel.: +385 51 648900 mnikolic.ri@gmail.com www.rident.hr Fig. 18: Facial view of the bar construction and PS TiBA abutments. Fig. 19: Oral view of the bar. Fig. 20: After an additional healing period of one month after muco-gingival surgery, the bar was inserted. Fig. 21: Final prosthetic restauration of the upper and lower jaw. 32016 Tel.: +38551648900