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ePaper created 2016-10-04, 09:33:57 | version 1.38.0
case report cone beam supplement | 51 CAD/CAM 3 2016 need to include additional surgical sites are the drawbackstoautografts,whichhaveintensifiedthe search for suitable alternatives. Bone-substitute materials have increased in popularity as adjuncts to or replacements for autografts in bone aug- mentation procedures to overcome the limitations related to the use of autografts. Bone-substitute materials can be categorised into three groups: (1) allogenic: from another individual within the same species; (2) xenogenic: from another species; or (3) alloplastic: synthetically produced. The technique of guided bone regeneration (GBR) was evolved to augment atrophic or damaged ridges.11 GBR employs a physical barrier to selec- tivelyallownewbonegrowthintothespacecreated between the barrier and the existing bone.12 The emergence of synthetic bone substitutes for graft- ing should enable today’s practitioners to perform analmostendlessvarietyofproceduresthatinvolve the repair or regeneration of alveolar bone around dental implants or natural teeth. Such materials must satisfy various regulatory requirements and meet clinicians expectations for safety and effec- tiveness.13 It has been shown that an expanded polytetrafluoroethylene membrane can be used to improve the healing of both pathologic and experi- mentally created defects; however, this material is notrigid.14 Therationaleofusingatitaniummeshis tocontainandstabilisethegraftwithanunyielding material, allowing maximum bone regeneration andminimisingoveralllossofbonevolume.Various forms of titanium mesh have been successfully used to rigidly main- tain the alveolar contour with dif- ferent types of grafts. Graft mate- rials such as alloplastic bone in combination with membranes en- hance the treatment success of bone defects. Case report A 19-year-old male reported with a missing maxillary right central incisor. The patient gave history of trauma due to accident, which re- sulted in the loss of the maxillary right central incisor. On clinical ex- amination, deficiency in the ante- rior residual alveolar ridge with loss of buccal cortical plate was noted. The patient was in good health and was a non-smoker with no medical contraindications for surgery, had excellent oral hygiene and a strong desire to restore the area with a fixed prosthesis. On examination there were no clinical signs of periodontitis and dental caries. Radiographically, the clinical findings were verified and revealed vertical and horizontal bone loss that was limited to the maxillary right central incisor (Fig. 2) Using the native software, non-distorted measurements were made on the cross-sectional slices to determine the dimensions of the defect within the residual socket site, and lack of facial cortical-plate as confirmed in the axial view. Treatment planning Differenttreatmentoptionswerereviewedwiththe patient to replace the missing central incisor tooth. Figs. 2a–g: CBCT showing the vertical bone loss and deficient labial cortical bone in relation to 11. Fig. 2a Fig. 2b–g 32016