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ePaper created 2016-10-04, 09:33:57 | version 1.38.0
| cone beam supplement case report 52 CAD/CAM 3 2016 After discussing the pros and cons of each option, it was determined that the most acceptable treat- ment plan would be an implant-supported resto- ration. In order to facilitate implant placement, it would also require augmentation of the compro- mised alveolar ridge using an alloplast bone graft secured with a rigid titanium membrane. The ulti- mategoalwasforasingleimplant-supportedpros- thetic replacement. Treatment procedure A local anaesthetic agent was administered in the area of the maxillary right upper central incisor. An incision was made on the buccal and palatal aspect of the involved edentulous ridge and a full thickness flap was reflected from the maxillary right lateral to the maxillary left central incisor tooth to reveal the anticipated horizontal and ver- tical bone defect diagnosed with CBCT imaging (Fig. 3). Once the soft tissue was removed from the defect area, an osteotomy was prepared under copious irrigation to receive a single implant 3.8 mm in diameter by 11.5 mm in length inserted at 35 Ncm (KeltImplant)(Fig.4).Approximately1ccofcalcium phosphosilicate (CPS) Morsels (NovaBone) (Fig. 5) wasmixedwithsterilesalineandallowedtohydrate before being placed and packed into the defect and positioned to fill all void areas. A sterile titanium mesh (Fig. 6) was trimmed to size and placed under the facial flap following the GBR protocol to secure the bone graft in its place and was fixated with the cover screw of the implant. Extensive periosteal releasing incisions were made in the facial flap to permit complete tension-free coverage of the membrane. Primary wound closure was obtained by horizontal mattress and inter- rupted cytoplast 4/0 sutures (Osteogenics). Post- operative oral hygiene instructions were discussed with the patient. The patient was seen post-surgically after two weeks for suture removal; no untoward post-oper- ative symptoms were noted. The patient was put on a 2 week, 1 month, 3 month and 6-month recall, ensuring the proper management of implant site. An interim fixed resin-bonded retainer (Maryland Bridge) was utilised during the healing phase. After 5months,priortosecondstagesurgery,apost-graft CBCT (Figs. 7a–d) was performed and a horizontal bone gain of 5.3 mm was noted. A comparison of pre- and post-operative CBCT images revealed the extent of bone volume achieved (Figs. 8a & b). The patient was recalled for second stage surgery, where the titanium membrane was removed and the healing collar placed (Figs. 9a & b). After 3 weeks of additional healing, fixture level impressions were accomplished for the laboratory phase. (Impregum 3M ESPE). The final single tooth Fig. 3: Bone defect. Fig 4: Surgical placement of implant. Fig. 5: Novabone CPS. Fig. 6: Placement of bone graft and securing of with titanium mesh. Fig. 5 Fig. 6 Fig. 3 Fig. 4 32016