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ePaper created 2016-11-23, 14:26:06 | version 1.38.0
| industry 18 implants 4 2016 The atrophic crest Vestibular cortical stabilisation with bone graft Authors: Dr Paolo Borelli & Dr Massimiliano Favetti, Italy Introduction The insertion of implants in atrophic bone crests can easily create fenestrations in the coronal part of the implant site. For this reason, many authors advo- cateusingGBR(guidedboneregeneration)toprevent possibledehiscenceinthepost-surgicalphaseandto guarantee the survival of implants, which is at- tributed to adequate bone thicknesses in the corti- co-vestibular portion of the crest.1-2 Vestibular bone lossisfrequentlycausedbythetechniqueusedtopre- pare the implant site, that, for insertion of an implant of Ø 3.75 mm diameter, usually anticipates an osteo tomy with a drill of at least Ø 3.2 mm diameter.3 In these cases, the use of self-tapping implants and auto-condensersenablesustoreducetheosteotomy toaØ 2.8 mmdiameterdrill,makingitpossibletosave at least 0.4 mm of vestibular cortical bone, funda- mental in obtaining an optimal aesthetic and func- tional result that is long-lasting.4 Case overview Apatient,female,45-yearsold,non-smoker,without any particular problems in her medical history, pre- sentedcomplainingaboutaprobleminthemandibular left quadrant. The physical examination revealed bridgedecementationoftheteeth35,36and37.Simply redoingthisbridgeasimpossible,duetotheabsenceof an adequate ferrule as well as uncertainty regarding the long- term prognosis for tooth 37. It was decided, therefore,toreplacetooth36withanimplantandGBR witharesorbablemembraneandheterologousgraft. Extraoral examination The patient was normotrophic with regard to soft tissues and the perioral musculature without signifi- cant asymmetries of the face. Intraoral examination Intraoral examination showed a good level of oral hygiene, some signs and facets of dental wear as well as an absence of mobility problems (Fig. 1). X-ray examination The preoperative oral X-ray (Fig. 2) suggests that tooth 37 has an uncertain long-term prognosis as bridge abutment. The CBCT (Figs. 3a & b) shows the crestalbonetobeverythin,butofadequateheightfor the insertion of an implant of 13 mm in length. Materials used The following materials were applied: – – NeOimplantØ 3.75 x 11.5 mm(Alpha-BioTec.,Israel) inzone36 – – Resorable collagen membrance – – Xenograft – – PTFE 4-0 suture (Omnia, Italy). Treatment objectives and work plan Thetreatmentplanincludedapre-implanthygiene session.Properpositioningoftheimplantwillrequire Fig. 1: Frontal view of the patient. Fig. 2: Ortho-panoramic X-ray. Fig. 2 Fig. 1 42016