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ePaper created 2017-05-12, 09:42:21 | version 1.38.0
| industry A detailed description of these various tech- niques and the meaningful options are discussed in more detailed articles because many new tech- nical issues have arisen and current developments are still being integrated into this field since the original review article was published in 2013. The current situation is: Autogenous bone is the best material if it is ap- plied either as particles or as fresh cancellous bone. Analogously to the gap healing of fractures, there are four phases: 9–12 – aseptic inflammation leading to chemotaxis of pluripotent cells, – loose replacement tissue (soft callus), – specific tissue differentiation (mineralisation to hard callus), – remodelling to functional restitution of the bone. A useful complex augmentation technique is the shell technique.2,13–17 There are a number of different applied techniques of this concept: autologous shells (Khoury shells), lactide membranes (Iglhaut tech- nique), metal-reinforced PTFE membranes, titanium membranes and under some conditions allogeneic bone shells as well. The Yxoss titanium grid from ReOss/Geistlich and the 3-D adapted membranes (Draenert-modified Iglhaut technique) are some of the modern 3-D-based improvements.2 Fig. 3a Fig. 3b Fig. 3c Fig. 3d Fig. 3e Fig. 3f Fig. 3g Fig. 3: Immediate implantation and load-free restoration in the anterior region in the upper jaw: a) atraumatic tooth extraction to preserve soft tissues; b) positioning of the angled implant (Straumann BLT SLActive); c) impression taking; d) cover screw; e) particulate augmentation with autogenous bone; f) fixed interim Incisions should, where possible, avoid large restoration; g) stabilisation on the adjacent teeth with Ribbond. openings and the risk of dehiscence. Augmentation techniques and alternatives The bone defect after tooth loss In pre-prosthetic surgery prior to dental implan- tation, a bone defect is a common indication for sur- gical treatment.18 Edentulism leads to bone resorp- tion in the jaws.19–21 Analogous to the indications for bone augmentation, complex bone defects can be differentiated specifically by indication. There are in principle five applications that can be differentiated: – complete edentulism in one jaw – the anterior jaw region – indirect and direct sinus floor elevation – alveolar ridge augmentation in the posterior teeth of the upper jaw – alveolar ridge augmentation in the posterior teeth of the lower jaw Complete edentulism in one jaw With a completely edentulous jaw, the pressing question when planning an implant prosthetic res- toration is whether a fixed or removable prosthesis will be used because this has a considerable influ- Fig. 4a Fig. 4b Fig. 4c Fig. 4: Immediate implantation and load-free restoration in the anterior region on the lower jaw: a) Straumann BLT 2.9 mm; b) positioning of the implant; c) interim restoration with immediate implant crown. Fig. 5a Fig. 5b Fig. 5c Fig. 5: Direct sinus floor elevation: a) osteoplastic window and implant insertion (Straumann BLT SLActive); b) inserted implant and augmentation with Geistlich BioOss; c) radiographic check. 34 implants 2 2017