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ePaper created 2017-10-06, 11:56:35 | version 1.38.0
6(cid:9) DENTAL TRIBUNE(cid:9) Pakistan Edition(cid:9)May 2017 CLINICAL IMPLANTOLOGY Guided Bone Regeneration using NeoGen Ti-Reinforced Membranes: Case Reports By Neoss Ltd, Cases & Dr Norbert Hassfurther M embranes are used in Guided Bone Regeneration (GBR) to aid in the regenerative healing of bone defects. The membrane is surgically placed under the oral mucosa. It stops the soft tissue from growing into the defect and creates space for complete fill of the defect with regenerated bone.(cid:9) In many cases where substantial bone regeneration is required, such as vertical bone augmentation, a titanium- reinforced non-resorbable membrane is required to achieve predictable results.(cid:9) NeoGen Ti-reinforced Membrane is a new generation of non-resorbable titanium-reinforced membrane combining the handling and tissue interactions of expanded PTFE with the enhanced barrier function offered by dense PTFE. The membrane has a three-layer design. The outer, soft tissue friendly, PTFE layer has a tight texture that is impermeable to bacteria; the middle layer is a strong and highly shapeable titanium mesh that retains its shape throughout the healing period; and the inner PTFE layer has an expanded texture that enables predictable hard tissue integration. This combination results in a membrane that is easy to handle and protects the augmentation site in a predictable manner.(cid:9) This article describes three cases of GBR using a Ti-reinforced PTFE membrane and simultaneously placed dental implants without the use of bone substitutes. Case 1 Vertical ridge augmentation of severely resorbed mandible(cid:9) A 52 year old male was referred to the clinic with a severely resorbed anterior mandible due to a failed bone graft after removal of a large cyst (Figure 1). Pre-treatment radiographic assessment (Figure 2) showed that the bone height was inadequate to properly house implants. It was decided to perform a vertical ridge augmentation using NeoGen™ Ti-Reinforced Membrane and simulta- neous placement of Neoss ProActive Straight Implants.(cid:9) A full thickness flap with releas-ing incisions was opened and four Neoss ProActive Straight implants were placed; two anterior and two posterior. The vertical defect be-tween the two anterior implants was 5-6 mm (Figure 3). Autogenous bone cylinders (3.4 x 4-5 mm) were harvested from the oblique line of the mandible in the molar region and placed between the two anterior implants to accelerate regen-eration and to act as space fillers. A N e o G e n ™ Ti - R e i n f o r c e d Membrane Large was trimmed, shaped, and fitted at the surgical site and secured buccally with two tacks (Figure 4). A stable membrane configuration was achieved using the implants as tent posts (Figure 5). Stress free flap closure was achieved by releasing the periosteum on the buccal side. The soft tissue healing was uneventful (Figure 6).(cid:9) After 4-5 months, second stage sur- gery was performed. A mid-crestal incision was used to lift a flap and expose the membrane. The membrane was removed, excess bone removed and PEEK healing abutments were connected to the implants. As seen in figure 7, the implants were totally enclosed in newly formed bone, and the ridge had been regenerated to the desired height. Case 2 Regeneration of an extremely narrow ridge(cid:9) A 19 year old female presented with two congenitally missing teeth in the premolar area of the upper jaw, resulting in a very narrow atrophic ridge, with inadequate bone width to properly house implants (Figure 8). The treatment plan included regen- eration of the ridge using NeoGen™ Ti-Reinforced Membrane and simul- taneously placed Neoss ProActive Straight Implants.(cid:9) A full thickness flap was opened, osteotomies were prepared on the palatal aspect of the ridge, and two Neoss ProActive Straight implants were placed. Both implant sites had fenestrations on the buccal side (Figure 9) and palatal dehiscences (Figure 10). A Neogen™ Ti-Reinforced Membrane Medium was trimmed, shaped, and fitted at the implant site. Autogenous bone chips collected during drilling of the implant osteotomies were used to fill the palatal dehiscence (Figure 11). No material was used to fill the buccal fenestration, the strength of the mesh created the space for bone regeneration. The membrane was secured with two tacks buccally (Figure 12). Flap closure was achieved, and the soft tissue healing was uneventful (Figure 13).(cid:9) After 7 months, second stage surgery Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6 Fig 7 Fig 8 Fig 9 Fig 10 Fig 11 Fig 12 Fig 13 Fig 14 Fig 15 Fig 16