Periimplant Regeneration Fenestration

Transcription

1 Indication Sheet PIR Periimplant Regeneration Fenestration Treatment concept of Dr. Jean-Pierre Gardella (surgeon) and Dr. Christian Richelme (prosthodontist), Marseille, France > Filling of a peri-implant defect, combining an autogenous bone graft with Geistlich Bio-Oss to correct substantial tissue loss > Extraction of a mandibular incisor also valid technique for a maxillary incisor > For early implantation. Indication profile (see Figure a and b) Region Bone quality Soft tissue Indication for bone filling aesthetic zone one missing tooth absence of bone lesion bone augmentation indicated absence of recession inflammation without complications soft-tissue augmentation indicated yes, at the time of implant insertion no non-aesthetic zone several missing teeth bone lesion(s) recession infection thin lack of keratinised gingiva

2 Background information Substantial tissue loss usually necessitates grafting prior to implant placement. However, the anatomy of the defect determines whether primary implant stabilisation is possible,. If this is possible, it can be performed simultaneously with an autogenous bone graft. This reconstruction can be optimised by combining the osteoinductive potential of autogenous bone with the osteoconductive capacity of Geistlich Bio-Oss as well as its low resorption speed. This technique can also shorten the treatment time because grafting and implant placement are performed during the surgical operating phase. In order to manage this type of situation and improve the biotype of the future implant site, primary closure of the extraction site is performed with the aid of an epithelial connective tissue graft. Concept: > Rapid treatment to halt the progression of bone resorption caused by the infectious process > Primary closure of the extraction site with an epithelial connective tissue graft > Combining Geistlich Bio-Oss with autogenous bone makes it possible: to combine osteoinduction of the autogenous bone and osteoconduction of Geistlich Bio-Oss, to reduce the volume of autogenous bone harvested, which allows for a less invasive surgical technique and more comfortable postoperative course for the patient > Use of a Geistlich Bio-Gide bilayer membrane in double layer technique. Surgical technique: > Atraumatic extraction technique > Closure of the extraction site with an epithelial connective tissue graft which allows: soft-tissue healing within a short time, while recreating aesthetic crestal morphology, and re-operation for implant placement before alveolar bone resorption reaches its peak > Assessment of the site two months postoperatively (the expanded operation window for treatment is obtained by using Geistlich Bio-Oss or Geistlich Bio-Oss Collagen) > Obtaining of adequate primary stability by adaptation of the drilling sequence > Performing an autogenous bone graft with core bone harvested by trepan (symphyseal region) > Placement of Geistlich Bio-Oss above the graft and onto the outer surface of the vestibular cortex. The Geistlich Bio-Gide membrane is placed over the site in a double layer. > After months, the second surgical phase is started with a minimal incision > Placement of the temporary prosthesis after months of healing > Usual prosthesis at months Limitations and open questions: As a result of post-extraction resorption, we sometimes have to perform grafting prior to implant placement. Despite this compensation, remodelling continues for months following extraction and occasionally leads to mucosal collapse, which can compromise the aesthetic outcome. To make up for this, in eminently aesthetic situations, an excess of soft tissue must be available, which is why over-correction of the defect at the bony and mucosal level is necessary 6.. Aims of the therapy > To optimise and speed up soft tissue healing in order to allow peri-implant reconstruction > Early implantation combined with an autogenous bone graft, combining Geistlich Bio-Oss and Geistlich Bio-Gide > To restore natural tissue architecture

3 . Surgical procedure Fig. a Tooth is compromised for obvious endodontic reasons. This tooth has already undergone retrograde surgery and apicectomy. Fig. b See Figure a. Fig. a After extraction, in order to solve the problem of primary closure of the site, an epithelial connective tissue graft was raised from the tuberosity and grafted to the extraction site. Fig. b See Figure a. Fig. Clinical view of healing after days. Fig. a Clinical view of healing after months. Fig. b See Figure a. Fig. Clinical view of the defect, the two vestibular and lingual cortices are swollen. The probe passes through the drill hole. Fig. Implant placement. Fig. Filling the defect with autogenous bone cores. Fig. Placement of Geistlich Bio-Oss to maintain volume and protect the autogenous graft against resorption. Fig. Postoperative radiograph of the first surgical phase. Fig. a Geistlich Bio-Gide arranged in a double layer. Fig. b See Figure a. Fig. a Closure of the site by first intention.

4 Fig. b See Figure a. Fig. a Clinical view of the second phase of surgery. Fig. b See Figure a. Fig. Postoperative radiograph of the 2nd surgical phase. Bone regeneration with very good results and observed. Fig. a Clinical view of the temporary prosthesis and after it has been unscrewed. Fig. b See Figure a. Fig. Radiograph of the temporary prosthesis in place. Fig. Clinical view of the final prosthesis 8 months after extraction. Fig. Radiograph of the final prosthesis in place. Fig. a Clinical view of the mucosa after unscrewing of the prosthesis one year post- extraction (note the extent of soft and hard-tissue reconstruction). Fig. b See Figure a.

5 Pre- and postoperative situation Pre-operative clinical view. Clinical view, months after extraction. Excellent soft-tissue integration and splendid laboratory work. Literature references 1 Antoun H, Sitbon JM, Missika P, Martinez H; A prospective randomized study comparing two techniques of bone augmentation: onlay graft alone or associated with a membrane; Clin. Oral Impl. Res. ; :. 2 Cardaropoli G, Hayacibara R, sukekava F, Araujo M, Lindhe J.; Healing of extraction sockets and surgically produced-augmented and non augmented defects in the alveolar ridge. An experimental study in the dog; J Clin Periodontol. ; :. 3 Funato A; Salama MA; Ishikawa T; Garber DA; Salama H.; Timing, Positioning, and Sequential Staging in Esthetic Implant Therapy: A Four-Dimensional Perspective; International Journal of Periodontics and Restorative Dentistry ; :. 4 Gardella JP, Chelli S.; Atraumatic extraction technique; In Press. 5 Gardella JP, Renouard F.; Guided bone regeneration, autegenous bone graft: limits ans indications; Journal de parodontol & implantol orale ; :. 6 Grunder U, Gracis S, Capelli.: Influence of the -D bone-to-implant relationship on esthetics; Int J Periodontics Restorative Dent. ;:. 7 Hämmerle CH, Chen ST, Wilson TG Jr.; Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets; Int J Oral Maxillofac Implants. ; Suppl:. Review. 8 Jung RE, Siegenthaler DW, Hammerle CH; Postextraction tissue management: a soft tissue punch technique; Int J Periodontics Restorative Dent Dec; :. 9 Von Arx T, Buser D.; Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with patients; Clin Oral Implants Res. Aug; :. Contact > Dr. Jean-Pierre Gardella, avenue du Prado, Marseille, France telephone: +, fax: +, jpgardella@gardellaclinic.com Suppliers > Implant: Speedy NP Nobel Biocare > Suture material: Surgilon, Monosof Syneture > Medication: Amoxicillin g/day, Ibuprofen mg times/day, for 8 days Further Indication Sheets > For free delivery please contact: > If you no longer wish to collect Indication Sheets, please unsubscribe with your local distribution partner

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