CATEGORY 94 AUSTRALASIAN DENTIST LINICAL Female patient aged 74, on Ramipril and Statins. Non-smoker and non-diabetic. The case resulted from a vertical fracture of the 46, the lower right 1st molar (Fig 1). There was a large peri-apical area and the tooth was removed with a straight forceps extraction.The site was then allowed to heal for 4 weeks, not merely to attain soft tissue closure but to allow the host macrophages to help clean the infected site. The patient returned 4 weeks post extraction and a flap was raised, with the incision more lingually, and the site was cleaned with degranulation burs (Fig 2 & 3). This revealed a very large defect and whilst a Max implant could have been used to attain stability it was decided to graft with EthOss and merely push the implant into the graft. This protocol has been done by the author for almost 9 years with only 2 failures in nearly 400 cases. So whilst it is very successful it is seen a last resort, rather than a planned protocol where primary stability would be preferred. The cleaned site was grafted with 0.5cc of EthOss (Fig 4) and the cover screw attached to the implant in the carrier (Fig 5). The implant was then pushed into the graft to the correct level and angle and the graft set using light pressure with a dry sterile gauze for 5 minutes (Fig 6). The site was then sutured closed using PTFE sutures (Coreflon) (Fig 7) and an xray taken (Fig 8). Sutures were removed a week later. Ten weeks later (Fig 9) a flap was again raised (Fig 10) to show the new host regenerated bone and an xray taken (Fig 11). The implant was accessed using a round bur (Fig 12) and a stock healing abutment fitted, with the soft tissue then sutured around the abutment (Fig 13-15). A week later an open tray impression was taken and screw retained crown made. This was then fitted a further week later (Fig 16 & 17) and the case is now successfully loaded a year later (Fig 18). Whilst it is not a published protocol, this technique is very predictable and merely showcases the potential of the grafting materials used to up regulate the host regeneration of bone. Implant placement with no bone to implant contact: innovative techniques and materials By Dr Peter Fairbairn, BDS, UK Fig 1 Initial situation – vertical fracture, large peri-apical area Fig 4 0.5cc EthOss® bone graft material placed into defect Fig 7 Site sutured closed Fig 10 Flap raised – new host bone has regenerated over implant Fig 2 Flap raised 3 weeks postextraction, site cleaned with EthOss® Degranulation Burs Fig 5 Cover screw driver attached to implant Fig 8 Xray at placement – implant is completely enclosed by EthOss® with no primary stability Fig 11 Xray at 10 weeks Fig 3 Site cleaned and prepared for grafting Fig 6 Implant placed into graft material and held at correct angle / position for 5 minutes whilst the EthOss is set using light pressure with a sterile gauze Fig 9 Healed site 10 weeks later Fig 12 Round bur needed to access implant Dr Peter Fairbairn
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