Australasian Dentist Implant Dentistry Today No 15

Implant Dentistry Today 24 mplant emoval and ocket raft Case tudy Fig 1: Initial situation Fig 5: Implant removed and site socket grafted with EthOss Fig 9: Ten weeks later – new host regenerated bone visible at site Fig 13: Scan taken at the time of impressions at a further 10 weeks, with open tray pick up for a screw retained restoration Fig 2: Buccal plate reasonable but could probe deeply between the implant and the plate Fig 6: EthOss stabilised with light pressure from a sterile gauze for three minutes Fig 10: Pilot bur used to measure and check the angle Fig 14: At load – One week later Fig 3: Degranulated with Degranulation Burs around the Implant Fig 7: Site sutured closed with PTFE Fig 11: Versah system to drive EthOss into the sinus site, using reverse at 200 rpm Fig 15: Stable hard and soft tissues with nice buccal attached Keratinised tissue Fig 4: Removed implant sinus checked with Valsalva Fig 8: X-ray at grafting showing EthOss Fig 12: New Paltop Implant 3.75mm by 10mm placed into the site and EthOss placed into the sinus Fig 16: X-ray of loading site, at 4 months, appears stable and will improve further in function Patient history: Patient is male, 65 years of age, non-smoker. Patient referred in with fractured screw on an Astra implant placed 10 years prior (Image 1). Peri-implant bone loss as can be seen on the initial x-ray, especially on the palatal aspect. reatment & ro edure: Attempted to remove the screw using specialist tools however this was not possible so took the decision to explant, socket graft the site and place a new implant. A flap was raised to visualise the site prior to implant removal. This revealed a reasonable buccal plate; however a deep pocket was revealed between the implant and the plate upon probing (Image 2). The area surrounding the implant was degranulated using EthOss Degranulation Burs and then the implant was carefully removed due to the proximity to the sinus (Image 3, 4). The site was subsequently socket grafted with 0.5cc of EthOss (Image 5). The material was stabilised using pressure from a sterile gauze for 3 minutes before suturing closed with PTFE and obtaining primary closure (Image 6, 7, 8). The patient returned 10 weeks later and a further flap was raised to prepare the osteotomy and place the new implant. At this stage new host regenerated bone was clearly visible in the site (Image 9, 10). The Versah bone densification system was used to drive a small additional EthOss graft into the sinus (Image 11) and the implant (3.75 x 10mm Paltop) was placed (Image 12). The patient returned a further 10 weeks later for impressions (Image 13) and a further 1 week later the implant was loaded. At this stage stable hard and soft tissues can be seen (Image 14, 15). It is particularly interesting to note the increase in attached keratinised tissue surrounding the graft site without the need for soft tissue surgery. The final result shows the implant loaded for 4 months with stable hard tissues (Image 16). Con usion: Both the hard and soft tissues are showing great long-term stability. Whilst the final scan was taken at four months, this case has now been loaded over one year and both patient and clinician are very happy with the outcome. As with all EthOss cases, the situation will further improve with time. As the implant is in function, EthOss will be fully reabsorbed and replaced by host bone, the hard tissues will turnover and remodel accordingly. n By r Peter airbairn