Australasian Dentist Implant Dentistry Today No 15

Implant Dentistry Today 26 Patient history Patient is female, 77 years of age, on HRT, non-smoker and non-diabetic reatment an Patient presented with a draining abscess in the 36 region (fig 1) and was sent to the endodontist for evaluation who verified the tooth was unsavable. Routine protocol (published in 2015) by the author was utilized. This involves a 3-4 week healing period following extraction followed by simultaneous implant placement and graft with EthOss®, a synthetic graft particulate. Pro edure At 4 weeks post-extraction soft tissue healing allowed a flap to be raised (fig 2) and the site was degranulated extensively using curettes and EthOss degranulation burs (fig 3). There was extensive bone loss due to the infected nature of the removed tooth, particularly on the distal root surface of the premolar (fig 4). One of the key benefits of the 4 week healing period using this Protocol is that it not only allows for soft tissue closure but also allows the host macrophages to help clean the site prior to implant and graft placement. The implant, a Paltop 4.2 by 8.5mm, was then placed into the bifurcation (figs 5, 6). The root sockets and mesial defect were grafted with EthOss (fig 7) and the material was encouraged to set by holding a dry, sterile gauze over the graft for 4 minutes (fig 8). A collagen membrane was not used in this case. The built-in Calcium Sulphate cell occlusive binder within EthOss removes the need for a separate membrane. The flap was repositioned with primary closure and the site was then left to heal for 12 weeks (fig 9). A healing cap was then fitted by making an incision in the soft tissue and opening the site (fig 10). The case was loaded one week later with an Osstell stability reading of 76 ISQ (figs 11, 12, 13). Con usion As the graft will turn over fully to host bone, the two year follow up shows a nice stable site and healthy hard and soft tissue along with restoration of the hard tissue distal to the premolar (fig 14). Due to the age of the patient and the reduced upper dentition it was decided to only have 1 molar and not place another implant. Both patient and clinician are pleased with the outcome. n mplant placement with simultaneous th ss grafting By r Peter J airbairn Fig 3: Site cleaned with EthOss Degranulation Bur, removing all soft tissue Fig 7: Root socket grafted with EthOss Fig 11: Final crown, screw retained Fig 4: X-ray prior to simultaneous implant placement and grafting. Note 3-4mm to the IAN, however key factor here is angle of the mandible Fig 8: Additional grafting. Material dried with sterile gauze for 5 minutes before flap repositioned and sutured closed Fig 12: Implant loaded, Bluem oxygenated healing gel to improve soft tissue Fig 1: Initial situation Fig 5: Implant placement – drifted slightly distal Fig 9: X-ray at placement – approximately 2.5mm to IAN and 1.5mm to angle of mandible so very low primary stability Fig 13: Implant loaded Fig 2: Flap raised 4 weeks following extraction to allow for soft tissue healing Fig 6: Implant placement Fig 10: Uncovered at 12 weeks and healing cap fitted. Image shows 2 weeks later, patient returned for final restoration Fig 14: X-ray at 2 years, graft will have turned over to new host bone