Australasian Dentist Issue 93

CATEGORY 70 AUSTRALASIAN DENTIST LINICAL Predictable Management of an Implant Dehiscence Defect with Guided Bone Regeneration Treatment by: Dr Justin Soon Aim: To functionally and aesthetically restore missing tooth 11 and to reduce the extent of gingival recession on the labial aspect of tooth 13. Tooth 11 was missing due to a traumatic injury that resulted in avulsion of tooth 11 and damage to the associated labial plate. Conclusion: Guided bone regeneration has become one of the most commonly used techniques to manage bony dehiscence defects and contour deficiencies. Geistlich Bio-Oss® and Geistlich Bio-Gide® are complimentary xenogeneic materials that are ideally suited to GBR; providing a safe and predictable treatment option. Long-term clinical data reports that implants placed in sites managed with GBR have similar survival rates to implants placed in pristine bone (R.E. Jung et al., 2021). Geistlich Bio-Oss® has a low substitution rate, a feature that ensures long-term volume stability of the augmented tissues. u References: R.E. Jung, L.V. Brügger, S.P. Bienz, J. Hüsler, C.H.F Hämmerle, N.U. Zitzmann. Clinical and radiographical performance of implants placed with simultaneous guided bone regeneration using resorbable and nonresorbable membranes after 22-24 years, a prospective, controlled clinical trial. Clinical Oral Implants Research (2021). 32(12);1455- 1465 Figure 1. The presurgical situation (occlusal view). Note loss of labial ridge contour at site 11 (significant loss of alveolar ridge width). Figure 2. Intra-operative situation demonstrating placement of implant and labial bony dehiscence. The morphology of the defect is favourable in terms of guided bone regeneration (GBR). The bone augmentation material (Geistlich Bio-Oss ® ) will be stabilised by the existing bony walls and overlying barrier membrane (Geistlich Bio-Gide ® ). Figure 3. A 50:50 mixture of autogenous bone and Geistlich BioOss ® was placed over the exposed implant; filling the entire bony defect. Geistlich Bio-Gide ® membrane was positioned over the augmentation material to stabilise it and to serve as a temporary barrier (yet to be folded into final position in this image). Figure 4. Tension-free primary wound closure achieved (with aid of periosteal release) using PTFE sutures. The situation was restored with an aesthetic “suck-down” temporary denture; being careful to not impinge on the healing soft tissues. Figure 5. Post-operative healing after 3.5 months. The horizontal ridge dimension has been re- established. Figure 6. After 4 months of healing, the implant was uncovered and a healing abutment placed. Concurrent autogenous connective tissue grafting was performed to improve the soft tissue volume and to reduce the extent of the gingival recession on tooth 13 (connective tissue graft and coronally advanced flap). Figure 7. Tension free primary wound closure achieved using PTFE sutures. Note the coronal advancement of the flap over tooth 13. Figure 8. A screw-retained implant crown was delivered and the composite restoration on tooth 21 was replaced. The gingival tissues appear healthy with a harmonious and aesthetically pleasing outcome. Figure 9. Final peri-apical radiograph demonstrating sufficient mesial and distal crestal bone levels. Dr Justin Soon