Australasian Dentist Issue 93

CATEGORY 72 AUSTRALASIAN DENTIST LINICAL Managing the Failing Maxillary Central Incisor with Guided Bone Regeneration and Implant Therapy Surgery by: Dr Peter Chen, periodontist Brisbane Implant Dentistry and Perio Care Aim: Tooth 21 was deemed unrestorable subsequent to injury from a car accident (mid-root fracture). The aim of the treatment was to replace tooth 21 with an implant-supported crown. The treatment plan involved the careful extraction of tooth 21 and subsequent early implant placement. Guided bone regeneration was performed at the time of implant placement to re- establish the required alveolar bone volume. Conclusion: The predictable use of Geistlich Bio-Oss® and Geistlich Bio-Gide® for simultaneous grafting of implant dehiscence defects is welldocumented 1 . In this clinical case, excellent bone height and width has been achieved at 3-months, with minimal comorbidity compared with autogenous grafting. Geistlich Bio-Oss® is a material with a low substitution rate; long-term stability of the soft and hard tissues is expected. u References: 1. 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 pre-treatment clinical situation showing tooth 21 in position. As a consequence of the damage caused by recent trauma, the tooth was deemed not restorable (fractured tooth root). Figure 2. Clinical situation 6 weeks following extraction of tooth 21. Soft tissue closure over the healing extraction site has been achieved. Figure 3. Prosthetically-driven implant placement. The labial bony dehiscence can be clearly observed. Figure 4. Guided Bone Regeneration was performed. Geistlich Bio-Oss ® was placed over the exposed implant surface and to fill the bony defect. Figure 5. Geistlich Bio-Gide ® was placed over the defect to help stabilise the bone augmentation material and to act as a temporary barrier to exclude soft tissue cells from invading the bony defect. Figure 6. Immediate post-operative situation showing tension free primary closure of the surgical flap. Figure 7. Excellent healing of the soft tissues observed at 2 weeks post-implant placement. Figure 8. Final restorative situation; 3-months after insertion of the final crown (screw-retained crown). Figure 9. Final periapical radiograph (3-months post-restoration) showing the stable situation of the mesial and distal crestal bone levels. Dr Peter Chen