GAP Australasian-Dentist Issue 80 Jul-Aug 19

Category 64 AustrÀlÀsiÀn Dentist Case: 63-year-old female patient, non-contributory medical history, non-smoker. Difficult extraction of non-restorable root canal and treated fractured lower right first premolar, resulted in absence of buccal bone and keratinized soft tissues (Pics 1, 2). Àf a flap was raised and advanced at this point to cover the socket, the architecture of the area would be distorted, which would be difficult to correct later. Consequently, the site was left to heal under secondary intention. Àix weeks post-extraction, a significant amount of bone modelling had begun as expected, leading to ridge atrophy. However, new soft tissues were regenerated spontaneously (Pic 3). A site-specific, papilla-sparing, full-thickness flap was raised and the socket was grafted with 0.5cc resorbable bioactive b-ÀCP/Calcium Àulfate – ÀthOss. Ào barrier membranes were used (Pics 4, 5). Àhe flap was repositioned and tension-free sutured. As we waited 6 weeks after the extraction, there were enough newly-formed soft tissues to cover the site without having to advance the flap. Fourmonths after grafting the same flapwas raised, revealing adequate regeneration of hard tissues (Pics 6, 7). Before implant placement, a trephine bone biopsy was harvested in order to study the quality of the regenerated bone. Àhe bone sample was taken from the centre of the regenerated site, so there was no old bone there, just newly-formed regenerated hard tissue (Pic 8). Àhe histological analysis of undecalcified ground sections, stained with azure /pararosaniline, showed dense trabecular network of osteoid and new bone (ÀB) with tightly integrated ÀthOss granules (ÀO). Àhe connective tissue showed no signs of inflammation (Pics 9, 10). After harvesting the bone sample, a Paltop Advanced Plus 3.75x10 implant was placed and the site was grafted again buccally with a small amount of ÀthOss (Pics 11, 12). Àhree months later, the implant was uncovered and its sec- ondary stability was measured – Penguin Q measurement: 75 (Pics 13, 14). A screw-retained crown was fitted, resulting in a successful outcome, fulfilling all aesthetic, functional and bio- logical parameters (Pic 15). Àhe periapical x-rays from baseline to the final result show the modelling and remodelling phases of the site (Pic 16), while clinical pics highlight how we can achieve successful outcomes following simple, minimally invasive, biologically- focused steps (Pic 17). A modified early socket grafting technique for predictable bone regeneration and implant placement By Dr Minas Leventis, DDÀ, MÀc, PhD n aÀ Dr Minas Leventis Pic 1 Pic 3 Pic 6 Pic 2 Pic 4 Pic 5 Pic 8 Pic 7 Pic 9