CATEGORY 58 AUSTRALASIAN DENTIST LINICAL Regenerating Labial Plate using Guided Bone Regeneration Treatment by: Dr Fadi Dalati Aim: A healthy male patient presented with a missing maxillary right lateral incisor. This tooth was extracted 12 months earlier as a consequence of a late-diagnosed vertical root fracture. The site had a long-standing draining fistula; as a consequence, alveolar ridge preservation at the time of extraction was not performed. The patient was keen on an implant-supported and retained restoration. Fig 1 Pre-operative close-up of site 12. Mesial and distal papilla heights are acceptable, however there is evidence of a labial contour deficiency. Fig 4 A 50:50 mix of Geistlich Bio-Oss® small granules and autogenous bone chips (harvested with the Meta SafeScraper) was used to cover the exposed implant surface and to fill the dehiscence defect. Fig 7 Clinical appearance at 6 months postimplant insertion; including a 3-month period of provisionalisation. A minor connective tissue graft was performed at the time of provisionalisation to help improve the overall labial contour. Fig 2 The occlusal view clearly demonstrates the extent of the labial contour deficiency. Fig 5 The graft material (Geistlich Bio-Oss® and autogenous bone mix) is covered and stabilised by a GeistlichBioGide® membrane. This membrane serves to temporarily separate the bony compartment form the overlying soft tissues. Furthermore, the collagen membrane encourages angiogenesis and new bone formation. Fig 8 Final restorative situation. The crown was placed 12 weeks earlier; note the acceptable and maturing papillae. Fig 3 The extent of the expected bony dehiscence is evident. Fig 6 The three-sided muco-periosteal flap is repositioned and secured with multiple simple interrupted sutures. Fig 9 Final periapical radiograph (6 months postcrown insertion) showing stable mesial and distal crestal bone levels. Conclusion: This case illustrates a situation in which alveolar ridge preservation was not possible at the time of dental extraction due to chronic infection. In such situations, it needs to be accepted that a GBR procedure will be required at the time of implant placement to regenerate the bone over the labial dehiscence and to improve the labial contour. Geistlich Bio-Oss® (alone or in combination with autogenous bone) and Geistlich Bio-Gide® are wellproven biomaterials that offer safe and predictable long-term clinical outcomes* u References: *R.E. Jung et al., 2021, 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);14551465). Dr Fadi Dalati
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