Implant Dentistry Today No 14

Implant Dentistry Today 16 Patient Profile: 35-year-old female, referred with severe hard and soft tissue loss and preferring a synthetic, ethical solution. Both the buccal and palatal plates had been lost, as well the bone mesial to the second premolar, and required regeneration. Procedure: The slightly larger flap (not papilla-sparing) was raised. Unfortunately, the optimal amount of residual host bone to place the implant was moved centrally while drilling and could not be located. The palatal aspect was initially grafted using a ‘wetter’ mix of EthOss and a 3.5mm x 10mm AnyRidge® implant placed. The cover screw was fitted and a second drier layer of EthOss grafted over the buccal aspect. A total of 0.5cc of EthOss was used, divided into two portions. The site was closed leaving a small opening on the palatal aspect. After 4 days sutures were removed and healing by secondary intention was seen. After 10 weeks another flap was raised, this time papilla- sparing as the host had now regenerated the defect on the adjacent teeth. An additional small graft was placed and sutured closed using a healing cap and PTFE sutures. After 4 days the sutures were removed and a few days later a larger healing cap was fitted. Two weeks post procedure an impression was taken and the screw-retained crown placed one week later. Result: The case has been loaded for 6 months and a CBCT scan has shown regeneration of both the buccal and palatal plates, as well as the defect on the adjacent premolar. The patient is very happy with the results. UPPER RIGHT PREMOLAR A Case Studywith True Host Bone regeneration to restore hard tissue Fig 1. Vertical and horizontal loss, hard and soft tissues Fig 4. Hard tissue loss on the palatal aspect – check the angle Fig 7. Implant placed Fig 10. Passive closure using PTFE sutures. Small opening on palatal aspect Fig 6. Palatal graft into the site and placement of 3.5 mm wide AnyRidge to the correct level (mm sub crestal) Fig 9. Radiograph of implant placement Fig 3. Bigger flap required as we will also be restoring the defect on the medial of the second premolar as shown by arrow Fig 12. Healed site at 10 weeks Fig 2. Radiograph showing bone defect Fig 5. Radiograph showing hard tissue loss on the palatal aspect – check the angle Fig 8. Additional graft to the correct level and on the buccal aspect with drier mix of EthOss Fig 11. Sutures removed at 4 days -healing on the open palatal area by secondary intention Performed andManaged by Peter Fairbairn , founder of EthOss