Osteology abstract 202 cbct

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Osteology abstract 202 cbct

  1. 1. abStractbooKwww.osteology-cannes.org
  2. 2. PoSter abStractS oSteology foundation PoSter PreSentationTo promote the active scientific exchange the Osteology Foundation invited researchersand clinicians within the field of regenerative dentistry and dental tissue engineering tosubmit poster abstracts of original investigations for the Osteology Poster Presentation.We have invited the following six expert clinicians and researchers to participate in theposter abstract committee:Tord Berglundh, SwedenJean-Louis Giovannoli, FrancePaul Mariani, FranceFrancis Mora, FranceIsabella Rocchietta, ItalyEric Rompen, BelgiumThe poster committee evaluated more than 160 poster abstracts. The five best abstractsin each of the categories clinical research and basic research are invited to presenttheir work verbally to the poster committee.Osteology poster priceThe prize for the best poster in each of the two categories will be awarded on Friday,april 15, 2011 at 16.40 at the beginning of the Osteology Research Session.poster ExhibitionThe poster exhibition will take place in the exhibition hall.The accepted poster abstracts are subdivided into four different topics which can bedistinguished by the different numbering:Clinical research:Case Reports – 101, 102, 103,… (red)Clinical Studies – 201, 202, 203,… (green)Basic research:In Vitro Studies – 301, 302, 303,… (blue)Pre-Clinical Studies – 401, 402, 403,… (grey)The poster authors will be presenting their work on Friday, April 15, 2011 from 12.30 to13.45 and on Saturday, April 16, 2011 from 13.30 to 14.30.Pascal Valentini franck bonnet 27
  3. 3. Conclusions: Extensive loss of bone and teeth in the anterior maxilla presents CliNiCal rESEarCH, CaSE rEpOrTS a complex problem for reconstruction, especially in patients with severe bone loss in the horizontal and vertical planes. This technique is valuable for the reconstruction of severe bone loss. 101 i Secondary intention Surgical Wound Healing With Biomaterials in damaged Extraction Sockets 103 i using postauricular Split Thickness Skin Graft for Vestibuloplasty and prosthetic rehabilitation Of Fibula Free Emanuele Tamburini (italy) Flap reconstructed Mandible With dental implants Objectives: The objectives of the “ridge build-up technique” are to simplify the Sermet Sahin (Turkey), Metin Sencimen, Hasan Ayberk Altug, Gurkan Rasit Baykar hard tissue augmentation procedure and to reduce discomfort for the patient. In damaged extraction sockets it is better to wait some weeks until the infected Objectives: This case report describes the surgical and prosthetic rehabilita- site has healed. The biological approach of the post-extraction protocol is to tion process of a case of excessive bone and soft tissue defect secondary to a augment the alveolar bone with biomaterials in the early phase of the healing facial gunshot injury. process. Methods: A 34-year-old male patient who had received a vascularized fibula flap Methods:The surgical protocol provides for the avulsion of irredeemable secondary to a gunshot injury involving the left side of the mandible presented teeth because of abscess. Three to six weeks from extraction, the augmen- to the Gülhane Military Medical Academy, Department of Prosthodontics, com- tation procedure is carried out using current biomaterials only. The volume plaining of difficulty in chewing and distorted physical appearance. According to of biomaterials, membrane included, exceeds the volume of original alveolus the patient’s history, the fibular grafting had been performed two years previous- in order to provide for resorption of bone substitutes. The surgical protocol ly and healing had been uneventful. Dental implants were subsequently inserted. is designed in such a way as to make the exposed surface of the surgical Due to inadequate vestibular sulcus depth, vestibuloplasty combined with split- site resemble a post-extractive alveolus. It is possible to recover and rotate thickness skin grafts harvested from the post auricular area was performed. the abundant repair connective tissue from the alveolar defect on the colla- results: The surgical process produced satisfactory functional and aesthetic gen membrane. Bacterial wound proliferation is controlled with clorexidine outcomes. mouthwashes and application of hyaluronic acid. After 1 year, the implant and Conclusions: The posterior split thickness skin grafts are useful in the treat- fixed crown are inserted into the augmented bone (baseline) and observed for ment of cases with inadequate vestibular sulcus depth. We believe that this is 1–4 years of follow-up. an effective and reliable technique for composing attached gingival. As a result, results: Soft tissue results: the exposed surface of the membrane is covered our patient demonstrated successful prosthetic and functional results. after 1–2 weeks and is sealed by soft tissue after 4–6 weeks. Hard tissue aug- mentation. The greatest linear horizontal and vertical bone gain are detected by cone-beam computed tomography. Clinical evaluations are performed be- 104 i alveolar Bone regeneration using anorganic fore extraction, 3–6 weeks after extraction (“control” wound healing), 1 year af- Bone Matrix and platelet-rich plasma ter the augmentation procedure and 1–4 years after implant of the prosthesis. No implant or prosthesis loss, biological complication or patient discomfort is antonin Fassmann (Czech republic), Peter Augustin, Jan Vokurka, Lydie Iza- observed. kovicova Holla, Jiri Vanek Conclusions: Like the ridge preservation technique, surgical secondary inten- tion wound healing with current biomaterials is also possible without problems Objectives: Tissue engineering is a progressive regeneration procedure and is 3–6 weeks from extraction. Bone volume after 1 year is enough to insert a suc- used in several medical specializations such as periodontology, implantology cessful implant into the augmented site. The limitation of this technique lies and orofacial surgery. in the difficulty of precisely predicting the final coronal shape of bone and soft Methods: Platelet-Rich Plasma (PRP), autologous growth factors concentrate, tissue. In any event, it is possible during implant surgery to correct bone and can significantly enhance the physiological regeneration of tissues. PRP is ac- gingival contour with biomaterials or a connective tissue graft. tivated by adding thrombin and calcium and is applied together with anorganic bone matrix as a composite gel during guided tissue regeneration procedures. results: Alveolar augmentation in a patient with severe periodontitis is pre- 102 i aesthetic and Functional reconstruction Of Severe sented. After multiple extractions, only a narrow alveolar ridge remained, with atrophic Maxillary alveolar Crest By autogenous Bone Graft little retention for a partial denture. After alveolar ridge treatment and removal and dental implants of granulomatous tissue, osteoplasty was performed. A composite gel was implanted and covered with resorbable collagen membrane. A temporary re- Sermet Sahin (Turkey), Metin Sencimen, Hasan Ayberk Altug, Aydin Gulses movable denture was given to the patient after the procedure. After 6 months, endosseous implants were placed in the maxilla and a metal ceramic bridge Objectives: Although many osseous augmentation techniques have been de- was cemented on to the osseointegrated implants. veloped, autologous bone grafting remains the gold standard in maxillofacial Conclusions: The procedure leading to the full cosmetic, functional and social reconstruction. Various donor sites for bone grafting have been investigated rehabilitation of the patient using this progressive surgical approach will be and described in the literature, including the tibia, fibula, calvarium, scapula, presented step by step . clavicula and ilium. In addition, local bone grafts from the maxilla and man- dible have also been used. The obvious advantages of local bone graft are con- venient access, low morbidity, short healing periods, minimal graft resorption 105 i immediate implants in The aesthetic zone. and maintenance of high bone density. The aim of this report is to describe a Technique to preserve The Buccal Wall the treatment and rehabilitation of severe bone loss with autogenous graft and dental implants. Celia alves (portugal), André Correia, professor, Manuel Neves Methods: This paper demonstrates the surgical and prosthetic rehabilitation process of a patient with excessive bone loss in the anterior maxilla, secondary Objectives: The aim of this paper is to present a novel technique for preserv- to a gunshot injury. ing the buccal wall dimensions when performing an immediate implant in the results: The use of autologous bone grafts with osseointegrated implants is aesthetic zone. Immediate implants in the aesthetic zone are a challenge to a well-accepted procedure in oral rehabilitation. Bone harvesting can cause the clinician due to the possibility of buccal wall loss with direct consequences postoperative complications such as donor site morbidity and sometimes in the fixed rehabilitation function and aesthetics. Evidence in the literature does not provide a sufficient quantity of bone. Therefore, synthetic biomateri- suggests that immediate placement does not prevent vertical or horizontal re- als have been investigated to be used in conjunction with autogenous bone sorption and that bone regeneration techniques should be applied to ensure grafts. preservation of the shape of the alveolar ridge.28
  4. 4. clinical reSearch, caSe rePortSMethods: Methods: After the immediate implant drilling phase, the socket is formed at the same visit and the preparation of the recipient bed and suturingfilled up with Bio-Oss Collagen® (Geistlich Pharma AG® Switzerland) trimmed techniques were similar. Test and control treatments were randomly assignedwith a cone form, in order to closely adapt it to the socket buccal wall. Then, to either recipient sites, and they were sized similarly to cover the wound bedthe implant is placed with a low rotation speed (15rpm) into the drilled socket, and stabilized with sutures. Patients were seen in follow-up at 2, 4, 6, 8 and 13pushing the Bio-Oss Collagen® buccally and making it more condensed. weeks and then recalled for long-term examination at 12 months. A soft tissueresults: Results: The technique presented uses a material that is mouldable biopsy was obtained from both test and control sites at 13 weeks from fourand easy to place into the extraction socket just before implant. As Bio-Oss® patients for histological examination.(Geistlich Pharma AG® Switzerland) particles are linked by the porcine col- results: All patients healed uneventfully without any graft-related adverselagen, the material condenses better during the implant insertion. At the 6 events. The test and control sites exhibited normal healing, with excellent co-months follow-up visit, the Cone-beam CT scan (I-CAT® Imaging Sciences) lour and texture at the test sites equalling tissue maturation at the control sites.showed both vertical and horizontal stability of the buccal bone. No clinical The 12-month examination revealed that the increase zone of attached gingivachanges were observed in the facial soft tissues of the immediate implants remained stable for both groups. Unlike the control sites, the tissue contour,and peri-implant soft tissues showed normal values for pocket depth and at- colour and texture of the test sites blended nicely with the native adjacent softtachment loss. tissues. The Wilcoxon signed rank test for pre and postoperative measurementsConclusions: Conclusion: In immediate implant cases in the aesthetic zone, revealed a statistically significant increase in the amount of keratinized gingivathis technique may be very helpful in order to reduce resorption of the buccal for the test (P = 0.041) and the control group (p = 0.042). No statistically sig-wall, since it promotes excellent biomaterial compaction between the implant nificant differences were found on all other measured parameters. The Mann-and the alveolar wall. Whitney U Test did not find statistically significant differences between the test and control groups on any examined variable, including changes in keratinized gingiva and epithelial thickness. The histological findings between test and con-106 i deproteinized Bovine Bone Matrix in periodontal trol sites were remarkably similar for each patient. Mature connective tissueregeneration in Organ Transplant patients was covered by well-formed keratinized epithelium, over which a small band of dense orthokeratin was consistently found. The rete peg morphology of test andpeter augustin (Czech republic), Augustin Fassmann, Jan Vokurka, Lydie Iza- control specimens appeared similar for each patient. In all instances inflamma-kovicova Holla, Hana Poskerova, Jarmila Celerova tory cells were notably absent. Small fibrous remnants of collagen matrix were the only evidence that a graft material had previously been placed.Objectives: Organ transplant patients are successfully treated with complex Conclusions: The results of this study comparing Mucograft to autogenousimmunosuppressive therapy. gingival graft identified the likelihood of the Mucograft being a viable alterna-Methods: Drug-induced gingival overgrowth (DIGO) is an unwanted side effect tive when the goal of therapy is to increase the zone of keratinized tissue andof the therapy. Drugs inducing DIGO are Cyclosporine A, Azathioprin, Myco- obviate the need for palatal harvest. This is especially true in areas of reason-phenolate, Verapamil and Nifedipine. Many other etiological factors contribute able vestibular depth and minimum musculature.to the condition and are further aggravated by oral biofilm accumulation. Fi-brosis, inflammation and cell accumulation depend on doses, time and type ofdrug administrative, oral hygiene and individual reaction of organism. 108 i platelet-rich Fibrin in The Treatmentresults: We are using our treatment protocol: After patient hygiene instruc- Of Bilateral Gingival recessionstions, scaling and root planing (SRP), the surgical treatment (gingivectomy) isperformed. After six months, regenerative periodontal therapy using tissue en- Gulnihal Eren (Turkey), Gul Atillagineering with deproteinized bovine bone matrix (DBBM) and platelet rich plas-ma (PRP) is started. After activation with thrombin and calcium, a composite Objectives: Coronally advanced flap (CAF) + connective tissue graft (CTG) hasgel is prepared for implantation into periodontal defects. The gel is covered with been suggested as the most predictable technique for correction of recessionresorbable collagen membrane. Degranulation of thrombocytes and release of defects. However, CTG technique necessitates a second surgical site and in-growth factors significantly improve the quality of periodontal regeneration. creases the risk of morbidity linked with harvesting the autogenous palatal do-Conclusions: The poster demonstrates the use of this method in patients with nor mucosa. Platelet-rich fibrin (PRF), containing autologous growth factors,drug-induced periodontitis following transplantation of heart and kidney. This has been thought to accelerate soft tissue healing. The use of PRF in treatmenttherapeutic practice is performed successfully. of gingival recessions eliminates the requirement for a donor site. The aim of this case report is to evaluate the clinical effectiveness of coronally advanced flap CAF+PRF combined technique and also to compare its results with CAF+107 i The use Of Mucograft® Collagen Matrix To augment CTG in the treatment of bilateral gingival recessions.The zone Of keratinized Tissue around Teeth Methods: This case report concerns the surgical treatment of a 22 year old pa- tient with bilateral gingival recessions in maxillary canine incisors. Sites wereSoo-Woo kim (uSa), David Kim, Peter Schupbach, Marc Nevins randomly assigned into CAF+PRF (test) or CAF+CTG (control) groups. Clinical periodontal parameters were recorded at baseline and at 1, 3 and 6 months.Objectives: The importance of a functional and healthy mucogingival complex Clinical photographs were taken at baseline and at 1, 3 and 6 months and theto underlying osseous stability around teeth is evident by the increasing atten- recession area analyzed by digital image analysis (ImageJ Windows, Nationaltion given to soft tissue augmentation procedures in clinical practice. An intact Institutes of Health, Bethesda, MD). Soft tissue thickness was also evaluatedattached band of keratinized gingiva is seen as a critical component to the pro- at baseline and at 6 months.tective function of the mucogingival complex, although minimum width require- results: Root coverage amount, soft tissue thickness levels, increase in kera-ments of this tissue type remain controversial. The exact quantity of attached tinized tissue depth, clinical attachment level and probing depth were improvedgingiva necessary for maintaining periodontal health has not been defined, but a for both study groups. The test group showed better wound healing than thenumber of studies suggest that it necessary to have a minimum of 2 mm of ke- control group at the 10th day. Fewer complications were also recorded in theratinized gingiva for sustainable periodontal health. The purpose of our prospec- test group, due in particular to the fact of not having a donor site.tive split-mouth case series was to evaluate the safety and efficacy of Mucograft® Conclusions: Based on the results, CAF+PRF technique is a predictable treat-(Xenogenic porcine bilayer collagen matrix) as an alternative to the autogenous ment for gingival recessions. PRF may accelerate wound healing and causegingival graft in procedures designed to increase the zone of attached gingiva. less patient discomfort in the treatment of gingival recessions.Methods: Five healthy patients presenting with 2 mm or less bilaterally of at-tached keratinized gingiva on the buccal aspect of mandibular posterior teethwere recruited. Plaque and Gingival Indices as well as probing pocket depth, 109 i use Of Nanocrystalline Hydroxypatite in Blocks For Bone Graftgingival recession, and the amount of attached gingiva were determined at the in atrophic areas. Clinical, Tomographic and Histological analysisbuccal aspect of each test (Mucograft) and control (autogenous gingival graft)tooth and again at 12 months. Both the test and control procedures were per- Sergio Gehrke (Brazil) 29
  5. 5. Objectives: The objective of this study was to evaluate the performance of the Guilherme piragine, Marco Pontual, Hedilberto Sousa, Danielle Lima, Marco nanocrystalline hydroxyapatite in blocks NanoBone® (Artoss GmbH, Germany) for Bianchini the recovery of atrophic areas to allow subsequent placement of dental implants. Methods: Performance was assessed through clinical and tomographic follow- Objectives: To demonstrate through Cone Beam CT image the horizontal and up as well as histological examination to evaluate the osteogenic potential of vertical gain in bone volume 6 months after grafting surgery with functional the material in six patients. prosthetic rehabilitation on implants of different diameters in the posterior results: The samples showed a large bone formation inside the blocks. Clini- mandible. cally we observe a proper consistency of newly formed tissue, allowing stabi- Methods: Patient MR, 53, female, leukoderma, came complaining of difficulty lization of the implants. Tomographically, the grafted blocks showed adequate in chewing due to lack of teeth in the posterior region of mandible, failing to radiopacity, enabling control and evaluation to be carried out. make use of removable partial denture. Cone beam tomography of the man- Conclusions: The results show that nanocrystalline hydroxyapatite in blocks dible showed initial marked loss of bone volume to be deployed in the regions NanoBone® is very promising for use as a graft material to obtain volume, be- (34-36, 44-46). Due to the length and proximity of donor and recipient sites, the cause it promotes higher cellular activity and bone substitution. surgery, which involved reconstruction of bilateral mandibular bone height and thickness with autograft taken from the symphysis mandibular and left ramus mandibular, was performed in a hospital environment. During the reconstruc- 110 i Bone regeneration in Maxillary anterior region tive surgery, the bone blocks were stabilized to the recipient site and fixed 1 By Microplate and Non-resorbable Membrane mm above the crest to induce bone height gain. After six months of the new cone beam tomography grafted region was ordered after surgery to install 05 Jung-Bae dan implants (Straumann SLA-active). After 4 months the patient was rehabilitated with fixed prostheses screwed. Objectives: Block bone grafts have been widely used in the reconstruction of results: Flap debridement exposing all the donor and recipient sites allowed the maxillary anterior region. Recent advances have enabled clinicians to deal repositioning of normal tissues, so the volume of the bone blocks was pre- with various situations. The author attempted to regenerate the bone in the served by the absence of tension, and since the patient did not use the prosthe- maxillary anterior region using a microplate and non-resorbable membrane. sis during the healing period there was also no pressure on them. The grafted Methods: The 45 year old female came to WooJung Dental clinic in Seoul, Ko- area showed a gain in height (H) and thickness (T) after 6 months, region 34 rea with a left central incisor displaying severe mobility. (H-0.1mm / T-2.6mm), region 35 (H-3.3mm/T-3.5mm), region 36 ( H-4.7mm/T- After extraction of the left central incisor, the bone graft was delayed for 2 3.9mm), region 45 (H-6.8mm/T-3.6mm) and region 46 (H-7.4mm/T-5.2mm). months until the soft tissue had matured. After soft tissue maturation, the The volume obtained permission to install the parallel implants, and centered bone graft procedure was performed. There was severe bone destruction in on the rim and without any complications such as detachment of the block the buccal plate. graft, or trepanning exhibition breathes. The bone blocks were well adapted About 5 mm vertical loss was observed in the buccal plate. A 5-hole-length to the original bone with good vascularization and density. In the region of el- microplate (Jeil Medical Corporation,Korea)was bent to fit the contour of the ement 44 it was decided not to install the implant, since a bone defect was facial bone and fixed with bone tack (Frios®,Germany). BioBarrier (Imtec®,USA: found that could have jeopardized a successful outcome. Screw-retained metal non-resorbable, non-porous type) was fixed from the lingual side with bone tack. ceramic fixed prostheses were fabricated. The right side of the prosthesis re- Irradiated cancellous bone and marrow (Rocky Mountain Tissue Bank, USA) ceived the cantilever element 44. 0.25g and Cerasorb (Curasan,Germany) 0.5cc mixed with PRGF (Platelet Rich Conclusions: The surgical technique has enabled the volume of the bone in Growth Factor) were placed under the membrane. Finally, bone tack was blocks to be maintained due to modification of the incision providing free ac- fixed to the covering membrane to stabilize the bone graft. cess to donor and recipient sites and the repositioning of the flap free from results: After 8 months, re-entry was performed and the implant installation tension. Rehabilitation with implants in grafted area is a treatment used in carried out. At this time, the core of the graft site was taken out by trephine clinical practice, but still more studies are needed in order to assess the sur- burr. Though some Cerasorb particles maintained their integrity in macroscop- vival rate of these implants, as well as the stability of the bone volume around ic appearance, primary stability of the implant was good. The microscopic ap- prosthetic implants. pearance of the graft core showed some degree of bone formation. The second operation was performed 3 months later. A papilla-saving incision helped to conserve papillae. Though some degree of bone resorption was observed in the 112 i Two year Follow-up Of an autogenous crestal region, the replacement of Cerasorb by bone had progressed relative to Transplantation Of Maxillary Molar the previous state (i.e. at installation). Final restoration shows good harmonious appearance with adjacent tooth and Ozgun Ozcaka, Kanik Ozgur, Bicakci Tolga, Arikan Fatih soft tissue. The soft tissue has a firm and healthy appearance. The author experienced the benefit of soft tissue maturation. Thick, firm and Objectives: Autogenous tooth transplantation has been used as a predictable healthy soft tissue is important in order to avoid membrane exposure and for surgical approach to correct malocclusion and replace edentulous areas. The the success of the bone graft and long-term maintenance in the anterior re- purpose of this case report is to describe a patient undergoing autotransplan- gion, where aesthetics are a major concern. The author recommends a staging tation of an impacted maxillary third molar into the socket of the extracted approach for graft sites with weak soft tissue. Furthermore, even soft tissue second maxillary molar. enhancement is needed for successful implant. Most clinicians have major Methods: A 54 year old systemically healthy male subject was referred concerns for bone in GBR and for the coupling action of osteoblast and os- for dental treatment on his right maxillary second molar. Panoramic and teoclast: the author likes to use the term “coupling action of bone and soft periapical radiographs revealed the existence of a periapical lesion and tissue”. The microplate technique is a non-invasive, time-saving procedure periodontal bone loss. Tooth extraction was therefore indicated. The same without bone harvesting. clinical and radiographical examinations showed that the unerupted right Conclusions: 1. The staging approach to soft tissue maturation was beneficial maxillary third molar was healthy and suitable for tooth autotransplanta- and contributed to the success of the GBR and to the aesthetic aspect. tion. The procedure involved transplantation of the third molar into the ex- 2. GBR through microplate was a non-invasive and time-saving procedure traction socket of the non-restorable second molar. Five basic procedural compared with block bone graft. steps were taken: 1) atraumatic extraction, 2) apical contouring of bone at 3. Sufficient bucco-lingual bone dimension was secured through use of the the transplantation site, 3) preparation of a 4-wall bony socket, 4) avoidance microplate. of premature occlusal interferences and 5) stabilization of the tooth with placement of a cross suture. The patient was recalled at 1, 3, 6, 12, and 24 months. 111 i Gain Of Bone Height and Thickness in The posterior results: No differences were found in clinical periodontal parameters at 1, Mandible using Bilateral reconstruction With autogenous Graft 3, 6, 12 and 24 months. At the two year follow-up, no pathological signs were Of ramus Mandibular and Mentum detected clinically or radiographically.30
  6. 6. clinical reSearch, caSe rePortSConclusions: Autogenous transplantation of the third molar may be consid- bances due to mental nerve compression. Pre-operative CT Scan measurementsered as an alternative to prosthetic and implant rehabilitation treatment in loss at the symphysis revealed 4 mm. of residual ridge height and 6 mm. of width. Theof first and second molars. procedure was performed under conscious sedation and local anaesthesia. A full thickness flap in the anterior area and a partial thickness flap in the posterior area were performed to avoid nerve damage. GBR was performed using a xeno-113 i The Outcome Of implant rehabilitation graft (Bio-Oss) and a titanium-reinforced e-ptfe membrane (Goretex). Mattressin The anterior Maxilla With a papilla-preserving sutures provided primary closure. After 6 months of healing time the membraneincision Technique and Grafting: a Case report was removed and three implants were placed (Branemark System) in the inter- foraminal area. Resonance Frequency Analysis (RFA) was used to assess pri-aysun kaya, Turker Ornekol mary stability. A core sample was obtained for histological analysis. results: Post-operative CT scans after 6 months of healing revealed 12 andObjectives: To prevent the regression and recession of soft tissue and underly- 6mm of vertical and horizontal bone height gain, respectively. The newly gen-ing hard tissue after the extraction of an infected tooth. erated bone allowed for the placement of three dental implants to support anMethods: Tooth # 21 extracted due to persistent apical infection and extru- implant-assisted overdenture. Primary stability of the implants was achievedsion. Immediately after extraction, socket was augmented with allograft (Bio- and measured by means of RFA. Implant Stability Quotient (ISQ) measure-oss,Geistlich Biomaterials) and opening of the socket was covered with a re- ments taken at the mesial, distal, buccal and lingual aspects of each implantsorbable membrane(Bio-Gide,GB). As a temporary, extracted tooth crown was ranged from 66 to 76. Histological analysis revealed vital and mature bone sur-trimmed and bonded to the adjacent teeth to block the opening by pressing rounding Bio-Oss particles.over the membrane. Two weeks from the extraction, a 5x10 mm tapered Nobel Conclusions: Within the limitations of this case report, we can conclude thatReplace implant (Nobel Branemark) was placed. A papilla-preserving incision GBR is a valid technique for bone reconstruction in cases of severe mandibulartechnique was used to elevate the flap, keeping the papillae intact. Guided bone resorption, avoiding the use of autogenous bone grafts and the consequentregeneration (GBR) technique was used in conjunction with the implant place- donor site morbidityment. A Maryland bridge was cemented in for the healing period immediatelyafter the surgery. Six weeks after the surgery, a screwable temporary crownwas produced to remodel the surrounding soft tissue. Twelve weeks after the 116 i a Combination Of zygomatic Fixtures, autograft, allograftsurgery, a permanent Procera Zirconia ceramic crown (NB) was cemented on and prp (platelet-rich plasma) Or prF (platelet-rich Fibrin)to the procera zirconia abutment (NB). allows a Fixed prosthesis rehabilitation Of Extremely resorbedresults: On post-operative examinations, a stable state both in the alveolar bone Or accidental Bone loss in Edentulous Maxillacontour and on soft tissue topography was observed. 1 year and 2 year follow-up sessions showed minimal (negligible) tissue loss distobucccal to the crown. laurence Evrard, Yassin Bouzelmat, Ramin Atash, Régine GlineurConclusions: GBR is essential to prevent the collapse of surrounding tissuesafter the extraction. The papilla-preserving incision technique and placement Objectives: For the maxilla, in the case of post-traumatic loss or of majorof a provisional prosthesis are also important requirements for achieving suc- post-edentation resorption, functional and aesthetic rehabilitation with a fixedcessful functional and aesthetic outcomes in the maxillary anterior region. prosthesis can be achieved by means of two or four zygomatic fixtures plus two to four conventional implants in the anterior region. In these cases, a reconstruction of the anterior part of the maxilla can be performed, using a114 i Horizontal reconstruction of alveolar ridge bone autograft supplemented by an allograft and platelet concentrates (PRP orusing autogenous block bone graft PRF), which have been shown to enhance the maturation rate of bone and bone density and to accelerate resorption of some biomaterial particles.albert Barroso panella (Spain), Pablo Altuna Fistolera, Albert Calaf Cot Methods: Clinical cases are presented, involving placement of two to four zygomatic fixtures, in conjunction with a cranial or mandibular symphysisObjectives: The aim of our communication is to expose a case series in which autograft, supplemented by use of Freeze Dried Bone Allograft (FDBA) andwe have used the autogenous block bone graft for the management of the hori- Platelet-Rich Plasma (PRP) in the form of gel and membranes. Biopsies werezontal alveolar defect and to evaluate the results and the complications. taken 4 to 6 months after bone grafting, at the time of implant placement in theMethods: A case series are presented and the results are compared to late region of the anterior maxilla. Histological analysis was performed, in order topublications. All of the cases presented moderate-severe horizontal alveolar evaluate the effects of PRP on bone maturation and bone density, in the caseridge defects. All of them have been reconstructed with intraoral autogenous of a bone autograft used in conjunction with an allograft. The four year clinicalblock bone graft. A follow up of 6 to 36 months has been done. The results are results are presented.analyzed depending on: kind of device used for the osteotomy, location of donor results: Histological sections show the very good degree of maturation of thesite, morbidity of the donor site and possible complications. reconstructed bone (lamellar bone, poor cellularity, absence of inflammatoryresults: The results have become to be favourable by using these techniques after infiltrate). X-rays show the level of bone around implants.an average follow up of 16 months. These results are in accordance to actual lit- Conclusions: The results presented here show that PRP used in conjunctionerature, in which the survival rates and the aesthetic results are very satisfactory. with allografts and autografts produces very good bone quality and density,Conclusions: The use of the intraoral autogenous block bone graft for the re- allowing implants to be placed. After four years of functional load, all implantsconstruction of the alveolar ridge seems to be predictable for the rehabilitation are successful.with fixed prosthesis of our patients. 117 i Minimally invasive removal Of a115 i Bone regeneration in Extremely dental implant displaced into The MaxillarySevere atrophic Mandible. a Case report. Sinus using dental Mini-C-arm Fluoroscoperadia Hrichi, Joan Pi Anfruns, Joan Pi Urgell uilyong lee, Pillhoon Choung, Jongho Lee, Juhyung Yi, Mihyung KimObjectives: The objective of this case report is to present a non-invasive tech- Objectives: A dental implant displaced into the maxillary sinus must be re-nique for bone regeneration in an extremely atrophic mandible with GBR utiliz- moved because the implant can cause sinusitis by disturbing mucociliarying a xenograft in combination with a synthetic barrier to allow the placement clearance or causing tissue rejection. Implant migration into the maxillary si-of dental implants. nus has been reported several times. To remove foreign bodies dislodged intoMethods: A 75 year-old female, edentulous in both maxilla and mandible with the maxillary sinus, three treatment options have hitherto been proposed inextremely severe bone atrophy (type E). The patient’s chief complaint was in- the literature: suction from the socket, classical open surgery via the caninestability of the lower denture with severe functional problems and nerve distur- fossa and the endoscopic approach. 31
  7. 7. We describe a method to retrieve a displaced dental implant from the maxillary hydroxyapatite and 40% beta-tricalcium phosphate, while inorganic bovine bone sinus using a dental mini-C-arm fluoroscope. The unit used in this study was a matrix (ABBM) is manufactured from bovine bone mineral. This study evaluated DreamRay®. The DreamRay® fluoroscope was specifically developed for dental the efficacy of MBCP (MBCP) to ABBM (Bio-Oss®) in the histomorphometrical implant surgery, endodontic treatments, tooth extractions and preparations aspects of new bone formation in maxillary sinus augmentation. for fillings. The light weight and compact design of the DreamRay® enables Methods: Eight patients were selected after a medical and dental examination. it to be moved easily and used in any location and orientation during dental Patients had insufficient residual bone height (less than 5 mm) for simulta- procedures. neous installation of implant fixtures on maxillary posterior regions. Residual Methods: We retrieved the dislodged dental implants from the maxillary sinus bone height was measured by a CT scan. in two patients through the socket using a mini-C-arm fluoroscope. The socket They were divided into two groups as determined by randomization and un- was expanded to 6 mm for further instrumentation. In the beginning, we tried derwent maxillary sinus floor elevation and bone grafting using MBCP (n=4) to remove the implant using a mosquito by viewing fluoroscopic images. Real- or Bio-Oss (n=4). After a healing period (average 6.5 months after surgery), time fluoroscopic imaging facilitated delicate control of the mosquito in order bone cores were harvested for a histomorphometric evaluation and the implant to grab the implant. However, controlling the mosquito through the socket fixtures were installed. These bone cores were decalcified and 5 um thick sec- proved to be difficult. Thus various surgical curettes were used to drag the im- tions were cut along the longitudinal plane using a microtome. All sections are plant toward the socket. Finally, the implant was positioned close to the socket stained with Hematoxyline-eosin and evaluated via light microscope coupled to and retrieved using suction. a video camera. The percentage of the different components of the harvested results: The dislodged dental implants were removed successfully. It took only tissue (i.e., new bone, residual bone particles, and soft/marrow tissue) were 5 minutes to remove the slipped implant, which had been dislodged into the calculated and recorded. maxillary sinus. The enlarged socket was then covered with a collagen mem- results: Healing process after sinus graft procedure was uneventful, even though brane and primary watertight closure was done with 4-0 black silk. The pa- small tears (‹ 5 mm) occurred in two sinuses. Bone cores were obtained 22 to 36 tients returned for follow-up appointments and the wounds healed well. weeks post surgery. Histomorphometric analysis of 4 MBCP cores and 4 ABBM Conclusions: By using a mini-C-arm fluoroscope to remove the dislodged den- cores revealed an average of new bone of 26.94% and 28.94%, respectively. The tal implants from the maxillary sinus through the socket in two patients, we percentage of residual graft particles was much less in MBCP (11.59% vs. 31.10% confirmed that the mini-C-arm is an effective and minimally invasive method for ABBM) with more soft and marrow component (61.47% vs. 39.96% for ABBM). for retrieving displaced dental implants. The amount of new bone formed in the sinus does not seem to be related to the length of healing time. The gross histology of the retrieved tissues was similar for the both types of graft material. Histological evaluation revealed that most of 118 i Bone quality Enhancement By platelet Concentration Method the graft particles, both MBCP and ABBM, were surrounded by or embedded in new bone, and in close contact to surrounding new bone. The boundary between Jung-Bae dan (korea) particles and new bone was irregular and the contact was close, implying the resorption of particles with the simultaneous apposition of new bone. Objectives: Weak bone quality is a challenge for successful implantation. Conclusions: Since the number of patients and sinuses was limited, the Especially in an extraction site in a severely inflamed condition, bone heal- data obtained in this pilot study should not be considered conclusive. How- ing is not good. Even after a long period of healing time, bone quality is very ever, histological appearance showed that both materials have osteoconduc- poor on that site. The author experienced implant failure after loading . The tive properties. Both materials are, therefore, appropriate for maxillary sinus author concluded the reason for failure was poor bone quality because the augmentation followed by dental implant placement. It is not known whether ISQ value during healing was so low and didn’t go up well. There have been differences of percentage obtained in histomorphometric analysis have any many implant surfaces to enhance osseointegration. But there are so few clinical relevance. bone quality enhancing methods for a osteotomy site with poor bone quality. So the author tried to enhance the bone quality at the osteotomy site with poor bone quality. 120 i different Technique Of ridge Splitting according Methods: The author installed 2 Straumann implants in the maxillary posterior To The Thickness Of The Buccal plate: Clinical Cases report region. One of the implants shows some peri-implant radiolucency and mobil- ity. That implant was removed after some loading period. After removal of the dong Wook Chang (korea) implant, synthetic bone material(Cerasorb) was filled. After the healing period, reimplantation was practiced. At installation, the ISQ Objectives: Narrow alveolar ridges are a serious challenge for successful im- value was not estimated for very low stability. PRGF (Platelet-Rich-in-Growth plant placement. The ridge split technique seems to be a predictable technique Factor) was prepared from venous blood. And the Straumann implant was to correct narrow alveolar ridges as compared to onlay bone graft and GBR. soaked with PRGF. Excess PRGF filled the osteotomy site. Ridge splitting can be applied in both maxilla and mandible. But generally, results: 3 weeks later, the ISQ was estimated. The ISQ value was 44. 6 weeks bone splitting in the maxillary ridges with mostly lower bone density and thin- later ISQ went up into the seventies. ner cortical bone plate can more easily be performed than in the mandibular Conclusions: Implant surface and poor bone quality osteotomy site was en- ridges with the denser bone of buccal plate. Occasionally, maxillary ridges hanced by PRGF. PRGF assisted implant installation was strong for poor bone with thick buccal plate are present. Therefore, a different method must be ap- quality osteotomy site. plied in the thick and thin buccal plate respectively. In the thin buccal ridges, mostly maxillary ridges, ridge splitting requires crestal and vertical osteotomy. In thick buccal ridges, ridge splitting needs long vertical osteotomies and/or 119 i Histomorphometric Comparison Of a Macroporous Biphasic basal horizontal osteotomy to prevent buccal plate fracture additionally. Calcium phosphate and inorganic Bovine Bone For Maxillary Sinus Methods: Case I is ridge splitting with simultaneous implant placement in the augmentation in Human: a pilot Study maxillary ridge with thick buccal plate. Full thickness flap was elevated and mid-crestal osteotomy with a piezoelectric device was performed in the alveolar Ji-Hyun lee (korea), Ik-Sang Moon ridge. Then long vertical osteotomies on the mesial, distal side were performed apically. Ridge expansion was performed with a chisel osteotome. Then the im- Objectives: The maxillary sinus augmentation technique has been considered plant was inserted into the widened alveolar crest. And then the defect was cov- as a routine procedure to achieve sufficient vertical bone height on the maxillary ered with bone graft material and bioresorbable membrane. The primary closure posterior region with severe alveolar bone resorption. As far as bone grafting was achieved. Case II is ridge splitting in the mandibular ridge with thick buccal material for sinus augmentation is concerned, it is still accepted that autog- plate. After flap elevation, mid-crestal osteotomy with piezoelectric device was enous bone graft is the gold standard. However, many researchers have studied performed in the alveolar ridge. Then the vertical osteotomies on the mesial and other bone substitutes, due to limitations affecting the harvesting of a sufficient distal side and additionally basal horizontal osteotomy was performed. After the amount of bone and the need for a second surgical site. In particular, macropo- expansion, the widened alveolar crest was filled with bone graft material and rous biphasic calcium phosphate (MBCP) belongs to alloplast, consisting of 60% covered with bioresorbable membrane. The primary closure was achieved.32
  8. 8. clinical reSearch, caSe rePortSresults: Case I. 4 months after ridge splitting with simultaneous implant compromised the restorative-driven approach to implantation. Vertical boneplacement, 2nd surgery was performed and the implant was surrounded in augmentation where horizontal bone loss has occurred is still regarded as aregenerated bone at the ridge split site without thread exposure. And then 1 challenging topic.month later, implant prosthesis was completed. Methods: A fourty-five year old female with a severely deteriorated maxillaryCase II. 5 months later after ridge splitting, 2nd surgery was performed and the lateral incisor requested an implant in order to make a fixed restoration. Se-regenerated bone in the ridge split site was sufficient to implant the placement. vere bone resorption circumferentially around the root had lost the neighbour-Conclusions: As regards the thin buccal plate, ridge splitting requires only ing proximal septum and jeopardized the standard procedure. We used guidedcrestal and vertical osteotomies. On the other hand, as regards thick buccal bone regeneration using a xenograft and barrier membrane for bone replace-plate, ridge splitting needs additional osteotomies such as long vertical oste- ment after tooth extraction. Late implantation was performed and final crownotomies, basal horizontal osteotomy. delivered after healing period.This ridge splitting technique according to the thickness of buccal plate is reli- results: Uneven healing after bone regeneration, implant placement, andable and enables the buccal plate not to be fractured. loading occurred. Significant amount of new bone gained in radiographic and clinical findings. Primary stability of implant placed in regenerated bone was demonstrated via high insertion torque. Appropriate bone remodelling and os-121 i Clinical Evaluation Of Coronally advanced Flap (CaF) + seointegration was demonstrated by the high score of implant stability (ISQ).Mucograft® in isolated recession Type defects. Case reports Follow up radiographs taken 8 months after loading showed stable bone level around the fixture neck. Clinically, we could deliver an aesthetic crown withoutMarco Clementini (italy), Gianluca Vittorini, Nicola Baldini any significant mismatch with neighbouring teeth. Conclusions: Optimal results in single implantation would be a predictableObjectives: The primary goals of mucogingival surgery have changed over approach even in a compromised situation. Appropriate case selection, flaptime from increasing the band of keratinized gingiva to providing predictable design, and proper materials are necessary for replacing a tooth with reducedroot coverage to satisfy patients’ aesthetic demands. Various different surgi- periodontium.cal techniques have been utilized to augment gingival tissue dimensions. Areview comparing the free gingival graft (FGG), the connective tissue graft(CTG) or the coronally advanced flap (CAF) in recession coverage revealed 123 i reconstruction Of The Critical Size peri-implantnon considerable difference between the individual treatments. In order to Osseous defects With porous Titanium Granulesimprove the predictability of complete root coverage, a new technique hasbeen developed using the CAF in conjunction with CTG. Even if this approach Sermet Sahin (Turkey), Metin Sencimen, Hasan Ayberk Altug, Yesim Erkan,showed improved clinical outcomes, it may be associated with significant pa- Aydin Gulsestient morbidity due to the wound at the palatal donor site. Instead of usingallograft material or autologous transplants, a promising option of avoiding Objectives: Pure titanium and titanium alloys (Ti6Al4V) have been used in thepatient morbidity is the use of collagen matrices from animal origin, such as manufacture of dental and orthopaedic implants because of their superior me-Mucograft® (MG). chanical properties and high corrosion resistance. Porous titanium granulesMethods: The surgical technique utilized to achieve soft tissue coverage is the (PTG) have used in many treatments for dental bone regeneration. The mostCAF for single recession. Following administration of local anesthesia, the flap common are sinus lift, regeneration of bone in peri-implantitis defects andis designed with two vertical releasing incisions and then elevated in a split- post-extraction socket fillings. The aim of this study was to explore the osteo-full-split fashion, the exposed portion of the root is scaled and then conditioned conductive properties and biological performance of porous titanium granuleswith EDTA to remove the smear layer, finally thoroughly rinsed with sterile sa- used in the critical size osseous defects adjacent to titanium implants.line. The MG is cut to size and placed over the dehiscence defect. The matrix is Methods: A 27 year old male patient with multiple implants was referred to ourplaced 3 mm apically to the bone dehiscence and 1 mm from the lateral inci- clinic for treatment. Three months after dental implant insertion, peri-implan-sions (avoid placing MG beneath the sutures) on the prepared mucosal bed and titis occurred with bone resorption in region around the implants. The followingthen sutured in place. Subsequently, the root surface and MG will be covered treatment steps involved debridement; full mouth disinfection and accompany-with the CAF: the tissue flap is secured slightly coronally of the CEJ by the use ing antibiotic treatment aiming to reduce any active inflammation. The muco-of a sling suture placed at the papilla, using non-irritating sutures. The verti- periosteal flap was removed up to the edge of the infected bone. Removal of allcal incisions are closed by at least 2–3 sutures. Light pressure will be applied granulation tissue and cleaning of the titanium surface with curette. The decon-after suturing. tamination of implant and bone was carried out with the tetracycline capsule. Atresults: At 6 months CAF+MG showed very positive outcome measurements in the end of the treatment for regeneration and augmentation, PTG were appliedterms of root coverage and KT width in 4 out of 5 patients, according to the sys- with soft tissue stabilization and renewed pocket formation was prevented.tematic review data available in literature about CAF+CTG; these results seem results: The results of the case show that bone can be regenerated using PTGto be stable and associated with a good aesthetic integration and with healthy (Porous Titanium Granules), and tissue samples show that new bone growsperiodontal conditions; furthermore no signs of inflammation or infection were in and around titanium granules and regenerates the bone tissue around thedetected in the period of observation, all the patients reported only a transient, implant. For the patient and dentist, this means that much time can be saved,slight pain with a very short FANS medication intake. unpleasantness can be avoided and costs can be reduced.Conclusions: These preliminary results suggest this new surgical technique Conclusions: In the literature, PTG have previously shown that titanium is(CAF+MG) could be a reliable alternative to the traditional bilaminar technique much more thrombogenic than the other two. Biomaterials are often used in(CAF+CTG) because of its predictable outcomes in terms of root coverage % implants, i.e. PVC and steel. Apart from their physical properties, the granulesin association with a significantly lower patient morbidity avoiding a palatal have also shown indications of having good biological properties, such as re-donor site duced inflammation and faster coagulation of the blood.122 i Socket augmentation as a useful procedure For replacing 124 i delayed implant placed into Grafted Extraction Socketa Severely involved anterior Tooth By dental implant Of Molar affected By Chronic periapical lesion in MandibleGolamali Golami (iran), Reza Amid Sermet Sahin (Turkey), Hasan Ayberk Altug, Metin Sencimen, Hanand AltugObjectives: Hard tissue deformities are considered to be among the most seri- Objectives: The aim of this case report was to show the clinical outcome ofous limitations on implant placement in a proper position. Different kinds of an implant placed into a grafted extraction socket of molar tooth affected bymaterials and methods are available. Despite the success of bone regenerative chronic periapical lesion.procedures documented in so many publications, bone regeneration has been Methods: A 66-year old partially edentulous male patient with a tooth requir-a controversial issue. Periodontally involved teeth with severe bone loss have ing extraction and chronic periapical lesion was referred to our clinic. Tooth 33
  9. 9. was extracted, chronic periapical lesion was curetted and that side was treated the complexity of peri-implant guided bone regeneration of bone loss owing to according to the principles of guided bone regeneration (GBR) by means of spontaneous implant exposure. During the uncovered phase, a subepithelial deproteinized bovine bone mineral particles in conjunction with a bioresorb- connective tissue graft was applied as a biological barrier and for soft tissue able collagen membrane. Survival and radiographic bone loss of implant were closure. evaluated after two years of function. Methods: At 4 months post implant placement using the traditional 2-stage results: Extraction site displayed sufficient new bone volume to allow inser- approach, a spontaneous exposure of the implant cover screw was observed. tion of a dental implant. No complication was recorded with implant and pros- Surgery included a mid crestal incision and full thickness flap elevation and thesis was successful. debridement. Crestal bone resorption exposing 3 mm of 2 implants in the cer- Conclusions: Implant placement into such sites can, therefore, be successfully vical surface was detected. The exposed implant surfaces were cleaned and performed. This procedure can be considered a safe and effective treatment irrigated. Free subepithelial connective tissue graft (SCTG) was harvested option. from the inner side of the palatal flap. The SCTG was perforated in 2 locations and threaded through the neck of the implants with the periosteal side of the connective tissue facing the bone/implants. Healing abutments were placed 125 i Mandibular reconstruction With securing the SCTG in place. Bovine bone mineral, as the filler material, was Tissue Engineering, a Case report. applied beneath the membrane on the exposed implant surface. The SCTG was inserted under the palatal and the perforated vestibular mucosa. Flaps were Vanessa ruiz Magaz (Spain), Federico Hernández-Alfaro, Manuel Ribera, Pablo sutured close to the healing abutments leaving the SCTG exposed in the area Altuna, Eduard Ferrés, Lluís Giner Tarrida between the abutments. results: The healing period was uneventful. Gradual epithelisation of the ex- Objectives: Show a new approach to bone regeneration instead of bone trans- posed graft surface from the surrounding tissue was achieved and at 2 weeks plantation in a 32-year old patient who presented an ameloblastoma in her left nearly all exposed portions of the SCTG were re-epithelialised. At 4 weeks mandibular angle. post operation, a normal appearance was restored without evidence of in- Methods: The area affected by the ameloblastoma was resected using an ex- flammation. The area of the facial keratinized tissue surrounding the implant traoral access. At the beginning of the surgery a bone marrow aspirate from increased significantly presenting a thick type B masticatory mucosa morpho- the iliac crest was centrifuged in order to concentrate the mesenchymal cell type. The donor site in the area of the palatal flap presented no signs of mor- fraction. Using a stereolithographic model of the mandible a titanium mesh was bidity due to the precise excision of the SCTG, without flap perforation, which moulded to recreate the angle of the mandible. Two xenograft blocks mixed with could result in secondary wound healing. At the end of 3-month follow-up, the recombinant human bone morphogenetic protein-2 and stem cells were used to area was asymptomatic, and the implant sites showed no signs of infection or recreate the resected area on the model. Then the titanium mesh and this com- bleeding when probed. The radiographic examination revealed bone gain in the bination of biomaterials were adapted to the mandible of the patient to recreate area of previously exposed implant threads. The implants were restored with the original anatomy. After 6 months three endosseous dental implants were provisional crowns designed to enhance soft tissue contouring and maturing. placed in the regenerated bone to restore the masticatory function of the pa- Conclusions: Soft and hard tissue management following spontaneous expo- tient. At the time of the implant placement bone samples were collected using a sure of implant cover screws, using SCTG, can lead to satisfactory peri-im- trephine bur and were subjected to histomorphometrical analysis. plant healing and enhancement of peri-implant bone level. The wound closure results: The fundamental of tissue engineering is the regeneration of tissue over partially exposed SCTG prevents the displacement of the mucogingival and restoration of function through implantation of cells/tissue grown outside junction and increases the width and thickness of the peri-implant keratin- the body or stimulating cells to grow into an implanted matrix. It is an alterna- ized mucosa. tive to conventional reconstruction methods. The three main components of tissue engineering are scaffolds, cells and signalling molecules. Bone mor- phogenetic proteins (BMPs) are multifunction proteins with a wide range of 127 i resorbable Collagen Membrane Vs. No Membrane biological activities involving a variety of cell types. BMPs comprise the os- in The Sinus lift procedure. a Split Mouth Case report. teoinductive component of several tissue engineering products. In late-stage development they are used as replacements for autogenous bone graft. Stem Basilio Matamoros (Spain), German Solis, Marc Quevedo, Antoni Castellón, cells are unspecialized cells which are characterized by two properties: their Pablo Altuna high self-renewal activity and their multilineage differentiation potential. The xenograft blocks stabilized by the titanium mesh act as a scaffold for these Objectives: To compare the clinical and radiographic changes in a bilateral si- tissue engineering materials that promotes the integration of the graft and the nus lift procedure using a resorbable membrane on one side and no membrane new bone formation. on the other side. Conclusions: In this case the histomorphometric analysis revealed new bone Methods: A 45-year-old male patient came to our dental school clinic seeking formation around particles of xenograft material. This kind of approach made a fixed rehabilitation in the upper jaw. A fixed implant-supported denture was it possible to restore the aesthetics and the functions for the patient with a planned. Both right and left maxillary sinus were pneumatized and a bilateral limited morbidity and treatment time. sinus lift was needed to place implants in the posterior regions. Right sinus was grafted with a bovine xenograft (Bio-Oss®) and covered with a resorbable collagen membrane (Bio-Gide®). The same graft was used to fill the left si- 126 i Subepithelial Connective Tissue Graft as a Biological Barrier nus but no membrane was used to cover the lateral window due to operating Membrane in The Treatment Of peri-implant Crestal Bone complications. After the healing and graft consolidation, eight conical shaped deficiency resulting From Spontaneous Early implant Exposure internal hex Nanotite® implants were placed in the maxilla. After the osseoin- tegration they were rehabilitated with a metal-ceramic fixed denture. avital kozlovsky (israel), Shimshon Slutzkey, Zvi Artzi results: After 7 months of sinus graft healing, a new CT scan was performed to measure the new height of both posterior maxillary regions. Different bone Objectives: Premature exposure of submerged implants predispose to peri- density was observed between both sinuses. On the right side the radiographic implant bone loss which when encountered has to be approached using inter- aspect of the graft was dense and well delimited. In the left sinus the graft was ceptive treatment aimed to restore the bone. Therefore, therapeutic modality dispersed and invaded by less dense tissue. based on the principle of guided bone regeneration (GBR) should be applied. Conclusions: Using a resorbable collagen membrane in the lateral window af- The use of resorbable or non- resorbable membrane is questionable due to ter the sinus lift improved the graft preservation, isolation and maintenance of the risk of exposure and early resorption of the former and contamination of the dimensions. Combining a particulated xenograft and resorbable collagen the latter resulting in impaired bone regeneration. Reclosing the implants to membrane for the sinus lift with the lateral approach is a predictable and well protect the membrane is complicated due to the presented perforation of the documented technique. Absence of a barrier between the graft and the peri- mucosa covering the implants and is a disadvantage due to the need for a sec- ostium may produce a migration of the graft particles and an invasion of the ond surgical intervention. An innovative technique is suggested to overcome connective tissue infiltrating the graft material.34
  10. 10. clinical reSearch, caSe rePortS128 i The use Of a New Collagen Matrix (Mucograft®) for bone augmentation with high morbidity of the donor side. This case reportin Soft Tissue improvement around implants demonstrates the possibility of using cortical lamina in small sized alveolar bone defects.Georg Gassmann (Germany), Adrian Lucaciu, Philip KeeveObjectives: Up to now free gingival (fGTG) or connective tissue grafts (fCTG) 130 i Horizontal and Vertical ridge augmentationhave successfully been used in achieving attached soft tissue around dental in aesthetic zone: a Case reportimplants. Recently a new collagen matrix (Geistlich Mucograft®) has beensuggested as a substitute for the autogenous transplants. It is the aim of this aliye akcali (Turkey), Muhittin Toman, Nejat Nizampresentation to clinically show stages of healing up to twelve months after in-sertion in three cases. Objectives: The loss of vital soft and hard tissues after tooth removal can re-Methods: Materials and Methods: In three female patients (mean age 59.4) the sult in alveolar ridge defects which lead to aesthetic and functional problemscollagen matrix was used to enhance peri-implant attached mucosa around six especially in the anterior maxilla. In such defects, soft and hard tissue graftsimplants (2 in the upper posterior / 4 in the lower posterior jaw). Patients gave are often the treatment of choice. In this case report we aimed to demonstrateinformed consent. The matrix was sutured to the neighbouring soft tissue and horizontal and vertical ridge augmentation using bone graft material, titaniumthe periosteum after peri-implant buccal mucosa split-flap preparation. Heal- membrane, and subepithelial connective tissue graft.ing was documented by taking clinical photographs after one, three, eight and Methods: A 66 year old male patient presenting Seibert class III ridge defect infourteen days and after three, six and up to twelve months. According to the the right maxillary central and lateral incisor area and Seibert class I ridge de-McGuire/Scheyer study (2010) Doxycycline 100, Ibuprofen 600 and CHX mouth- fect in the left lateral incisor area was referred to the clinic. The Seibert classwash 0.12% (Paroex®) were administered postoperatively. III defect was reconstructed using bone graft material and titanium membraneresults: Results: Healing was uneventful in all cases. No pain was reported and the Seibert class I defect was treated only with connective tissue graft inby two of the three patients so that they refused to take the pain control medi- consecutive appointments. At the right site, the papilla preservation flap wascation. One patient needed pain control. After 14 days sutures were removed reflected, the defect was filled with cancellous particulate allograft, coveredand complete matrix integration was seen in all cases. A range of 3-9 mm with titanium membrane and flap was closed primarily. At the left site, a pouchenhanced peri-implant attached mucosa without keratinisation was attained was formed in the vestibular area and filled only with connective tissue graft.in the peri-implant cases within the observation period of up to twelve months. The titanium membrane was removed at 6th month. Before 6 and 12 monthsConclusions: Conclusion: The porcine collagen matrix may be used as an au- after the augmentation procedures, clinical periodontal parameters were re-togenous graft substitute in establishing attached peri-implant mucosa. Ac- corded, the impressions were taken and casts were optically scanned in ordercording to conflicting protocols concerning postoperative medication the need to obtain the digital images and make the soft tissue analyses.for postoperatively administered antibiotics seems questionable. results: During the healing period, neither soft tissue dehiscence nor mem- brane exposure were noted. Healing was uneventful at both augmented sites. No differences were found in clinical periodontal parameters during the follow129 i use Of Cortical lamina For Simultaneous Closure Of up period of the case. The alveolar ridge defect was decreased both in verti-Oronasal Fistula, reconstruction Of alveolar defects. a Case report. cal and horizontal dimensions. Soft tissue width was increased at 1st and 2nd months compared to the baseline.atef ismail (Egypt), Khaled Barakat Conclusions: Soft and hard tissue grafts for ridge augmentation in anterior maxillary area could be effective treatment choices in development of functionObjectives: Oronasal defects represent a challenging problem for reconstruc- and aesthetics.tion as there is a need for cortical cover, good adaptability and an easy fixingtechnique. Although the autogenous bone is the gold standard for augmen-tation, it lacks adaptability and there is donor side morbidity and difficulty of 131 i periodontal Bone regeneration Withfixation and stability. Nd: yaG laser and laNap protocolContouring and reshaping of the ridge with cortical contoured bone is considereda real challenge because of the absence of semi-flexible bone. Use of cortical raymond yukna (uSa)lamina can provide semi-flexible degrees customized to the exact defect shape.Methods: A 35 year old male was suffering from nasal fluid discharge during Objectives: The purpose of this presentation is to illustrate the radiographicdrinking following a history of surgical removal of the upper left central incisor. and histological bone regeneration seen following the Laser-Assisted New At-Clinical examination showed loss of contour of alveolar buccal bone with slight tachment Procedure (LANAP) surgery using the Nd:YAG laser in humans.depression at the vestibular site with slight spearing fistula. CBCT revealed Methods: Pre-treatment and post-treatment dental radiographs of patientsloss of apical bone forming a fistula connected to the nasal cavity. Defect analy- treated for chronic periodontitis or peri-implantitis with the Laser-Assistedsis revealed a fistula measuring 3 mm x 5 mm and buccal bone defect measur- New Attachment Procedure (LANAP) surgery using the Nd:YAG laser will being 7 mm wide x 12 mm long. The flap was totally elevated; granulation tissue presented. Cone beam images of some of the patients will be shown. Humanin the bed was excised. histology sections will also be presented.The fistula was curetted to a healthy bone margin. The nasal floor was elevated results: Consistent increase in bone support for both natural teeth (infrabonyand sutured in place. Lamina was dipped in saline for 7 minutes then a piece defects and furcations) and dental implants has been seen with the LANAPwas cut such as to close the fistula, cortices up towards the nose. The defect surgical protocol. The cases shown will illustrate various examples of peri-was filled with collagenized corticocancellous bone chips. The lamina was fixed odontal and peri-implant bone regeneration. Human histology reinforces thein place using 3.0 vicryl sutures to surround periosteum radiographic findings.results: Lamina was tolerated to a convex shape restoring the contour accord- Conclusions: The Laser-Assisted New Attachment Procedure (LANAP) surgerying to the pre CBTC. The flap was scored on its undersurface to allow stretch protocol using the Nd:YAG laser demonstrates appreciable potential for peri-and complete coverage of lamina. No major complication developed postop- odontal and peri-implant bone regeneration.eratively. Minor complications like oedema and lip swelling developed post-operatively increasing after 72 hours and then regressing totally after 7 days.Slight dehiscence appeared at the crestal palatal interface which was treated 132 i rotated pedicle palatal Connective Tissue Flapwith careful cleaning and irrigation and was completely resorbed after 10 days. For Soft Tissue Management after Electrocautery injuryNo nasal discharge was reported by the patient whereas buccal contour wastotally appreciated by the patient. CBCT after 6 months reveals closure of the ilker keskiner (Turkey), Hanifi Ipekdefect and valuable bone formation.Conclusions: Versatility and adaptability of cortical lamina and an easy fixa- Objectives: The incorrect usage of electrocautery in dentistry may cause in-tion method provide a good solution in such a case without secondary surgery juries in gingiva and bone. A surgical procedure, based on a rotated pedicle 35
  11. 11. palatal connective tissue flap containing periosteum to achieve primary soft Objectives: The purpose of this case report is to evaluate the clinical and ra- tissue closure and to preserve the alveolar bone in the interproximal area after diographical comes out of an emerging surgical technique by comparing in the necrotic bone removal, is presented. same patient and for the same type of bone defect two guided bone regenera- Methods: A 24-year-old male presented with an electrocautery injury on ac- tion techniques. count of the excision of gingival tissue extending into carious lesion between Methods: A 52-years-old patient presented with bilateral edentulous areas in the maxillary right first molar and second premolar. The lost interdental pa- the mandible. Cone beam tomography (CBT), showed a major resorption and pilla area showed ulcerations, exposed bone and gingival recession with se- the necessity of a bone augmentation. Using CBT-based software it has been vere pain. A mucoperiosteal flap was elevated and necrotic bone was removed. possible to obtain a surgical guide and a precise 3-dimensional model of the The pedicle palatal connective tissue flap was planned to achieve soft tissue patient’s jaw using a sterilizable material. Split mouth rehabilitation was per- closure. It is initiated by making a horizontal incision 2 mm from the gingival formed. Four ITI Bone Level Straumann implants were placed using a teeth- margin of the teeth on the mesial side of the defect. After a vertical incision in supported guide in position 3.4, 4.4 (postextractive), 3.6 and 4.6. On the right the canine area, a mucoperiosteal flap was elevated. The pedicle connective atrophic crest, bone chips collected with a scraper mixed with Bio-Oss and tissue containing periosteum was harvested, elevated, and rotated to cover the resorbable membrane have been used. On the left side a corticocancellous bone in the interproximal area. The superficial layer of palatal flap was then allograft block, shaped before surgery on the stereolithographic model of the repositioned and sutured. patient’s jaw, was secured with osteosintesis screws and protected with a re- results: The healing was uneventful with no connective tissue necrosis. One year sorbable membrane. Following a 6-month healing period, a second CBT evalu- follow-up showed approximately 1 mm creeping attachment on the root surface ation was carried out. After complete tissues recovery, two CAD-CAM zirconia and increase in papilla height in comparison with appearance in the third week. bridges were screwed as definite prosthesis. Conclusions: The described surgical approach is advantageous since blood results: The preoperative and postoperative scans were then aligned pair supply is provided from the pedicle, which differs from free connective tissue wise using an iterative closest point algorithm, which allowed for compari- and gingival grafts. The technique, using a rotated pedicle palatal connective son between planned and actual implant positions. All measurements were tissue flap, seems to be a viable treatment approach to achieve primary soft performed using Mimics software (Materialise). Four deviation parameters tissue closure in the maxillary interproximal areas. between each virtual and corresponding actual implant were measured: the mean coronal discrepancy was 0.34 ± 0.29 mm; the mean apical difference was 0.28 ± 0.30 mm; the mean angular deviation was 2.29 ± 1.43 degrees; the mean 133 i using xenografts in 3d Bone reconstruction Surgery. vertical discrepancy was 0.15 ± 0.32mm. The major discrepancy has been given a Case report. by post-extractive implants. With the same software it has been possible to quantify the regenerated bone status. A bone resorption of 15% from the ini- Octavi Ortiz puigpelat (Spain), Marin Lissette Meriño tial volume inserted has been registered for the allograft; 5% portion for the conventional technique. Both the bone regeneration was successfully stable a Objectives: Autogenous bone grafts have been for many years the gold stan- 1 year follow-up. dard in bone regeneration surgery. The use of biomaterials as an alternative Conclusions: The block allograft procedure has shortened surgical time and it is still controversial especially in critical defects such as vertical-horizontal reduced post-operation morbidity. Further research is needed to determine alveolar defects. In such situations Khoury developed 3D bone reconstruction whether the 3D block technique had survival rates equal to the others graft some years ago , where the autogenous cortical blocks serve as buccal and materials in term of long follow-up time. As with any regenerative technique, palatal walls and the space between them is filled with cortical and/or cancel- however, treatment of soft tissue will play a crucial role, and the surgeon must lous autogenous bone particles. This technique has been shown to be a predict- treat it skilfully to achieve success. The implants position has a good corre- able technique for vertical bone augmentation with a low rate of complications. spondence with the presurgical planning. However, the use of this technique sometimes requires a large amount of bone particles to fill such a space. The aim of this paper is to show, through a clinical case, the use and the histological evaluation of a xenograft as an alternative for 135 i intraoral soft tissue regeneration with a tissue filling the space between the blocks during 3D bone reconstruction surgery. engineered metabolic active fibroblast layer Methods: A 35 year old healthy woman was treated in our private office in order to reconstruct a vertical defect of 6 mm in her upper posterior maxillary area. Hans-Joachim Gath (Germany), Martin Heel A 3D bone reconstruction technique was performed using a mandibular block harvested from the mandibular ramus area. The space left was filled with xe- Objectives: Tissue engineering offers the ability to new ways of wound treat- nograft cancellous bone particles (0.25–1 mm). Once the particles were well ment in the oral cavity. Soft tissue defects are often covered with transplants packed, a collagen resorbable membrane of 0.3 mm in thickness was placed witch leave donor site defects. After covering a defect with a transplant the over the particles to prevent soft tissue migration. A 5 month healing period structure of the tissue is different which often results in functional defects. The was left to accomplish bone regeneration. Then, three bone biopsies were taken method of tissue engineering offers now the ability to grow a dermal like tis- from the xenograft area using a 2 mm internal diameter trephine. This trephine sue consisting of living fibroblast. In closed bio reactors juvenile human living served as a drill to prepare the implant site. 3.7 by 10 mm implants were in- fibroblast are seeded on a three dimensional scaffold of resorbable vicryl. In serted in each biopsy. Then, the biopsies were sent for histological evaluation. these settings the cells create a dermal like living tissue which can be frozen at results: High number of vital osteocytes was found in the biopsies as well as -80 degrees Celsius. This tissue can be shipped world wide in a just in time set- large amounts of mineralized bone surrounding the xenograft particles. Simi- ting and than after thawed at 37 degrees transplanted. Then after a short time lar observations were in accordance with those found by Khoury in biopsies the fibroblast get metabolic active. This tissue can be used to cover intra and obtained in areas where autogenous bone particles were used. extraoral defects. The living juvenile fibroblast cells secret a panel of growth Conclusions: Within the limits of this case report we can conclude that the use factors like VEGF (vascular endothelial growth factor), PDGF (platelet derived of xenograft particles can be a good option when the space between cortical growth factor), IGF (insulin like growth factor) and KGF (keratinizing growth blocks is large and large amounts of autogenous particles cannot be obtained factor) all of them substantial in wound healing. As these growth factors are during the 3D bone reconstruction. More controlled and prospective studies secreted from living cells the concentration is physiological and acting for a are needed to determine the effectiveness of such material compared to the prolonged time. autogenous bone particles. Methods: We used the above described living dermal like tissue to cover in- traoral defects resulting from surgical resection of SSC (squamous cell car- cinomas), preprothetic surgery and periodontal surgery. A SSY of the anterior 134 i Block allograft technique vs. standard guided floor of the mouth was resected and would have been reconstructed with a bone regeneration: clinical and radiographical results of a radialis flap. Because of the multiple risk factors of the patient a short op- split mouth guided surgery case report erating time was required. Instead of the radialis flap we covered the defects with the dermal like tissue which was fixed with several sutures to allow the leonardo amorfini (italy), Stefano Storelli, Eugenio Romeo intense contact of the fibroblast with the wound bed. After 10 days the covering36

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