Prosthetically Guided Regeneration (PGR) in the posterior maxilla.

Major Bone Augmentation

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Dr. Paolo Casentini, DDS

Prosthetically Guided Regeneration (PGR) in the posterior maxilla.

The Situation The 60 years-old female patient’s chief complaint was represented by unsatisfactory esthetics and function, related to loss of multiple maxillary teeth. Her request focused on improving esthetics and function by means of a fixed reconstruction.

The patient presented 5 residual anterior maxillary teeth (from 13 to 22) that could be maintained. After preliminary periodontal diagnosis and treatment, specific diagnostic steps for implant treatment demonstrated inadequate bone volume for implant placement.

The Risk Profile Low Risk

Medium Risk

High Risk

Patient’s health

I ntact immune system/ Non-smoker

Light smoker

I mpaired immune system/ Heavy smoker

Patient’s esthetic requirements

Low

Medium

High

Height of smile line

Low

Medium

High

Gingival biotype

Thick – “low scalloped”

Medium – “medium scalloped”

Thin – “high scalloped”

Shape of dental crowns

Rectangular

Infection at implant sight

None

Chronic

Acute

Bone height at adjacent tooth site

≤ 5 mm from contact point

5.5 - 6.5 mm from contact point

≥ 7 mm from contact point

Restorative status of adjacent tooth

Intact

Width of tooth gap

1 tooth (≥ 7 mm)

Soft-tissue anatomy

Intact

Bone anatomy of the alveolar ridge

No defect

Triangular

Restored 1 tooth (≤ 7 mm)

2 teeth or more Compromised

Horizontal defect

Vertical defect

Using a diagnostic “The patient had template during the GBR a failing crown procedure helps to highlight with compromised thesoft-tissue presence of bone and defects in relationship to re­quested a single crown the restorativewith plan rehabilitation and future position improved esthetics.„ of implants.

Dr. Paolo Casentini, DDS Graduated in Dentistry at the University of Milan, Fellow and Past Chairman of the Italian section of ITI, Active member Italian Academy of Osseointegration.

Co-author of 10 text-books including ITI Treatment Guide volume 4 translated in 8 languages and “Pink Esthetic and Soft Tissues in Implant Dentistry” translated in 5 languages. His field of interest is advanced implantology in complex and esthetically demanding cases. He has extensively lectured in more than 40 Countries.

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The Approach Bi-lateral sinus lift with Geistlich Bio-Oss Pen® and horizontal bone augmentation with a 1:1 mix of autogenous bone and Geistlich Bio-Oss® were performed 6 months prior to implant placement, following a Prosthetically Guided Regenerative (PGR) approach. The augmented sites were protected with Geistlich Bio-Gide® stabilized with titanium pins. The template utilized for radiographic diagnosis and GBR was then used to guide the implants placement.

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The Outcome After a healing period of 6 months, adequate bone volume was achieved for the placement of 5 implants. Geistlich Fibro-Gide® was also used to optimize soft tissue volume at the buccal aspect of implants.

Implants were early loaded with a temporary screw-retained fixed prostheses 6 weeks after placement. The final prosthetic reconstruction included ceramic veneers of the frontal residual teeth and zirconium-ceramic screw retained fixed prostheses on implants.

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| 1 Baseline full mouth intra-oral view: the residual maxillary teeth were preliminarily reconstructed with a composite mock-up. The horizontal atrophy of the posterior areas of the maxilla is clearly visible. | 2 The cone beam, realized with a radio-opaque diagnostic template, shows inadequate bone volume for implant placement in all the analyzed sites. | 3 The use of the diagnostic template during the augmentation procedure helps to highlight the presence of bone defects in relationship to the restorative plan and future position of implants. | 4 Large Geistlich Bio-Oss® particles are directly applied inside the sinus with Geistlich Bio-Oss Pen®. | 5 The Geistlich Bio-Gide®, fixed with titanium pins is used to protect and stabilize the augmented site. As the surgical template shows, the bone augmentation is based on the future restorative project following the principle of PGR. | 6 The same surgical procedure is performed on the left posterior side of the maxilla. | 7 Cone-beam 6 months after surgery and prior to implant placement. The relationship between the template used for diagnosis and the bone crest reveals adequate bone volume to place implants in the correct prosthetically driven position. | 8 Implant placement was guided by the same template utilized for diagnosis and bone augmentation. | 9 Final view of the prosthetic reconstruction demonstrates bio-mimetic integration of implant-supported prostheses and ceramic veneers bonded to residual natural teeth. | 10 The panoramic radiograph shows adequate integration of the implants and absence of peri-implant bone resorption.

Keys to Success More details about our distribution partners: www.geistlich-biomaterials.com Manufacturer Geistlich Pharma AG Business Unit Biomaterials Bahnhofstrasse 40 6110 Wolhusen, Switzerland Phone +41 41 492 55 55 Fax +41 41 492 56 39 www.geistlich-biomaterials.com Affiliate Australia and New Zealand Geistlich Pharma Australia and New Zealand The Zenith – Tower A Level 19, Suite 19.01 821 Pacific Highway NSW 2067 Chatswood, Australia Phone +61 1800 776 326 Fax +61 1800 709 698 info@geistlich.com.au www.geistlich.com.au Affiliate Great Britain and Ireland Geistlich Sons Limited 1st Floor, Thorley House Bailey Lane Manchester Airport Manchester M90 4AB, Great Britain Phone +44 161 490 2038 Fax +44 161 498 6988 info@geistlich.co.uk www.geistlich.co.uk

Open communication with the patient and expectations management Prosthetically Guided Regeneration (PGR): use of the same template from the preliminary prosthetic project to the actual bone augmentation Prosthetically guided implant placement for a correct implant positioning and restoration Geistlich Biomaterials for a predictable regeneration

“Patient’s satisfaction is my driver for excellence. That’s why I always apply the Prosthetically Guided Regeneration principle together with Geistlich Biomaterials: proven and predictable long-term patient success”.

Dr. Paolo Casentini, DDS

Affiliate North America

602195/2201/EN

Distribution Canada HANSAmed Ltd. 2830 Argentia Road Unit 5–8 L5N 8G4 Mississauga, Canada Phone +1 800 363 2876 Fax +1 800 863 3213 orders@hansamed.net www.hansamed.net

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