BioBrief - Minor Bone Augmentation - Dr. Pretam Gharat

Minor Bone Augmentation

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Dr. Pretam Gharat

Restoring aesthetics and function at immediate implants with Geistlich Bio-Oss® Collagen.

The Situation Patient was referred by a colleague presenting infection and pain from the upper left central incisor. He had a consultation with a specialist endodontist who diagnosed a crack with the tooth and warned him of hopeless prognosis with the tooth.

Extraction and replacement options were discussed. The cone beam computed tomography was made available to us which revealed a periapical pathology associated with the tooth. Intact buccal wall was noted with 1.2–1.5 mm thickness.

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

Dr. Pretam Gharat – Practice limited to Dental Implantology, London Dental School & Degree (e.g. DDS, DMD, etc.) BDS MSc DPH (Lon.) MJDF (RCS, Eng.) DDPH (RCS, Eng.) F.R.S.P.H. FICOI (USA) Dip Imp Dent (R.C.S., Ed.) FCGDent Dr. Gharat’s philosophy is to strive for excellence and he aims at the very highest standards in modern dentistry for his patients. He strives to provide the most advanced treatments, the most beautiful and natural smiles and to have the most highly trained and caring team around him.

His work includes all complex dental implant treatments, Implant-supported dentures, complex restorative dentistry, aesthetic dentistry, cosmetic dentistry, veneers, crowns, bridgework, bone and soft tissue reconstruction & grafting, periodontal plastic surgery, occlusal rehabilitations and full mouth rehabilitations. His goal is to be able to deliver pain-free dentistry, in a comfortable, warm and friendly environment and to build caring lifelong relationships and trust with patients.

Vertical defect

“The patient had a failing crown “The bony envelope with wascompromised maintained soft-tissue and in the process, by filling re­q uested a single crown the gap with Geistlich ® rehabilitation with Bio-Oss Collagen” improved esthetics.„

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The Approach

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A flapless immediate placement approach was utilized. The protocols of immediate placement were followed to ensure a successful outcome with focus on aesthetics. We ensured that the bony envelope was maintained in the process, by filling the bone to implant gap with Geistlich Bio-Oss® Collagen. A decision to perform a connective tissue graft was made midway to the treatment to improve the final soft tissue profile.

The Outcome 5

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Excellent soft tissue & bone fill achieved.

Geistlich Bio-Oss® Collagen was utilized to gain the advantage of long-term volume stability of this xenograft, combined to enhanced handling properties. In a complex case like this, it is important for a clinician to understand & identify their expertise & recognize limitations. Accurate diagnosis, meticulous treatment planning, surgical skills in combination with correct materials to achieve a stable hard and soft tissue outcome are the key elements for success in immediacy in dental implants.

| 1 Pre-operative situation. | 2 Extraction of tooth #21. Visible vertical fracture with the periapical pathology. | 3 Visual inspection, noting the presence of intact bony walls. Mechanical debridement of the socket is performed. | 4 Implant in place. The jumping distance (gap) between the implant surface and the buccal bone is approximately 3 mm. | 5 Geistlich Bio-Oss® Collagen 100mg is hydrated with saline solution and cut into small pieces to aid its placement in the jumping gap. | 6 Geistlich Bio-Oss® Collagen gently packed in the gap. | 7 At the time of implant placement, a finished temporary crown with biomimetic emergence profile is produced. The screw channel is positioned palatally. | 8 Temporary crown in-situ. | 9 Soft-tissue appearance at 6-months post-surgery and prior to placement of the definitive restoration. A connective tissue graft was performed 3 months post-implant placement. | 10 Definitive restoration in place, six months after surgery. | 11 Final soft-tissue healing. | 12 Periapical radiograph following placement of the definitive restoration.

Keys to Success

Affiliate Australia and New Zealand Geistlich Pharma Australia Pty Ltd. The Zenith – Tower A Level 21, Suite 21.01 821 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 Affiliate North America Geistlich Pharma North America Inc. 902 Carnegie Center, Suite 360 Princeton, NJ 08540 USA Phone +1 855 799 5500 info@geistlich-na.com www.geistlich-na.com 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

Atraumatic extraction technique in order to minimize bone loss.

It is always beneficial to compensate soft tissue remodeling, by means of overbuilding buccally with biomaterial or by a soft tissue graft.

When possible, using provisional crowns in immediately placed implants to maintain soft tissue contours.

Always filling of the void between the implant and the buccal bone with a slow resorbable bone substitute, like Geistlich Bio-Oss® Collagen.

Choice of implant design to aid in a prosthetically driven implant placement.

Optimal surgical management of a buccal jumping gap following immediate implant placement by using appropriate biomaterials (Geistlich Bio-Oss® Collagen in this case) is extremely critical in achieving a stable result with minimal buccal bone remodeling & soft tissue recession.

Testimonial Dr. Pretam Gharat

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Manufacturer Geistlich Pharma AG Business Unit Dental Bahnhofstrasse 40 6110 Wolhusen, Switzerland Phone +41 41 492 55 55 Fax +41 41 492 56 39 www.geistlich-dental.com

Following the 5 diagnostic keys, (I) the presence of a buccal plate, (II) primary stability (III) implant design (IV) filling of the gap between the buccal plate and the implant, and(V) tissue biotype, can help reach a more precise diagnosis and case selection in order to obtain optimum results.

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