PD Dr. Daniel S. Thoma - Soft-tissue augmentation in the esthetic zone

Soft-Tissue Regeneration

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PD Dr. Daniel S. Thoma

Soft-tissue augmentation in the esthetic zone

The Situation A young male patient was referred to the clinic with a missing central incisor, 21 (FDI) and an implant placed in the respective site. The patient does not smoke and drinks occasionally. Following a trauma on tooth 21, an implant was placed and the patient referred for an implant-born recon-

struction. Upon a clinical examination, extensive horizontal and vertical contour deficiencies are present prior to abutment connection.

The Risk Profile Low Risk

Medium Risk

High Risk

Patient’s health

Intact immune system

Light smoker

Impaired immune system

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

Compromised 1 tooth (≤ 7 mm)

2 teeth or more Compromised

Horizontal defect

Vertical defect

“The patient presented with severe horizontal and vertical hard and soft-tissue defects. I needed a solution that could increase the soft-tissue anatomy around the implant and prosthetic„

PD Dr. med. dent. Daniel S. Thoma – Zurich, Prosthodontist – Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Zurich

PD Dr. Daniel Thoma is the Head of Reconstructive Dentistry and Vice-Chairman at the Clinic for Fixed and Removable Prosthodontics and Dental Material Sciences, University of Zurich, Switzerland.

He graduated in 2000 at the University of Basel, Switzerland and was trained in implant dentistry and prosthodontics at the Clinic for Fixed and Removable Prosthodontics and Dental Material Sciences, University of Zurich, Switzerland.

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The Approach The compromised situation with a horizontal and vertical hard and soft-tissue deficit required a soft tissue volume grafting procedure.

A buccal split-thickness flap was prepared and Geistlich Fibro-Gide® shaped and placed. Primary wound closure was obtained. Abutment connection was performed after 8 weeks later and the emergence profile created with a provisional reconstruction. The final reconstruction was placed at 3 months.

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The Outcome 6

The outcome of the case was very pleasing having fulfilled the patient’s expectation in terms of esthetics and function. The tissues are healthy and obtained volume through the grafting procedure match the contour of the neighboring natural tooth.

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12 | 1 Preoperative view buccal aspect with vertical tissue deficit. | 2 Preoperative view occlusal aspect with vertical tissue deficit. | 3 Preparation of a split-thickness flap (buccal pouch). | 4 Due to releasing incisions within the periosteum, the tissues can be advanced more coronally. | 5 Dimension and shape of Geistlich Fibro-Gide® with a maximal thickness (5mm) at the transition between the buccal and occlusal aspect. | 6 Geistlich Fibro-Gide® inserted and immobilized with a horizontal cross-suture to the palatal flap. | 7 Primary wound closure. | 8 Clinical view after abutment connection. | 9 A provisional reconstruction is inserted; blanching of the tissues can be observed. | 10 Final emergence profile established with a provisional reconstruction. | 11 Final view after insertion of the final reconstruction. | 12 1-year follow-up.

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

Healthy peri-implant tissues Primary wound closure Off the shelf product alternative to CTG (no second surgical site needed) Ready to use matrix to increase volume in all direction

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

Soft-tissue augmentation using Geistlich Fibro-Gide® results in a predictable volume gain and reduces surgery time, as well as patient discomfort.

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

REFERENCES 1

Thoma DS. et al. J Clin Periodontol. 2016 Oct; 43(10): 874–85

2 Zeltner M. et al. J Clin Periodontol. 2017 Apr; 44(4): 446–453 3 Huber S. et al. J Clin Periodontol 2018 Dec, 1-9

601907/1809/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

© 2018 Geistlich Biomaterials

Affiliate North America Geistlich Pharma North America Inc. 202 Carnegie Center Princeton, NJ 08540 USA Phone toll-free +1 855 799 5500 info@geistlich-na.com www.geistlich-na.com