im0110

The substitution of lost teeth by dental implants is being increasingly used to support prosthetic crowns or bridges. Many of these cases are associated with bone loss that requires the filling of the defects by some kind of bone substitute. The recent improvements in synthetic bone materials have led to increased predictability and explain the ever-increasing use of such materials in various bone augmentation indications...

user report _ bone augmentation I Fig. 5 Fig. 6 Fig. 7 Fig. 8 ograph as well as clinically (Fig. 1). The facts that the fracture was old and that a fistula developed around the root resulted in a large loss of the buccal bone wall. The treatment options were presented to the patient, who signed an informed consent form. The patient presented no contra-indications to the treatment. Case 2 was a 54-year old non-smoking male patient in good health with no contra-indication to the proposed treatment, who presented with a maxillary right central incisor following a root fracture as can be seen on the pre-operative radiograph and clinically (Fig. 7). Given the radiographic and clinical findings it seemed evident that the buccal bone wall was resorbed. The treatment options were presented to the patient, who signed an informed consent form. markings (Figs. 2 & 8). The implants placed were in each case a Straumann RN SP (4.1 mm diameter, 14 mm length). The implants were installed at the level of the crestal bone of the adjacent teeth. The injection of VitalOs must always be preceded by adequate control of the bleeding with the suction canula. The cement is placed within the defect without need for over-filling (Figs. 3 & 9), unlike what is often done with other types of bone substitutes like granules. Any material put in excess is always expelled or resorbed. With VitalOs, as the cement forms a block, a large quantity or even the whole material may be expelled. When the injected quantity is in large excess, the hardened block can easily break up and large pieces may be expelled out of the site. With granular materials it is only small granules that are expelled and this is less disturbing than pieces of cement. This is the reason why we never overfill sites with VitalOs. A suture is then made with a 5-0 nylon suturing material. No attempt is made to achieve primary suture over the implant (Figs. 4 & 10) because we observed that even when the cement remains exposed to the oral environment, the bacteriae cannot adhere onto the surface of VitalOs and therefore no infection develops. The implants with a large platform help to maintain the volume and anatomy of the gums because they act as a shape keeper for the gingiva. A post-operative radiograph is taken for each case 7 days after implantation. Tab. 1_Bone defect measurements (buccal dehiscence cases). _Immediate implantation in alveolus— Surgical protocol After administration of the local anesthetics (Scandicaine 2 %, Septodont), an intrasulcular incision was made around the root and a lateral one on the buccal side to provide access and allow visualization of the defect. The fractured roots were very carefully extracted to avoid increase of the bone loss. After curettage, the sites were prepared for the installation of the implant according to the manufacturer’s instructions. The bone defects were measured with a periodontal probe with millimeter Case Initial longitudinal measurement of the defect Initial mesiodistal distance of bone loss (at the ridge level) 2 mm 8 mm Initial area of bone lack in mm2 Longitudinal defect me asurement after 3 months % of area substituted by bone 1 2 12 mm 10 mm 82 132 2 mm 2 mm 95 97 implants 1 _ 2010 I 29