5 Years Followup
Case History:
42 years old male patient, who has got no systemic diseases and smokes 5-10 cigarettes a day, referred to our clinic for treatment of congenitally missing premolar tooth. In the first phase, initial periodontal therapy was performed. After clinical examination and cbct analyses, implant placement and simutaneous guided bone regeneration therapy with using allogenic bone substitudes and autogenous bone particles, was planned.(Picture 1,2)
Flap elevation was done with midcrestal and vertical incisions (Picture 3,4). In the process of drilling a fenestration defect was formed on vestibular crestal bone as expected. A 3,3mm width and 13mm length implant was placed with 35Ncm insertion torque and a 3mm fenestration defect was formed in vestibular crestal bone (Picture 4). The defect was augmented by a mixture of allogenic bone substitude and autogenous bone. Also collagenous membrane was used for barrier and fixed with membrane pins (Picture 5). Flap closed primarily with single sutures (Picture 6). No early surgical complication was occured and 10 days later sutures were removed.
We waited for 3 months for osseointegration period. After uneventful osseointegration period gingival former was placed (Picture 7). A cemented, metal supported porcelain crown was delivered (Picture 8). In control radiograph no incidence of bone resorbsion was seen (Picture 9).
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Discussion:
Guided bone regeneration is a well-established technique used for augmentation of deficient alveolar ridges with using membranes or not (1).4 major biologic principles necessary for predictable bone regeneration: primary wound closure to ensure undisturbed and uninterrupted wound healing, angiogenesis to provide necessary blood supply and undifferentiated mesenchymal cells, space maintenance/creation to facilitate adequate space for bone ingrowth, and stability of wound and implant to induce blood clot formation and uneventful healing events (2). In this case we tried to maintain 4 basic principle.
3 mechanism play role in bone regeneration: osseogenesis, osseinduction, osseoconduction. Many different graft materials may induce these mechanism in different proportions. While Autogenous bone has both osseogenesis, osseinduction, osseoconduction characteristics, allografts has osseinduction, osseoconduction and alloplasts has only osseoconduction characteristic. In this case, we used three of characteristics of autogenous bone, and osseoconduction characteristics of allograft material.
Barrier membrane was used for proper guided bone regeneration. sseogenesis, osseinduction, osseoconduction. Collagenous membrane was used for this purpose. Using barrier membranes in bony defects around implants is well documented procedure and collagenous membranes were reviewed as more user-friendly materials than nonresorbable membranes.Also it was concluded that fixation of membrane may represent more predictable healing (3).