Geistlich - Indication sheets IIP-1 - Extraction Sockets | Page 6

13.6.2007 14:18 Uhr Seite 2 Indication Sheet IIP-1 Extraction Sockets 3.2b Clinical concept in the aesthetic region Immediate Implant Placement Remark: The patient’s perception of an aesthetic result may differ from the clinician’s perception. The commonly used classification of aesthetic requirements into high, medium and low lip line may not serve the patient’s needs. Our suggestion is to consider every anterior case an aesthetic case regardless of the lip line. Fig. 16 Tooth socket after the atraumatic extraction. Fig. 15 A hopeless first upper premolar. Fig. 20 “Intra-external grafting” (inside and outside of the socket) with small Bio-Oss® particles (0.25 – 1 mm cancellous granules). In our experience, this grafting prevents resorption of the buccal bone plate and a subsequent concavity in the aesthetic zone. The particles are covered with a Bio-Gide® membrane. Literature reference 1 Araujo MG, Sukekava F, Wennström JL, Lindhe J: Ridge alterations following implant placement in fresh extraction sockets: An experimental study in the dog. J Clin Periodontol 2005; 32:645-652. 2 Araujo MG, Sukekava F, Wennström JL, Lindhe J: Tissue modeling following implant placement in fresh extraction sockets. Clin. Oral Impl. Res. 17, 2006; 615-624. 3 Testori T, Bianchi F, Del Fabbro M, Capelli M, Zuffetti F, Berlucchi I, Taschieri S, Francetti L, Weinstein RL: Implant aesthetic score for evaluating the outcome: Immediate loading in the aesthetic zone. Pract Proced Aesthet Dent 2005;17:123-130. Contact Fig. 17 Implant direction pin parallel to the root of the adjacent premolar. Fig. 18 Frontal view, implant should be angled to the buccal side. This buccal angulation has two clinical advantages: firstly, it helps to avoid apical fenestration due to the natural morphology of the maxilla; secondly, it helps to achieve a correct emergence profile of the future crown if the implant platform is more buccally positioned. It is easier to create the correct prosthetic profile. > Dr. Tiziano Testori, MD, DDS, FICD, Via Rubini 22, 22100 Como, Italy phone: [phone], fax: [phone], e-mail: [email protected], web: www.implantologiaitalia.it > Dr. Matteo Capelli, DDS, Via Brera 28A, 20121 Milano, Italy phone: [phone], e-mail: [email protected] Treatment concept of Dr. Tiziano Testori and Dr. Matteo Capelli, I.R.C.C.S. Galeazzi Institute, University of Milan > Immediate implant placement after tooth extraction > Maintenance of the buccal bone plates with Bio-Oss® particles in the anterior and posterior region > Clinical concept for aesthetic and non-aesthetic region Fig. 19 Implant positioned with a 2 mm healing abutment. 31218.1/0706/e 58770 Testori IIP1 e.qxp Further indication sheets For free delivery please contact: www.geistlich.com/indicationsheets Fig. 21 Bio-Gide® membrane is placed over the healing abutment. The membrane is intentionally left exposed in order to avoid any secondary mucosal approximation and to increase the amount of keratinised periimplant mucosa in a single procedure. 1. Indication profile x aesthetic region Region Bony situation Fig. 23a Temporary prosthesis, vestibular view. Fig. 22 Healing of the peri-implant soft tissue after 3 months. Fig. 23b Temporary prosthesis, occlusal view. x no bone defect x Implant insertion Soft tissue situation x x x Bone augmentation indicated Prosthetic treatment Fig. 24b Definitive prosthesis, occlusal view. Fig. 24a Definitive prosthesis, vestibular view. 5 x x non-aesthetic region x small bone defect large bone defect comment: Bony gap between implant and socket walls, bone walls around socket are intact single tooth replacement multiple tooth replacement thick biotype thin biotype interdental papillae intact papillae compromised or missing primary wound closure possible primary wound closure problematic yes, immediately at time of implantation no depending on size of defect (between day 1 and 6 months) © Geistlich Pharma AG Division Biomaterials CH - 6110 Wolhusen, Switzerland phone +41- 41 - 49 25 -630 fax +41- 41 - 49 25 -639 www.geistlich.com Fig. 24c X-ray of the final prosthesis restored with the platform switching concept. 1 6