Background information
Georgios Nikou, Peter Thoolen, Anton Sculean:
«When a tooth is lost and an implant is planned for replacing the tooth, the
amount of available alveolar ridge is an important factor. Inadequate bone height
and width may compromise the implant placement and jeopardize the aesthetic
outcome. Therefore augmenting ridge defects will allow for proper implant
placement. In case an implant is placed in a defective ridge, additional augmentation will be necessary in order to improve the aesthetic appearance.
For implant-supported restorations an adequate zone of attached gingiva or
thickened tissue is desirable to avoid complications such as mechanical tissue
trauma, inflammation and poor aesthetics. In recessions around implants as
presented here, a connective tissue graft as described by Azzi et al. (1) corrects
the mucogingival deficiencies by thickening the existing mucosa and creating a
collagenous collar around implants to enhance the soft tissue restoration at the
implant surface.»
Fig. 4 Decontamination of the implant surface by means of topical application of
tetracycline, according to a case series of
Mellonig et al. (3).
Fig. 5 Perforation of the cortical bone will
allow for easier access of desired cells from
the bone marrow presumably leading to a
higher rate of bone regeneration according
to Hämmerle (4).
Fig. 6 Application of Bio-Oss® granules.
Fig. 7 Bio-Gide® membrane application in
order to hold the granules in place and
prevent soft tissue in-growth.
Fig. 8 Connective tissue graft applied above
the membrane in order to increase the width
of the soft tissue and improve the aesthetic
appearance. The graft has been harvested
from the left side of the palate at the region
mesial to 26 and 6 mm from the gingival
margin. The length of the graft is 15 mm,
the width 8 mm and the thickness 2 mm
approximately.
Fig. 9 Suturing of the flap in coronal position after mobilizing the soft tissue with
periosteal incisions. The suture material is
non-resorbable ePTFE (Gore-Tex®). Horizontal mattress sutures are used to release
tension and interrupted single sutures are
used on the margins.
Fig. 10 Situation after 6 months healing:
adequate soft tissue has been created clinically (A) while almost no radiolucency is
visible radiographically anymore (B).
Fig. 11 The Modified Roll Technique, as described by Scharf & Tarnow (5), is used for
healing abutment placement during the
second stage in order to additionally improve the soft tissue condition. The healing
abutment and sutures are then placed.
Fig. 12 Healing abutment positioning and
suturing
Fig. 13 Clinical view 1 year after surgery.
The final restoration is already cemented.
Fig. 14 Radiographic appearance 1 year
after surgery.
Fig. 15 Profile appearance of the treated
region after hard and soft tissue augmentation. The profile shows considerable width.
2. Aims of the therapy
> Lateral ridge augmentation to improve peri-implant osseous condition, restore the
deformed ridge and build up the hard tissue basis for adequate soft tissue (‹soft
tissue follows hard tissue›).
> Soft tissue augmentation with connective tissue graft to achieve adequate soft
tissue thickness.
3. Concept of Georgios Nikou, Peter Thoolen & Anton Sculean
> Lateral ridge augmentation using Bio-Oss® and Bio-Gide® and soft tissue augmentation with connective tissue graft.
A
B
4. Surgical procedure
> Case: A 38 year old patient was referred to the department of Periodontology &
Biomaterials for treatment due to unaesthetic appearance of the tooth restoration
in the region of 21.
Suspected reasons for failure: The implant has been placed into an i