Geistlich - Indication sheets X3 - Failure Management - Page 3

Surgical Procedure: Implantoplasty + Regenerative Treatment (Class Ib)1, 4, 5, 6 Background information Soft Tissue Management: Collagen Matrix (Class Ib + II)1, 4, 5 PD Dr. Frank Schwarz: „On the basis of our own clinical studies, peri-implant bone defects may be divided into definable categories (3). In principle, one can distinguish an intraosseous (class I) from a supraalveolar (class II) defect component (see Fig 6, s (a)). The appropriate choice of the treatment concept depends on the appearance (or alternate: occurrence) of each defect component combination. The various treatment concepts are presented below.“ 2. Synopsis: Surgical Treatment of Peri-implantitis3, 7 Fig. 1 Baseline (implant regio 045): Thin mucosal biotype suppuration / BOP +. Ia Ib Fig. 1 Vestibular dehiscence Fig. 2 Vestibular dehiscence + semi-circumferential bone resorption Fig. 2 Clinical Situation at Baseline: Probing depth (PD): 6 mm suppuration / bleeding on probing (BOP) +. Fig. 3 Modified papilla preservation flap technique to access Class Ib defect configuration. Fig. 3 Vestibular dehiscence + circumferential bone resorption Fig. 6 Geistlich Bio-Gide® application (collagen membrane). Fig. 7 Clinical Situation at 12 months: PD: 2 mm suppuration / BOP –. Ie Fig. 4 Vestibular and oral dehiscence + circumferential bone resorption Fig. 5 Circumferential bone resorption II Fig. 7 The collagen matrix Geistlich Mucograft® is placed on top of the collagen membrane Geistlich Bio-Gide®. Fig. 8 Transmucosal wound healing (periand post-op administration of amoxicillin). Fig. 9 Undisturbed wound healing at suture removal (10 days). Fig. 10 Clinical Situation at 4 weeks. Fig. 11 Clinical Situation at 4 months: PD: 2mm suppuration / BOP–. Fig. 12 Clinical Situation at 8 months clearly indicating a clinically relevant gain in mucosal thickness. Fig. 6 Supracrestal exposure of structured implant parts Surgical Procedure: Implantoplasty + Regenerative Treatment (Control) (Class Ie + II) 1, 4, 5 2. Therapy: Clinical Procedure Decontamination In addition to the mechanical removal of the biofilm, a decontamination or conditioning of the exposed implant surface is necessary to optimise the removal of bacteria and lipopolysaccharides from the microstructured implant surface. For this purpose, sterile saline-soaked cotton pellets may be used to clean the exposed implant surface. Clinical data support the effectiveness of this procedure. 7 Fig. 6 Collagen matrix Geistlich Mucograft® – to compensate for the thin mucosal biotype. Fig. 8 Radiographic bone gain at 12 months. Surgical Procedure: Implantoplasty + Regenerative Treatment (Class Ic)1, 4, 5, 6 Id Fig. 4 Intrabony defect component (i.e. class Ib) using Geistlich Bio-Oss® (0.25–1 mm). Fig. 4 Implantoplasty to smoothen exposed (i.e. vestibular aspect) implant parts. Ic Fig. 5 Augmentation of the defect component (Class Ib) using Geistlich Bio-Oss® (0.25–1 mm). Fig. 3 Implantoplasty at the supracrestal component. Fig. 5 G eistlich Bio-Gide® application according to the „double-layer“ technique. Fig. 1 Funnel-form bone loss at implant regio 022. Fig. 2 Combined Class Ib + II defect configuration. Implantoplasty Remodelling of exposed implant parts by removal of the affected surface region using diamond abrasives. Depending on the defect component, this procedure may lead to reduced bacterial plaque deposits and promote the formation of fibrous connective tissue.7 This procedure is indicated for supracrestal (class II), and vestibularoral exposed implant regions without bony support (i.e. class Ia-Id).2, 6 Augmentation + GBR An augmentation and GBR should only be carried out in connection with an intraosseous defect component. In analogy to systematic periodontal therapy, regenerative therapy should be only considered after successful pre-treatment and when symptoms associated with acute inflammation have subsided. Fig. 1 Patelliform bone loss at implant regio 013. Fig. 2 Clinical Situation at Baseline: PD: 6 mm suppuration / BOP +. Fig. 3 Class Ic defect configuration. Fig. 4 A minor class Ia defect plus class Ic component. Fig. 1 Patelliform + supracrestal bone loss at implants regio 024 and 025. Fig. 9 Situation at suture removal indicating a slight exposure of the collagen membrane (should be managed by local antiseptic therapy, i.e. chlorhexidine gel for 10 days). 2 Fig. 6 Class Ic defect component using Geistlich Bio-Oss® (0.25–1 mm). Fig. 10 Clinical Situation at 12 months: PD: 2 mm suppuration / BOP –. 3 Fig. 7 „Double-layer“ membrane technique at both vestibular and lingual aspects. Fig. 11 Radiographic bone gain at 6 months. Fig. 3 Both implants revealed clinical signs of suppuration. Fig. 4 Combined Class Ie and Class II defect configurations. Fig. 5 Implantoplasty to smoothen exposed supracrestal implant parts. Fig. 5 Implantoplasty to smoothen exposed implant parts. Fig. 2 Fistula 025. Fig. 6 Augmentation of the intrabony defect component plus contour augmentation. Fig. 7 „Double-layer“ membrane technique at both vestibular and lingual aspects. Fig. 8 Transmucosal wound healing (periand post-op administration of amoxicillin). Fig. 9 Implant 024 – Clinical Situation at 12 months: PD: 2 mm suppuration / BOP–. Fig. 10 Implant 025 – Clinical Situation at 12 months: PD: 3 mm suppuration / BOP–. Fig. 11 Radiographic bone gain at 12 months. Fig. 8 Transmucosal wound healing. Fig. 12 Radiographic bone gain at 12 months. 4