| |
 |
REGEN BIOCEMENT™ and the INVERTED PERIOSTEAL GRAFT™
for the regeneration of osseous defects around
dental implants in a smoker
patents pending |
The following series of photographs will outline the materials and methods to
regenerate failing implants in a smoker. The patient was counseled on the negative effects of
her smoking habit and the patent reported that she would not quit smoking. Significant probing defects were located on all implants. Probings on the mesial
surface of #14 implant were to the apex of the implant with possible sinus involvement.
Pre operative
radiograph showing osseous defects with alveolar loss to the apex of implant
#14.
Pre
operative periodontal probing. > indicates greater than 9 millimeters
Pre operative view of
buccal gingiva
Pre operative
view of palatal gingiva
Initial
incisions are sulcular with a split thickness flap only extended to allow for
access to the lesions. At this stage flap is only reflected to gain access to
the lesions. The flap has not been extended to expose the palatal periosteum
that will be inverted. The granulation tissue is now removed and the
implant surfaces are gently instrumented with a metal curette and treated with
saturated citric acid.
This photo shows
the root surfaces have been detoxified and the palatal flap has been extended to
expose the connective tissue that will serve as the lingual inverted periosteal
graft.
The buccal
flap is raised with sulcular incisions. The flap is full thickness to the
mucogingival junction where the periosteum begins. At the mucogingival junction
the flap becomes split thickness leaving the periosteum over the bone. This
photo shows the periosteum that will serve as the buccal inverted periosteal
graft.
At this point the
periosteum is incised at the apical extent of the flap and freed with a curette (a 13K works well for lifting off the
periosteum). The buccal and lingual
periosteal grafts are elevated to ensure they will cover the bone grafts and
suture interproximally. The bone graft material is LD hydroxyapatite mixed equal
volume with REGEN BIOCEMENT and wetted with HYDRASE. Any hard
particulate bone graft material should suffice for this procedure. The
preparation of the bone graft material begins prior to surgery. The
estimated amount of hard bone graft material is dispensed into a mixing bowl. HYDRASE is used as a wetting agent (click
here for more information on HYDRASE). Using a mixing bowl, wet
the hard particulate bone graft material with HYDRASE and allow to soak until
needed. When the bone graft site is prepared mix REGEN BIOCEMENT and the
particulate hard bone graft material in equal portions by volume. Add HYDRASE as needed to achieve a thick paste. Carry the bone graft/REGEN BIOCEMENT mix to the graft site, fill the
defects and shape the surface for any additional appositional bone regeneration
if needed. This surgery was successful using a particulate bone graft material,
however, currently we are only using REGEN BIOCEMENT wetted with HYDRASE and achieving equally
satisfactory results.
The
bone graft in place mixed with REGEN BIOCEMENT with the buccal periosteum
inverted over the bone graft prior to suturing to the lingual inverted
periosteal flap. The exposed bone shows the periosteal donor site.
The inverted
lingual periosteal flap is covering the bone graft material and
is sutured interproximally to the buccal periosteum.
Primary closure of the
palatal flap
Primary closure of the
buccal flap
One month
radiograph showing ossification of the periimplant defects.
Post operative probings
One month post
op palate
One month post
op buccal.
ARMAMENTARIUM
HYDRASE wetting agent
from STEINER LABORATORIES
low density hydroxyapatite
from Calcitec
REGEN BIOCEMENT from STEINER LABORATORIES
Saturated citric acid for implant conditioning
4-0 vicril sutures
5-0 plain gut suture 1/2"
needle
250 mg Amoxicillin and 250
mg metronidizole tid for 10 days
Peridex bid sans manual
oral hygiene for two weeks
The inverted periosteal
graft is the intellectual property of STEINER LABORATORIES. Anyone using any of
the STEINER LABORATORIES bone graft products during this surgery is granted licensee
rights to the procedure. |
|
|
|
