
3D GBR for the treatment of bone atrophy on the Esthetic Zone
using a PTFE, Ti-reinforced NeoGen® membrane and 100% autogenous bone.
Dr. David González
DDS, M.Sc, PhD Master in Periodontics EFP and PhD Doctor at Complutense University of Madrid.
Private practice at Clínica Ortoperio in Murcia, Spain.
Facts
Patient:
21 years old woman, non-smoker, medically healthy.
Clinical problem:
Patient presented a severe periimplantitis at 22 and 23 with no papilla and a gingival recession between them and a papilla loss at distal aspect of tooth 21. Aesthetic was severely affected since the patient gad gummy smile.
Clinical solution:
Explantation and Guided Bone Regeneration using a PTFE, Ti-reinforced NeoGen® membrane and 100% autogenous bone.
Treatment plan:
- Explantation of implants at 22 and 23.
- 3 months later: (which turned out to be 2 years later because the patients was treated and failed elsewhere): 3D guided bone regeneration using 100% autogenous bone and a PTFE, Ti-reinforced NeoGen® membrane which was fixed by Neoss Tacks.
- 1 year later: Reentry and implant placement at 23 + connective tissue graft to solve the papilla loss at distal aspect of tooth 21.
- 2 months later: Free connective tissue to reposition the mucogingival line.
- 2 months later: 2nd surgical phase and temporary restoration.
- 2 years later: Final prosthesis.
- 4 years later: Clinical and Radiographic Evolution of the Aesthetic Zone.
Products:
1 NeoGen Ti-Reinforced PTFE Membrane.
Conclusion:
3D guided bone regeneration using an e-PTFE, Ti-reinforced NeoGen® membrane and 100% autogenous bone is a fully predictable treatment for the severe hard and soft tissue atrophy on the Aesthetic Zone. This statement is supported not only by panoramic and periapical x-rays, but also by CBCT sectional cuts where we can see the complete stability of the regenerated bone.
step by step
step by step
-
Figure 1.
Radiographic view of the failing implant-supported restoration at 22 and 23.
-
Figure 2.
Clinical view of the failing implant-supported restoration at 22 and 23.
-
Figure 3.
Observe the papilla loss between them and the gingival recession at distal aspect of 21.
-
Figure 4.
Clinical view of the alveolar ridge 2 years after explantation. The patient was treated elsewhere and failed. Observe the increase of the gingival recession at distal aspect of 21 and the presence of scars.
-
Figure 5.
Intrasurgical view of the 3D bone loss showing a 7 mm vertical defect.
-
Figure 6.
Bone harvesting from both mandibular external oblique lines.
-
Figure 7.
Fixation of the NeoGen® membrane at palatal aspect.
-
Figure 8.
100% autogenous bone graft.
-
Figure 9.
Membrane fixed by Tacks. Observe that the coronal placement of the membrane is at the same level as the inter proximal bone peaks.
-
Figure 10.
Surgical suture closure.
-
Figure 11.
Reentry 1 year after surgery.
-
Figure 12.
Complete vertical bone regeneration
-
Figure 13.
Implant placed at 23 level to support 2 crowns (22 will be a cantilever).
-
Figure 14.
Connective tissue graft folded and adapted to the distal aspect of 21 to reconstruct the papilla.
-
Figure 15.
Connective tissue graft folded and adapted to the distal aspect of 21 to reconstruct the papilla.
-
Figure 16.
Aspect 2 months later. The mucogingival line is displaced coronally and a surgery to reposition it is mandatory.
-
Figure 17.
Free Connective tissue graft to reposition the mucogingival line.
-
Figure 18.
Final prosthesis 6 years after loading.
-
Figure 18.
Sagital view of the implant (CBCT). Observe the stability of the bone at vertical and horizontal aspect.
"After 28 years using PTFE membranes for GBR I strongly believe that hybrid (dense and expanded) NeoGen® membranes are the best since they have a perfect combination of malleability and resistance due to the soft, easy to shape but strong titanium mesh. I dominate other regenerative techniques but no doubt that my first choice for regeneration of 3D bone defects is NeoGen® membranes."
Downloads
Downloads
-
Regenerative Materialien