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Clinical Case: NeoGen® PTFE Membran

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

  • 3
    Figure 1.

    Radiographic view of the failing implant-supported restoration at 22 and 23.

  • 1
    Figure 2.

    Clinical view of the failing implant-supported restoration at 22 and 23.

  • 2
    Figure 3.

    Observe the papilla loss between them and the gingival recession at distal aspect of 21.

  • 4
    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.

  • 5
    Figure 5.

    Intrasurgical view of the 3D bone loss showing a 7 mm vertical defect.

  • 6
    Figure 6.

    Bone harvesting from both mandibular external oblique lines.

  • 7
    Figure 7.

    Fixation of the NeoGen® membrane at palatal aspect.

  • 8
    Figure 8.

    100% autogenous bone graft.

  • 9
    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.

  • 10
    Figure 10.

    Surgical suture closure.

  • 11
    Figure 11.

    Reentry 1 year after surgery.

  • 12
    Figure 12.

    Complete vertical bone regeneration

  • 13
    Figure 13.

    Implant placed at 23 level to support 2 crowns (22 will be a cantilever).

  • 14
    Figure 14.

    Connective tissue graft folded and adapted to the distal aspect of 21 to reconstruct the papilla.

  • 15
    Figure 15.

    Connective tissue graft folded and adapted to the distal aspect of 21 to reconstruct the papilla.

  • 16
    Figure 16.

    Aspect 2 months later. The mucogingival line is displaced coronally and a surgery to reposition it is mandatory.

  • 17
    Figure 17.

    Free Connective tissue graft to reposition the mucogingival line.

  • 18
    Figure 18.

    Final prosthesis 6 years after loading.

  • 19
    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."

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