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:
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:
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.
Tension-free primary closure through correct management of the lingual and vestibular flaps and appropriate periosteal incisions, together with the application of simple horizontal mattress sutures.
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 19.
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."
Dr. David González Spain 
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