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Clinical Case: NeoGen® PTFE Membrane and Neoss ProActive® Implant

Simultaneous-to-Implant placement GBR

for the treatment of a severe bone dehiscence on the Esthetic Zone using a PTFE, Ti-reinforced NeoGen® membrane and 100% autogenous bone and a Neoss ProActive® Implant.

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:

28 years old woman, ex-smoker, medically healthy.

 
 
 
Clinical problem:

Patient presented a hopeless 21 (actually the tooth was loose, attached by composite to the adjacent teeth) and although being spaniard caucasian she had a severe melanosis and gummy smile.

 
 
 
Clinical solution:

To treat a severe bone dehiscence in the esthetic zone, simultaneous implant placement with guided bone regeneration (GBR) was performed using a titanium-reinforced NeoGen® PTFE membrane, 100% autogenous bone, and a Neoss ProAcitve® implant. 

 
 
 
 
Treatment plan:
  • Extraction of 21. Socket preservation using Xenograft (anorganic bovine hydroxylapatite-collagen), non cross-link collagen membrane and connective tissue graft.
  • 9 months later: after seeing by a CBCT that no bone augmentation was gained a Simultaneous-to-implant placement GBR procedure to regenerate a severe bone dehiscence.
  • 100% autogenous bone was used as a filling material. It was evident that due to the CTG from the palate (where there was no melanosis) the appearance of the gingiva was less pigmented.
  • 9 months later: Reentry was carried out, removing the membrane, connecting an 8 mm healing abutment and placing a “poncho” connective tissue graft from the palate.
  • 3 months later: A screw-retained zirconia-porcelane crown was delivered and a general peeling at both upper and lower gingiva was carried out.
Products:

1 NeoGen® Ti-Reinforced PTFE Membrane.
1 Neoss ProActive® Implant 4.5 mm x 13 mm 

 
Conclusion:

After 5 years of implant-supported screw-retained crown delivery hard and soft tissue stability was observed and an esthetic appearance was achieved.

Simultaneous-to-Implant placement GBR using a PTFE, Ti-reinforced NeoGen® membrane and 100% autogenous bone is a fully predictable treatment for the severe bone dehiscenceon the Aesthetic Zone. This statement is supported clinical exam and periapical x-ray.

Step by step

Step by step

Figure 1.
Figure 1.
Clinical view of the hopeless 21, which is only attached to the adjacent teeth by composite. Observe the severe melanosis that the patient showed although she was a caucasian spaniard.
Figure 2.
Figure 2.
After extraction and debridement of all soft tissue remaining a full thickness “envelope” was created.
Figure 3.
Figure 3.
After extraction and debridement of all soft tissue remaining a full thickness “envelope” was created.
Figure 4.
Figure 4.
Socket preservation using Xenograft (anorganic bovine hydroxylapatite-collagen) was placed and strongly condense inside the defect.
Figure 5.
Figure 5.
Socket preservation using Xenograft (anorganic bovine hydroxylapatite-collagen) was placed and strongly condense inside the defect.
Figure 6.
Figure 6.
A non cross-link collagen membrane was placed inside the contours of the defect covering the whole bone xenograft and stretching through the envelope.
Figure 7.
Figure 7.

A connective tissue graft was harvested from the palate and placed inside the defect ad modum “saddle” from the buccal aspect through the exposed coronal part to the palatal aspect.

Figure 8.
Figure 8.

A connective tissue graft was harvested from the palate and placed inside the defect ad modum “saddle” from the buccal aspect through the exposed coronal part to the palatal aspect.

Figure 9.
Figure 9.
1 week later it was evident healing was uneventful.
Figure 10.
Figure 10.
9 months later: after taking a CBCT was evident that no bone gain was achieved but soft tissue status was improved due to the CTG. It was also evident that due to the lack of melanosis at the palate, the CTG which generated a new keratinised epithelium showed no melanosis at the grafted area.
Figure 11.
Figure 11.
After raising a full thickness flap an atrophic ridge was disclosed.
Figure 12.
Figure 12.
A Neoss ProActive® Implant 4.5 mm x 13 mm was placed.
Figure 13.
Figure 13.
Optimal 3D position of the implant resulted in a severe dehiscence. The treatment of such dehiscences is not predictable using resorbable collagen membranes so in such cases is mandatory the use of non-resorbable PTFE membranes.
Figure 14.
Figure 14.
Optimal 3D position of the implant resulted in a severe dehiscence. The treatment of such dehiscences is not predictable using resorbable collagen membranes so in such cases is mandatory the use of non-resorbable PTFE membranes.
Figure 15.
Figure 15.
Autogenous bone graft was harvested from the adjacent area using a bone scraper.
Figure 16.
Figure 16.
After placing a 2 mm healing abutment, 100% autogenous bone was condensed to cover completely the implant surface.
Figure 17.
Figure 17.
A non-resorbable, Ti-reinforced NeoGen® membrane was placed covering the whole graft and fixed by tacks at buccal aspect and by a mattress suture at the palatal flap.
Figure 18.
Figure 18.
Non-tension, primary closure was achieved.
Figure 19.
Figure 19.
9 months later. Reentry was done. Notice the color of the anterior gingival. Melanosis was less evident.
Figure 20.
Figure 20.
After removing the membrane, complete bone regeneration was observed even covering the 2 mm healing abutment showing bone 2 mm vertical overgrowth.
Figure 21.
Figure 21.

A connective tissue graft was placed ad modum “poncho” around a 8 mm healing abutment.

Figure 22.
Figure 22.
Interrupted sutures.
Figure 23.
Figure 23.
Clinical status of the implant-supported restoration 5 years after crown delivery. Notice the complete resolution of the melanosis without signs of recidive after a peeling that was made right after crown placement.
Figure 24.
Figure 24.
X-ray image.
"Neoss ProActive® implant and NeoGen® non-resorbable, Ti-reinforced membrane is an excellent choice for the treatment of atrophic alveolar bone ridge on the aesthetic zone. The solution of bone dehiscences after implant placement by simultaneous GBR by using this protocol is fully predictable.
Dr. David González Spain
Dr. David González Spain

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