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Treatment Solutions
- 2-Stage Implant Placement(3)
- Gain of Keratinized Tissue(1)
- GBR Procedure(3)
- Peri-Implantitis Therapy(2)
- Recession Coverage(4)
- Ridge Preservation(5)
- Sinus Floor Elevation(2)
- Soft Tissue Thickening(7)
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Found 24 Results

Andrea Ravidà, DDS, MS, PhD
Anu Viswanathan DDS, MDS

Prosthetic-Surgical Approach to Regenerative Treatment for Peri-Implantitis

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Clinical presentation of tooth #31 showing radiographic evidence of bone loss, profuse bleeding on probing (BOP), deep probing depths, and suppuration, indicative of peri-implantitis with a Class I-infraosseous (c) circumferential-type defect, as described in the study by Monje et al. (2019) Clin Implant Relat Res, 21(4)635-643.

Crown removal by the prosthodontist, followed by placement of a healing abutment for non-surgical therapy using PerioFlow®. After therapy, a cover screw was placed, and the tissue was allowed to heal over the implant for eight weeks.

Surgical treatment initiated with a midcrestal incision and full-thickness flap elevation. Granulation tissue was removed using a surgical curette, revealing a deep infrabony defect.

Implant thoroughly decontaminated using Perioflow® with erythritol powder to ensure a clean surface for regeneration.

rhPDGF-BB was used to hydrate bone grafting materials (vallos® Demineralized Cortical Granules and Geistlich Bio-Oss®), which were first hydrated with sterile water before rhPDGF-BB was added. The materials were mixed in a 1:1 ratio and allowed to sit for 10 minutes before being applied to the deep infrabony defect to promote regeneration.

Flap closed primarily with 5-0 PTFE horizontal mattress and single interrupted suture for secure closure.

Collagen membrane stabilized with 5-0 chromic gut sutures using the lasso technique.

After 5 months of healing, significant bone gain is evident. Geistlich Bio-Oss® was placed on the buccal site to enhance thickness, covered with an amnion-chorion membrane. A healing abutment was placed at this stage.

Two-year follow-up shows disease resolution with shallow probing depths, no bleeding or suppuration, and complete bone gain. A new crown was fabricated with an increased final abutment height (>2mm), contributing to optimal maintenance and long-term stability based on evidence supporting its role in promoting long-term success. A second surgery may be necessary to gain additional tissue thickness or cover residual thread exposure to achieve the desired long-term results.

Baseline Radiograph

Flap reflection showing the defect tooth #30

Defect dimensions from the lingual aspect

Defect filled and graft is extended beyond margins, 1-2mm on the buccal aspect

Suturing with 5/0 polypropylene sutures. Primary closure is attained.

Radiograph 1-year post-op showing almost complete bone fill

Flap reflection showing defect on the mesial and distal of central incisor (#25)

Flap reflection showing 6mm deep infrabony one wall defect on tooth #25

Regenerative treatment: Allograft + rhPDGF-BB

Amnion/chorion membrane used to cover the graft

Polypropylene 6-0 used for suture placement

At 7 months, pocket depth reduced to 3 mm, with 90% bone fill and 3mm attachment gain. Patient had no mobility due to splinting and good compliance.

Pre‑operative occlusal photograph of the maxillary arch showing a pronounced Seibert Class III ridge deformity, with simultaneous horizontal and vertical soft and hard tissue loss in the edentulous area.

Intraoperative view following reflection of full‑thickness flaps, revealing a pronounced combined horizontal and vertical ridge deficiency.

Upper left view showing the mixture of large-particle vallos® allograft, demineralized cortical granules, and large-particle Geistlich Bio-Oss® xenograft, combined with rhPDGF-BB, a component of GEM 21S®.

Upper right view showing the mixture of large-particle vallos® allograft, demineralized cortical granules, and large-particle Geistlich Bio-Oss® xenograft, combined with rhPDGF-BB, a component of GEM21S®.

Closure of the maxilla was achieved using a PTFE barrier membrane and 4‑0 PTFE sutures. Horizontal mattress sutures were placed to provide initial tension relief and flap stabilization, while simple interrupted sutures were used for precise approximation of the wound margins.

Six‑month postoperative CBCT images with virtual implant planning reveal sites #5, 7, 10, and 12, exhibiting 5–7 mm of horizontal ridge augmentation and 3–4 mm of vertical ridge augmentation.

Intraoperative view demonstrating vertical and horizontal ridge augmentation at 7 months following the initial augmentation procedure.

A 4.3 × 8 mm tapered implant with crestal sinus elevation was placed at site #5, and a 4.3 × 10 mm tapered implant was placed at site #7.

(Left) A 4.3 × 10 mm implant was inserted at the site. (Right) Placement of a 4.3 × 10 mm implant in conjunction with a crestal sinus elevation.

Preoperative view showing the anterior maxillary defect with loss of #6 and #7; #5 and #8 are planned to be extracted because of severe mobility and advanced bone loss.

Full-thickness mucoperiosteal flap elevation revealing a vertically and horizontally deficient ridge in the #5–8 region, prepared for augmentation.

Adaptation and fixation of two allogenic cortical bone plates to the native ridge using micro screws to create a “box” configuration for vertical bone augmentation. The box between and around the plates is packed with vallos® mineralized cortico-cancellous granules mixed with rhPDGF-BB component of GEM 21S®, completing the three-dimensional reconstruction of the defect.

Immediate closure with PTFE sutures providing tension-free primary closure over the augmented site.

Site at five months post-op.

Re-entry after healing demonstrating well integrated cortical plates and a vertically augmented ridge suitable for implant placement.

Occlusal view showing well integrated particulate bone at relatively early stage.

Placement of two implants into the regenerat ed ridge, with a regular diameter implant anteriorly and a wide diameter implant posteriorly.

Geistlich Mucograft® is layed on top of the implants before flap closure to improve the tissue phenotype.

Flap closure

Occlusal view after the second stage for implant uncovery with Geistlich Fibro-Gide® left between the flap intentionally slightly exposed. Due to volume stability of Geistlich Fibro-Gide®, it aids in maintaining tissue verticality during healing.

Occlusal view after 2 weeks of the second stage showing excellent healing of Geistlich Fibro-Gide® with secondary intention with traces of keratinzed tissue forming between wound edges. Both healing abutments were replaced with bigger sizes to aid with tissue contouring before final restoration.

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