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Product: Geistlich Bio-Oss Collagen®
BIOBRIEF
Phenotype Conversion Using Geistlich Fibro-Gide® for Immediate Implants in the Esthetic Zone
THE SITUATION
A healthy non-smoking 50-year-old female patient who desires a single tooth solution to replace a non-restorable tooth, #12. A root fracture at the level of the palatal post was diagnosed in a root canaled tooth. Maintaining esthetics of the adjacent teeth is important as they are also restored with single full coverage porcelain crowns. Lastly, treatment time reduction and a minimally invasive surgical technique are desired by the patient for reduced downtime and post-operative morbidity.
THE RISK PROFILE
Low Risk | Medium Risk | High Risk | |
---|---|---|---|
Patient’s health | Intact immune system | Light smoker | Impaired immune system |
Patient’s esthetic requirements | Low | Medium | High |
Height of smile line | Low | Medium | High |
Gingival biotype | Thick – “low scalloped” | Medium – “medium scalloped” | Thin – “high scalloped” |
Shape of dental crowns | Rectangular | Triangular | |
Infection at implant sight | None | Chronic | Acute |
Bone height at adjacent tooth site | ≤ 5 mm from contact point | 5.5 – 6.5 mm from contact point | ≥ 7 mm from contact point |
Restorative status of adjacent tooth | Intact | Restored | |
Width of tooth gap | 1 tooth (≥ 7 mm) | 1 tooth (≤ 7 mm) | 2 teeth or more |
Soft-tissue anatomy | Intact | Compromised | |
Bone anatomy of the alveolar ridge | No defect | Horizontal defect | Vertical defect |
Facial Bone Wall Phenotype: High Risk (<1mm)
Esthetic Risk Profile (ERP) = Medium (summary of above)
THE APPROACH
A minimally invasive surgical removal of tooth #12 with maintenance of the buccal plate and leaving a 3mm buccal gap. The implant will be placed one mm below the level of the intact buccal plate with an anatomically correct surgical guide template to provide for a screw-retained solution. The gap will be filled with Geistlich Bio-Oss Collagen® to maintain the bone buccal to the implant, and a palate free approach utilizing Geistlich Fibro-Gide® for soft tissue thickening to accomplish “phenotype conversion.” The long-term surgical goal is >2-3mm thickness of both hard and soft tissue buccal to the implant.
THE OUTCOME
Minimally invasive surgery for buccal wall maintenance, virtually planning the buccal gap and implant width, using a xenograft in the buccal gap with phenotype conversion using a volume stable collagen matrix in conjuction with immediate contour management, allows for the best chance for papillae fill interproximally and maintenance of the mid-buccal gingival margin long-term.
Dr. Robert A. Levine
Robert A. Levine DDS is a board-certified periodontist at the Pennsylvania Center for Dental Implants and Periodontics in Philadelphia. He is a Fellow of the International Team for Dental Implantology (ITI), College of Physicians in Philadelphia, International Society of Periodontal Plastic Surgeons and the Academy of Osseointegration. He has post-graduate periodontology and implantology teaching appointments at Temple University in Philadelphia, UNC in Chapel Hill and UIC in Chicago and has over 80 scientific publications.
BIOBRIEF
Bone Augmentation L-Shape Technique with Early Implant Placement
THE SITUATION
The patient presented to the clinic with a discolored tooth #8, with mobility and a history of trauma. The tooth has a horizontal fracture in the apical third of the root and has recurrent infection after the root canal treatment. The patient feels discomfort and dislikes his esthetic appearance. He would like the fractured tooth #8 removed and replaced with a fixed solution.
THE RISK PROFILE
Low Risk | Medium Risk | High Risk | |
---|---|---|---|
Patient’s health | Intact immune system | Light smoker | Impaired immune system |
Patient’s esthetic requirements | Low | Medium | High |
Height of smile line | Low | Medium | High |
Gingival biotype | Thick – “low scalloped” | Medium – “medium scalloped” | Thin – “high scalloped” |
Shape of dental crowns | Rectangular | Triangular | |
Infection at implant sight | None | Chronic | Acute |
Bone height at adjacent tooth site | ≤ 5 mm from contact point | 5.5 – 6.5 mm from contact point | ≥ 7 mm from contact point |
Restorative status of adjacent tooth | Intact | Restored | |
Width of tooth gap | 1 tooth (≥ 7 mm) | 1 tooth (≤ 7 mm) | 2 teeth or more |
Soft-tissue anatomy | Intact | Compromised | |
Bone anatomy of the alveolar ridge | No defect | Horizontal defect | Vertical defect |
THE APPROACH
To carefully extract tooth #8 and to replace it with an early-stage implant placed with simultaneous guided bone regeneration through the use of Geistlich Bio-Oss Collagen® trimmed in an “L-Shape” under the protection of a Geistlich Bio-Gide® membrane. To augment the peri-implant soft-tissue with the use of a connective tissue graft during implant healing time, increasing the overall volume of site #8. To provisionalize the implant for the development of a proper emergence profile. To deliver a definitive reconstruction which is functional and esthetic for the patient.
THE OUTCOME
The implant and its prosthetic reconstruction were successful because they provided the patient with a fixed solution with adequate function and esthetics. The implant shows stable marginal bone levels due to the proper implant placement together with the guided bone regeneration procedure. The peri-implant soft-tissue is healthy and stable with sufficient volume created by the soft-tissue augmentation. The definitive reconstruction meets the patient’s esthetic demands and is functional in occlusion.
Prof. Dr. Ronald E. Jung
Prof. Dr. Jung is currently Head of the Division of Implantology, Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine at the University of Zürich. In 2006 he worked as Visiting Associate Professor at the Department of Periodontics at the University of Texas Heath Science center at San Antonio, USA (Chairman: Prof. D. Cochran). In 2008 he finalized his “Habilitation” (venia legendi) in dental medicine and was appointed associate professor at the University of Zürich. In 2011 he received his PhD degree from the University of Amsterdam, ACTA dental school, The Netherlands. He is an accomplished and internationally renowned lecturer and researcher, best known for his work in the field of hard- and soft-tissue management and his research on new technologies in implant dentistry.
BIOBRIEF
Ridge Augmentation and Delayed Implant Placement on an Upper Lateral Incisor
THE SITUATION
An adult female patient presented with an endodontic/prosthetic failure on the maxillary left lateral incisor. The patient‘s request was to have a definitive implant-supported single crown. The clinical situation revealed recession of the free gingival margin, while the CBCT evaluation showed the missing buccal bone plate, which contra-indicated an immediate implant placement. The treatment plan included a staged approach with a ridge augmentation procedure at the time of tooth extraction, in order to recreate the buccal bone plate and reduce the gingival recession. By moving the free gingival margin, keratinized tissue was gained through an open-healing approach.
THE RISK PROFILE
Low Risk | Medium Risk | High Risk | |
---|---|---|---|
Patient’s health | Intact immune system Non-smoker | Light smoker | Impaired immune system |
Patient’s esthetic requirements | Low | Medium | High |
Height of smile line | Low | Medium | High |
Gingival biotype | Thick – “low scalloped” | Medium – “medium scalloped” | Thin – “high scalloped” |
Shape of dental crowns | Rectangular | Triangular | |
Infection at implant sight | None | Chronic | Acute |
Bone height at adjacent tooth site | ≤ 5 mm from contact point | 5.5 – 6.5 mm from contact point | ≥ 7 mm from contact point |
Restorative status of adjacent tooth | Intact | Restored | |
Width of tooth gap | 1 tooth (≥ 7 mm) | 1 tooth (≤ 7 mm) | 2 teeth or more |
Soft-tissue anatomy | Intact | Compromised | |
Bone anatomy of the alveolar ridge | No defect | Horizontal defect | Vertical defect |
THE APPROACH
The treatment goals were to improve the soft-tissue levels and regenerate the buccal bone plate. After performing a flapless extraction procedure, a specifically designed resorbable bilayer collagen membrane, Geistlich Bio-Gide® Shape, was inserted into the socket with the long wing in contact with the buccal surface and the smooth, compact upper layer facing outward. The alveolus was then grafted with Geistlich Bio-Oss Collagen®. The three smaller wings of the membrane were folded on top of the graft material and sutured to the surrounding soft-tissue, allowing for open-healing.
THE OUTCOME
This case demonstrates how it is possible to improve the clinical and esthetic situation that was presented at baseline. Despite missing the buccal bone plate and the recession of the free gingival margin, the ridge augmentation procedure performed with the combination of Geistlich Bio-Gide® Shape and Geistlich Bio-Oss Collagen® was able to create a positive volume of the ridge, allowing for a prosthetically guided implant placement.
Dr. Daniele Cardaropoli
Periodontist – PRoED, Institute for Professional Education in Dentistry, Torino
Doctor of Dentistry and Certificate in Periodontology from the University of Torino, Italy.
Active member of the Italian Society of Periodontology, European Federation of Periodontology, Italian Academy of osseointegration and Academy of osseointegration. International member of the American Academy of Periodontology. Scientific Director of Institute for Professional Education in Dentistry (PRoED), Torino. Member of the Editorial Board of The International Journal of Periodontics and Restorative Dentistry. Private practice in Torino, Italy.
BIOBRIEF
Immediate Mandibular Molar Transition
THE SITUATION
The case here is typical enough, a failing mandibular molar with a vertical sub-osseous fracture. Traditionally, the replacement process can take three or more surgical exposures (extraction and regeneration), (implant placement), (second stage exposure) and more than a year of therapy.
THE RISK PROFILE
Low Risk | Medium Risk | High Risk | |
---|---|---|---|
Patient’s health | Intact immune system Non-smoker | Light smoker | Impaired immune system |
Patient’s esthetic requirements | Low | Medium | High |
Height of smile line | Low | Medium | High |
Gingival biotype | Thick – “low scalloped” | Medium – “medium scalloped” | Thin – “high scalloped” |
Shape of dental crowns | Rectangular | Triangular | |
Infection at implant sight | None | Chronic | Acute |
Bone height at adjacent tooth site | ≤ 5 mm from contact point | 5.5 – 6.5 mm from contact point | ≥ 7 mm from contact point |
Restorative status of adjacent tooth | Intact | Restored | |
Width of tooth gap | 1 tooth (≥ 7 mm) | 1 tooth (≤ 7 mm) | 2 teeth or more |
Soft-tissue anatomy | Intact | Compromised | |
Bone anatomy of the alveolar ridge | No defect | Horizontal defect | Vertical defect |
THE APPROACH
Immediate molar replacement requires atraumatic removal of the fractured tooth, careful socket debridement and development of a channel for an ideally positioned implant. The implant then needs to be placed down in the bone channel with the implant platform positioned just below the socket walls. It needs to be stable. Channel deficiency augmentation is achieved with Geistlich Bio-Oss Collagen® which is covered with a collagen matrix, Geistlich Mucograft® with the edges tucked under the gingival margins and sealed over with tissue glue.
THE OUTCOME
This single stage replacement protocol has proven to be simple, safe and highly effective providing the socket is fully degranulated and the implant is stable and not loaded in the early healing stages. It works well when a gingiva former is immediately placed into the implant instead of a cover screw, Geistlich Bio-Oss Collagen® is packed around the implant to fill the residual socket, then covered with a Geistlich Mucograft® and sutured. There is no need for flap advancement to cover over the socket.
Dr. Peter Hunt
After graduate training on an Annenberg Fellowship at the University of Pennsylvania, dr. hunt helped start up the University of the Western Cape dental School in Cape Town, South Africa. he returned to the University of Pennsylvania where in time he became Clinical Professor of Periodontics. later he helped start up Nova Southeastern‘s dental School where he was Professor of Restorative dentistry, Post Graduate director and director of Implantology. he has had a private practice in Philadelphia focusing on implant and rehabilitation dentistry since 1981.
BIOBRIEF
Ramal Bone Graft for Congenitally Missing Maxillary Lateral Incisor
THE SITUATION
An 18-year-old female presented with a congenitally missing tooth #10. The patient previously sought care by another provider and had undergone guided bone regeneration with allograft and subsequent implant placement with additional grafting at the time of implant placement. The implant ultimately failed and was removed prior to my initial consultation. An examination revealed maximal incisal opening, within normal limits, missing #10 with 6 mm ridge width. In addition there was a significant palpable cleft-like depression on the facial aspect of the ridge, adequate attached tissue but reduced vertical height in relation to adjacent dentition and attached tissue. Previous surgeries resulted in extensive fibrous tissue with scarring at site #10. Plan: A ramal bone graft is indicated at the congenitally missing site #10 with Geistlich Bio-Oss® and Geistlich Mucograft® matrix utilized for ridge augmentation prior to secondary implant placement.
THE RISK PROFILE
Low Risk | Medium Risk | High Risk | |
---|---|---|---|
Patient’s health | Intact immune system Non-smoker | Light smoker | Impaired immune system |
Patient’s esthetic requirements | Low | Medium | High |
Height of smile line | Low | Medium | High |
Gingival biotype | Thick – “low scalloped” | Medium – “medium scalloped” | Thin – “high scalloped” |
Shape of dental crowns | Rectangular | Triangular | |
Infection at implant sight | None | Chronic | Acute |
Bone height at adjacent tooth site | ≤ 5 mm from contact point | 5.5 – 6.5 mm from contact point | ≥ 7 mm from contact point |
Restorative status of adjacent tooth | Intact | Restored | |
Width of tooth gap | 1 tooth (≥ 7 mm) | 1 tooth (≤ 7 mm) | 2 teeth or more |
Soft-tissue anatomy | Intact | Compromised | |
Bone anatomy of the alveolar ridge | No defect | Horizontal defect | Vertical defect |
THE APPROACH
The goals for this patient are to reconstruct the osseous foundation and provide a matrix for improvement with the overlying soft tissue. Specifically, a coordinated multidisciplinary plan was established with the restoring dentist, periodontist and oral surgeon. A plan for idealized anterior cosmetic prosthetic restoration was established. Sequencing of treatment was established. Surgical phase one included a ramal bone graft to site #10 and Essix type temporary prosthesis for immediate post-operative phase followed by a temporary Maryland bridge. Surgical phase two included implant placement and simultaneous crown lengthening and osteoplasty. This stage was done with immediate provisionalization.
THE OUTCOME
This case was dependent upon adequate hard-tissue reconstruction combined with soft-tissue manipulation to eliminate scar tissue and provide esthetic recontouring. Obtaining an adequate autogenous graft combined with Geistlich Bio-Oss® at the periphery of the onlay graft is essential for anterior-posterior and vertical augmentation. Utilizing a Geistlich Mucograft® matrix at the ridge crest to help contain the particulate graft and improve the soft-tissue profile for subsequent immediate provisionalization and re-contouring of the surrounding soft tissue played a significant role in the esthetic success.
Dr. Richard E. Bauer, III
Oral and Maxillofacial Surgeon – University of Pittsburgh
Richard E. Bauer, III, DMD, MD is a graduate of the University of Pittsburgh Schools of Dental Medicine and Medicine. Dr. Bauer completed his residency training in Oral and Maxillofacial Surgery at the University of Pittsburgh Medical Center. Dr. Bauer has served on multiple committees for the American Association of Oral and Maxillofacial Surgery (AAOMS). He is a full-time faculty member and Residency Program Director at the University of Pittsburgh in the department of Oral and Maxillofacial Surgery and his practice is focused on dental implants and corrective jaw surgery. He has been active in research with focus on bone regeneration and virtual applications for computer assisted planning and surgery.
CLINICAL CASE
CLINICAL CASE
CLINICAL CASE
CLINICAL CASE
CLINICAL CASE
CLINICAL CHALLENGE:
The upper premolar had to be removed due to advanced periodontal disease and severe bone loss around the infected tooth. The bone defect was an intra-alveolar defect without dehiscence or fenestration.
AIM/APPROACH:
An early implant placement approach with a healing time of six weeks before implant placement was chosen. The bone augmentation with Geistlich Bio-Oss Collagen® was conducted simultaneously with implant placement. As this patient was treated in 1991, the case is one of the very first clinical applications of Geistlich Bio-Oss Collagen®
CONCLUSION:
A premolar grafted with Geistlich Bio-Oss Collagen® during implant placement showed good long-term result after 25 years. Satisfactory hard and soft-tissue contour are present 25 years after implantation.