Prosthetically Guided Regeneration (PGR) in the Posterior Maxilla
The 60-year-old female patient’s chief complaint was represented by unsatisfactory esthetics and function, related to loss of multiple maxillary teeth. Her request focused on improving esthetics and function by means of a fixed reconstruction.
The patient presented five residual anterior maxillary teeth (from 6 to 10) that could be maintained. After preliminary periodontal diagnosis and treatment, specific diagnostic steps for implant treatment demonstrated inadequate bone volume for implant placement.
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|
|Bone anatomy of the alveolar ridge||No defect||Horizontal defect||Vertical defect|
Bi-lateral sinus lift with Geistlich Bio-Oss Pen® and horizontal bone augmentation with a 1:1 mix of autogenous bone and Geistlich Bio-Oss® were performed six months prior to implant placement, following a Prosthetically Guided Regenerative (PGR) approach. The augmented sites were protected with Geistlich Bio-Gide® stabilized with titanium pins. The template utilized for radiographic diagnosis and GBR was then used to guide the implants’ placement.
After a healing period of six months, adequate bone volume was achieved for the placement of five implants. Geistlich Fibro-Gide® was also used to optimize soft tissue volume at the buccal aspect of implants.
Implants were early loaded with a temporary screw-retained fixed prostheses six weeks after placement. The final prosthetic reconstruction included ceramic veneers of the frontal residual teeth and zirconium-ceramic screw-retained fixed prostheses on implants.
Patient satisfaction is my driver for excellence. That’s why I always apply the Prosthetically Guided Regeneration principle together with Geistlich Biomaterials: proven and predictable long-term patient success.Paolo Casentini, DDS
Paolo Casentini, DDS
Graduated in Dentistry at the University of Milan, Fellow and Past Chairman of the Italian section of ITI, Active member Italian Academy of Osseointegration. Co-author of 10 textbooks including ITI Treatment Guide volume 4, translated in eight languages, and “Pink Esthetic and Soft Tissues in Implant Dentistry” translated in five languages. His field of interest is advanced implantology in complex and esthetically demanding cases. He has extensively lectured in more than 40 countries.