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10670/1.pt8p2f

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DOI: <

10.26226/morressier.5d3880c13ceb062ea26e5308

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Treatment of a horizontal bone deficiency with autologous bone augmentation prior to implant placement

Abstract

TITLETREATMENT OF A HORIZONTAL BONE DEFICIENCYECTS WITH AUTOLOGOUS BONE AUGMENTATION PRIOR TO IMPLANT PLACEMENTWITH AUTOGENOUS BONE GRAFTS AND IMPLANTATIONBACKGROUND32 year old male patient came to Istanbul University Faculty of Dentistry department of Periodontology clinic with a missing teeth problem. Patient has lost his tooth due to a recession of his gums 2 years ago. He is a nonsmoker with no other systemic disease nor he uses any medication for anything. His complain was his missing lower right first premolar. It was decided to perform an autologous bone graft to the area in order to increase the width of the bone. It was decided to get the bone block from ramus buccal shelf of the mandibule in order to get enough cortical bone. The anatomy of the ramus allows a smaller and thicker graft due to itu2019s proximity to the canal.The other problem with the procedure is the location of mental foramen. From the radiographs and the CBCT scans it has been located right under the second premolar and avoided to damage the area. The excessive bone loss usually prohibits the placement of dental implants in the ideal prosthetic position and compromises the protection of peri-implant health. Various techniques and materials have been developed for augmentation of the resorbed alveolar ridge. In cases with insufficient amount of alveolar bone for primary stability of an implant, the alveolar ridge has to be augmented prior to implantation. The defected area has been shown to be treated either with xenografts supported with different type of membranes, with autogenous bone blocks or with the mix of autogenous and xenografts. Among these, autogenous bone still remains as the u201cgold standardu201d because of its osteoinductive characteristics.32 year old male patient came to Istanbul University Faculty of Dentistry department of Periodontology clinic with a missing teeth problem. Patient has lost his tooth due to a recession of his gums 2 years ago. He is a nonsmoker with no other systemic disease nor he uses any medication for anything. His complain was his missing lower right first premolar. He didnu2019t want a bridge to cover the missing teeth and consulted our clinic if it was suitable to apply an implant to the area. Examination of the radiography and the CBCT images showed a missing bone on the buccal side of the area. The distance between the lingual and buccal side was not enough for an implant. After consulting with the Oral Surgery it was decided to perform a surgery to increase the width of the bone. AIM/HYPOTHESISThe aim of this case presentationstudy is to showobserve the short-term clinical outcomes of thethe implant surgery placementtreatment to the in an edentulous area where augmented with autologous bone graft harvested from the mandibular ramus. horizontally defected areas after the augmentation with autogenous bone. Literature shows that horizontally defected area could be treated either with xenografts supported with different type of membranes, with autogenous bone blocks or with the mix of autogenous and xenografts. For this case autogenous bone block treatment was found convenient. MATERIALS AND METHODS32 year old male patient came to Istanbul University Faculty of Dentistry Department of Periodontology with a missing teeth complaint. He had lost his right lower first premolar due to localized hard tissue loss 2 years ago. He was a healthy non-smoker and did not use any medication. After periodontal examination patient was scheduled for nonsurgical periodontal therapy and oral hygiene instruction. Following periodontal rehabilitation, patient were examined and evaluated for decision making for the edentulous area. He rejected the fixed partial prosthesis treatment choice. Following clinical and radiographic evaluation, alveolar crest in the edentulous area have been found to be horizontally extremely thin (3 mmkau00e7 mm olduu011funu yazmu0131u015fu0131zdu0131r) for the implant placement. The patient was informed that bone grafting was necessary prior to implant placement. A standard two-stage surgical protocol was planned. Autogenous bone block graft was suggested to the patient in order to augment the edentulous area because of its superior characteristics (osteoinductive, osteoconductive and nonimmunogenic material) compared to the alternatives. The bone block has been decided to harvest from the retromolar region (ramus mandibularis) on the same (right) side of the jaw. On the operation day, following the local anesthesia, a bone block graft harvested from the retromolar region was fixed with screws (vidanu0131n markasu0131 ve materyali nedir?titanium alloy) to the recipient site as onlay graft. After fixation of the graft flaps were fixed with the sutures in both operation areas. There was no need for bone chips around the block graft. Patient has been prescribed antibiotics (amoxicilin+clavulanic acid 1 gr i..m. twice daily during a week), non-steroid anti-inflammatory drug (every 6 hours during first 2 days) chlorhexidine mouthwash and corticosteroid (40mg i.m once on the operation day) postoperatively. Sutures were removed 1 week later. During 6 months, patient was controlled monthly and wound healing was uneventful. On the second operation day, following the local anesthesia, flap was raised and the fixation screw was removed. There was fully integrated and sufficient bone ridge on the implantation area (kret kalu0131nlu0131u011fu0131 kau00e7 mm). Straumann 4.1 in diameters 12 mm length (implantu0131n u00e7apu0131nu0131 ve boyunu yazmak lazu0131m buraya ve markasu0131nu0131) impant was placed and the wound closed by the sutures. Antibiotics and analgesics were prescribed postoperatively. Healing was uneventful. The patient came for suture removal a week later. There was a hard swelling on the buccal side of the implantation area on the 4. day postoperatively. There was no exposition or sequestration on the operation area. Patient stated it was painful when the swollen area were palpated. The wound was rinsed with hydrogen peroxide ((hidrojen peroksit)H2O2) and chlorhexidine mouthwash was prescribed. The swelling and pain was reduced at 1 week post-op. The swelling, pain and patient morbidity was completely eliminated at 2 weeks post-op. The healing has beenis being obs observed with control appointmentsed during the 2 months ofby the osseointegrastion process controls during 2 months until osseointegrastion process be completed. (bu cumleden emin degilim)The swelling, pain and patient morbidity was completely eliminated at 2 weeks post-op.32 years old male patient was examined in Department of Periodontology in Istanbul University Faculty of Dentistry. In his first appointment he periodontal tissues have been evaluated and decided to be treated with scaling and root planning. After the nonsurgical periodontal treatment the patient received an oral hygiene instruction and has been scheduled for a follow up appointment for an oral hygiene evaluation. After the the follow up appointment it has been decided that the patient has been ready for the surgical treatment and a CBCT scan has been requested. A consultation from Department of Oral Surgery in Istanbul University Faculty of Dentistry has also been requested in order to plan the surgical treatment.Patient has been complained from the first premolar site at lower right jaw. The CBCT scans has ben evaluated by both departments. The examination of the radiography showed the amount of bone is appropriate for an implant. The examination of the CBCT showed the distance between the lingual and buccal bone amount is not enough for an implant. An augmentation would be proper in order to gain enough bone for the implantation. For the augmentation of the site it has been decided to use autogenous bone graft. So patient has ben given an appointment for the surgery and has been informed about the steps of the surgery. A bone block graft harvested from the ramus buccal shelf has been fixated to the buccal side of the area by a screw. After the fixation surgery area has been closed with sutures. Patient has been subscribed antibiotics (amoxicilin+clavulanic acid Augmentin 1 gr 2*1 7 days), corticosteroid shot (prednol 20 mg IM single shot) and non-steroid antienflamatuar (Apranax 550 mg 3*1). Patient has been recalled at the 3rd day for the post-op and 7th day for the suture removal and waited for 6 months to heal. Patient visited the Periodontology clinic after 6 months hand has been given a new appointment for the implant surgery. Periapical views has been requested beforehand. The area has been opened during surgery and it showed that the bone block has been osteointegrated to the area. After removing the bone screw a single Strauman bone level implant has been placed to the area and sutured afterwards. Post-op appointment for 3rd day and 7th day has shown no problem. RESULTSFirst operation was designed to increase the amount of the horizontal bone and at the end of the surgeries healing process was unproblematic. The amount of bone before was 3 mm and it increased to 7 mm at the end of 6 month healing time. The second procedure was the implant surgery. The healing process showed there was no contraindication for an implant. After the removal of the screw the part in the newly formed bone was bleeding, which showed the liveliness of the newly formed none. Since the outcome was above expectations implantation process was again unproblematic. Healing process showed no complications and the patient was happy with the results. It is still in the osseointegration phase of the implants so we are expecting the final results.Gingival recession is a problem where it could be affected by either the periodontal health or by traumatic brushing. For this case however the reason for the recession is unknown since the patient applied to our clinic after he lost the tooth. For a single teeth loss treatments we either use bridges or implant surgery to replace the area. Aside from the expense difference the amount of bone is an important fact for an indication for implants. Horizontally or vertically defected bone is a common problem after a tooth loss and it might be a contraindication for an implant surgery. In order fix that a bone augmentation procedure could be arranged. Different type of approaches are available in order to increase the amount of bone in mandible for this case. Since xenografts are osteoconductive they only serve as a scaffold for bone growth. On the other hand autogenous bone grafts are osteoinductive so the can stimulate the osteoprogenitor cells into the area and form a new bone. In order to form a new bone we decided to get a bone block from the ramus buccal shelf, where we can get a strict cortical bone, and fixate it with screws to the defected area. With this approach we didnu2019t use any xenograft so it was cheaper for the patient and the block bone has been harvested from the patient himself so the graft itself is biocompatible with the patients bone tissue. While planning and performing these surgical procedures it is vital to decide if the patient is suitable for this procedures. Systemic diseases and smoking affects healing period directly so considering the fact are vital. Our patient was a nonsmoker and had no systemic disease. Even when patients have any systemic diseases it is not always a contraindication but a consultant with the doctor is a necessary. Oral hygiene is also an important factor because it affects the healing. After the periodontal nonsurgical treatment oral hygiene must be instructed to the patient in detail and follow up appointment should be given.CONCLUSION AND CLINICAL IMPLICATIONSHorizontally defected alveolar ridge is a common problem after a tooth loss and it might be a contraindication for implant placement. Autogenous bone still remains as the u201cgold standardu201d for bone augmentation procedures because of its osteoinductive, osteoconductive and nonimmunogenic characteristics. These type of defects may be treated with augmentation procedures with appropriate methods and materials usage and become recipient areas to be able to allow implant placement. While planning and performing these surgical procedures it is vital to decide if the patient is suitable for this procedures. Systemic diseases and smoking affects healing period directly so considering the fact are vital. Our patient was a nonsmoker and had no systemic disease. Even when patients have any systemic diseases it is not always a contraindication but a consultant with the doctor is a necessary. Oral hygiene is also an important factor because it affects the healing. After the periodontal nonsurgical treatment oral hygiene must be instructed to the patient in detail and follow up appointment should be given.Horizontally and vertically defected bone areas might be a contraindication for implant surgeries but it is possible to form a proper bone with autogenous bone grafts.

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