Live case study
aesthetic The hidden
In our latest look at a live course of implant treatment, Stephen Jacobs describes tissue augmentation
I
n the last article describing NC’s implant treatment, the implant placements were described and following some initial discomfort – more than
I would have normally expected – the healing phase was largely uneventful. At monthly reviews, the shape
of the tissue was observed and a normal amount of tissue shrinkage was noticed. Figures ı and 2 show the shape of the tissue at three months, and this was despite over- contouring with the anorganic bovine bone xenograft, at the time of surgery. In some cases in the aesthetic
zone, the shrinkage is such that further bulking of the tissue is indi- cated and for this we usually carry out a connective tissue graft. With aesthetic cases, I always mention
this possibility to the patient at the planning stage and include it as a possibility in the treatment plan. That way it does not come as a surprise to the patient when, at this stage, it is suggested that this proce- dure would enhance the final result. Currently, there are new bio-
materials available, taking the form of dermal allografts and two compa- nies, BioHorizons and Geistlich among others, are manufacturing them. I personally am trialling these products. We discussed in the last article
the principles of guide bone regen- eration and attempting to regain/ retain the architecture of the tissue overlying the implants, reducing the need to augment soft tissue. Further- more, over the last few years, much research and consequent published literature, has centred around prod-
ucts such as bone morphogenic proteins (BMP’s) and foundational tissue engineering principles using platelet rich growth factor (PRGF), platelet derived growth factors rhPDGF and recombinant bone morphogenic protein with acellular collagen sponge (rhBMP-2/ACS). These products are not available
in the UK, however our American colleagues are able to use them, sometimes ‘off-label’, with the prod- ucts being fairly expensive and with mixed results. I suppose the jury is still out on this one! In NC’s case I decided to go
with the anorganic bovine bone at implant placement combined with autogenous soft tissue graft prior to second-stage surgery, as I have been doing for many years. The standard procedure involves the harvesting of a sub-epithelial
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Fig 9 38 Scottish Dental magazine
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