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Paciente que acude a la consulta por múltiples fracasos de tratamientos parciales realizados previamente. Como objetivo principal nos planteamos rehabilitar la función y la estética del paciente, buscando devolver la dimensión vertical perdida y procurando una oclusión estable que, nos pueda mejorar a largo plazo los múltiples fracasos anteriores. Es un caso con cierta complejidad, pues se trata de una Clase III verdadera, lo cual nos obliga a hacer una planificación minuciosa y una serie de compensaciones dentoalveolares. Dicho tratamiento lo vamos a realizar con el sistema LavaZirconio de 3M, colocando coronas tanto sobre dientes naturales como sobre implantes, previa colocación de los mismos con un sistema de Cirugía Guiada.
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Dres. Salvador Alonso Pérez, Samuel Espías Alonso
Plate thicker and acellular
Rehabilitación del tercer sextante mediante implantes convencionales, un cigomático y un pterigoideo y regeneración horizontal simultánea mediante box technique
We are testing the digital flow and for this we are doing different guided surgeries with different software and implant systems. In this case we have to thank David Matute for his planning, which provided us with the design of the guided splint. The surgery was performed with the Euroteknika system. Six superior implants were placed with immediate loading prosthesis. The radiology seemed to indicate abundance of bone but it was too soft in some places, especially in back sectors, so an additional implant was added to distribute the loads. The design of the definitive prosthesis will be made taking as a basis the denture that the patient brought.
A complete aesthetic treatment from orthodontics to veneers made in a completely digital way without taking analog measurements. Intraoral scanning was made and CAD-CAM design for the milling in IPS Empress Esthetic, thanks to the expert hand of Guglielmo Parziale.
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Socket shield con MTD
A 47-year-old woman presented a severe alveolar defect associated to the failure of the implants in the left side of the mandible (Fig. 1, 2 and 3). A 2-step approach was schedule. Twelve weeks after explantation, bone reconstruction was performed with Fresh Frozen Bone block (Fig. 4) in combination with autogenous particulate cortical bone harvested from tibia (Fig. 5) ad modum Khoury (Fig 6, 7 and 8). Transposition of the inferior alveolar nerve was performed simultaneously due to the emergence on the top of the residual crest (Fig. 2). Autogenous bone marrow aspirate was added. Three 3,5x12 mm Galimplant IPX implants were placed sixteen weeks later (Fig. 9, 10, 11 and 12). A connective tissue graft was placed coronally to improve the soft tissue quality and quantity (Fig. 13). Bone sample for histological examination was obtained (Fig. 14).. Sixteen weeks later the exposure of the implants was performed and three multiunit abutments of height three were screwed and properly tightened. Provisional prosthesis was screwed two weeks later (Fig 15 and 16).
Discussion
Autogenous bone is still the gold standard in bone regeneration, however a donor site is required. Khoury technique is considered a predictable procedure for bone augmentation in moderate to severe alveolar bone defects (1). Fresh frozen bone is a reliable alternative to autogenous bone in implant surgery (2). Combination of both bone sources would provide the advantages of each one separately. To minimize the morbidity associated to this procedure, fresh frozen bone was used as cortical plates and marrow aspirated provided the ideal environment to induce bone formation (3) in combination with autogenous particulate bone (4, 5). Results of the biopsy also confirmed this procedure as an alternative in bone reconstruction.
Conclusion
In conclusion, at the light of the results it is an alternative treatment for the management of vertical defects at the posterior mandible sector.
Bibliography:
- Khoury F, Hanser T. Mandibular Bone Block Harvesting from the Retromolar Region: A 10-Year Prospective Clinical Study. Int J Oral Maxillofac Implants. 2015;30:688–97.
- Carinci F, Brunelli G, Zollino H, Franco M, Viscioni A, Rigo L, et al. Mandibles grafted with fresh-frozen bone: An evaluation of implant outcome. Implant Dent. 2009;18:86–95.
- Soltan M, Smiler D, Prasad HS, Rohrer MD. Bone block allograft impregnated with bone marrow aspirate. Implant Dent. 2007;16:329–39.
- Lacerda SA, Lanzoni JFA, Bombonato-Prado KF, Campos AA, Prata CA, Brentegani LG. Osteogenic potential of autogenous bone associated with bone marrow osteoblastic cells in bony defects: A histomorphometric study. Implant Dent. 2009;18:521–9.
- Smiler D, Soltan M, Lee JW. A histomorphogenic analysis of bone grafts augmented with adult stem cells. Implant Dent. 2007;16:42-53.
