Online Referral Form
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Technical Note:
PC Users
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Newsletter Articles
Case Study 6 The use of guided tissue regeneration membranes with immediate implants and other situations with bone loss
When attempting to place immediate implants (i.e. at the same time the tooth is extracted) guided tissue regeneration (GTR) membranes are a necessity in most cases. If stability is achieved with the implant, it is usually due to bone contact at the apical end of the socket, not the coronal end. The coronal end will usually be slightly open and some of the implant threads may even be exposed. This is due to the fact that the implant is smaller in diameter than the tooth it is replacing. The purpose of the GTR membrane is to become a barrier to the soft tissue and a covering to the bone graft that is placed in the socket around the implant. In most cases, the GTR membrane is actually sutured around the neck of the implant to keep the membrane from moving out of place. It is most imperative that the epithelium and soft connective tissue are not allowed to grow around the threads of the implant. If this takes place, the implant will not integrate, or will integrate only at the apical end and will have deep peri-implant pocketing.
The integrity of the membrane is important here. It must remain in place, without resorbing, for at least 6 weeks to give the bone enough time to form (in the form of osteoid). It takes about 3 months for bone to mineralize, therefore we will usually use a membrane that doesn't resorb for that period of time. The extended resorbtion time collagen membranes (BioMend Extend from Sulzer Dental) seem to work very well for this a do not require a second surgery to retrieve it.
Patient # 1 | |
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| Implant placed showing buccal dehiscence | Implant placed with bone graft and collagen membrane adapted |
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| Satured | Post-Op X-Ray |
Patient #2 | |
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| Pre-Op X-Ray | Pre-Op w/ Initial Incisions |
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| Implant Placed with Bone Graft Only | Implant Placed w/ Bone Graft & Collagen Membrane Adapted |
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| Satured | Post-Op X-Ray |
Patient #3 | |
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| Pre-Op | Flap Reflected Showing Large Bone Dehiscence |
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| Implant Placed Showing Several Exposed Threads | Implant Placed with Bone Graft and Collagen Membrane Adapted |
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| Sutured | Post-Op X-Ray |