Bone reconstruction in the aesthetic zone - Dr. David Baranes D.M.D

52 Rating(s).

Posted on 07.10.2017 03:26 PM By Rotem Maller In Bone Grafting

In the following case, a 30 years old female came to the clinic describing discomfort feeling and tooth mobility of the left upper lateral incisive. During clinical evaluation, a fistula was detached buccally near the apex zone of the tooth. preapical radiographic evaluation reveals a large radiolucency in connection with the tooth apex.
The treatment plan was to extract the tooth and to remove the lesion .to augment and to place an implant at the second stage.
After the extraction and the site preparation for augmentation Bone Apatite cement was used as a graft material .the soft tissue was primarily closed directly above the graft without using any membrane.
3 months post op one piece implant was placed and load with a provisional acrylic crown.

Periapical and CBCT scan slice radiographic appearance reveal Large bone deficiency at the apical Portion of the upper lateral incisive that was treated unsuccessfully By epecoectomy 4 years earlier

Fistula can be seen during Clinical examination

The defected tooth was carefully extracted and the granulation soft tissue was removed completely . Leaving behind a large bone defect with buccal plate deficiency .

Bond apatite was placed in the Augmented site

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6 Comments

Jorge Campos says on 07.14.2017 09:07 AM

Hi Rotem, nice regeneration. Even without membrane! What kind of material is bond apatite? Do you have a 2nd CBCT? It would be fantastic to see buccal regeneration.
Regards
Jorge

Rotem Maller says on 07.16.2017 09:35 AM

Bond Apatite is a bone graft cement, it is a composite graft, composed of biphasic calcium sulfate matrix 66.6% and 33.3% HA in different size and shapes .the biphasic calcium sulfate matrix is a patented formulation which enables us to enjoy from the cementing properties of the graft also in the presence of blood and saliva(it is moldable and set and harden instantly in the defect site –provides immediate stable structure and reduce the need for membrane ) this matrix also transform simultaneously into the patient own bone which improve the outcome ,the other component is particles of high-density hydroxyapatite in different sizes and shapes from 90 micron to 1 mm .the small to medium size resorb at about 4-6 months while the large ones can last longer but they are less than 10% . the HA serve just as a longer space maintainer so it’s slow the overall resorption of the graft and enable it to be used in large defect as well.

Regarding post op CBCT in this case Dr. Baranes didn’t took one, soon I will uploaded an outstanding webinar by Dr. Amos Yahav the inventor of the biphasic calcium sulfate cement. during his webinar, Dr. Yahav will elaborate about bone cement concept and will share clinical and scientific data.

Jorge Campos says on 07.17.2017 12:59 PM

Thanks very much for the info! This material looks perfect, almost ideal. Can we get this comercially in Europe?
Thanks again.
Jorge

Rotem Maller says on 07.17.2017 03:43 PM

Yes, you can buy him in Europe in several countries, the product has CE approved certificate. From where are you?

Kathleen Barton says on 07.20.2017 08:13 AM

Nice work David. We all know aesthetic restoration of anterior teeth with implant supported restorations is one of the most difficult procedures to execute.The main thing taht i must say is bone resorption following anterior tooth extraction often compromises gingival tissue levels for the implant restoration. In the last few years the focus has shifted from osseointegration, to creation of an implant borne restoration which is in harmony with the surrounding hard and soft tissue. Complete reconstruction of tooth and gingival related aesthetics remains the primary objective and in some instances can be very difficult to achieve. Your work is perfectly done. Congratulation. I am also a dentist. You can also visit my work at http://etoms.com.
Thank You

David Baranes says on 07.20.2017 12:26 PM

Thank you Dr. Katheleen
indeed the aesthetic zone is the most challenging area .
Thank you as well for inviting me to visit your site i will definitely will .