Bone Grafting

Dental implants offer excellent tooth replacement options however; peri-implantitis can limit their clinical success by causing failure. Peri-implantitis is an inflammatory process around dental implants resulting in bone loss in association with bleeding and suppuration. Dental plaque is at the center of its etiology, and in addition, systemic diseases, smoking, and parafunctional habits are also implicated. The pathogenic species associated with peri-implantitis include, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella
forsythia. The goal in the management of peri-implantitis is the complete resolution of peri-implant infection with function. Therapies using various biomaterials to deliver antibiotics have been used in the treatment of peri-implantitis e.g. fibers, gels, and beads. The use of
guided tissue regeneration barrier membranes loaded with antimicrobials has shown success in re-osseointegrating the infected implants in animal models. Several uncertainties still remain regarding the management of peri-implantitis. The purpose of this article is to present a background of peri-implantitis along with a case of peri-implantitis successfully treated for bone regeneration.

Aim: To associate the dimension of the facial bone wall with clinical, radiological, and patient-centered outcomes at least 10 years after immediate implant placement with simultaneous guided bone regeneration in a retrospective study. Material and methods: Primary endpoint was the distance from the implant shoulder (IS) to the first bone-to-implant contact (IS-BIC 10y). Secondary endpoints included the facial bone thickness (BT 10y) 2, 4, and 6 mm apical to the IS, and the implant position. At baseline, the horizontal defect width (HDW BL) from the implant surface to the alveolar wall was recorded. At recall, distance from the IS to the mucosal margin (IS-MM 10y), degree of soft tissue coverage of the mesial and distal aspects of the implants (PISm 10y , PISd 10y ; Papilla Index), pocket probing depth (PPD 10y), and patient-centered outcomes were determined. Width of the keratinized mucosa (KM), Full-Mouth Plaque and Bleeding Score (FMPS, FMBS) were available for both time points. Results: Of the 20 patients who underwent immediate implant placement with simultaneous guided bone regeneration and transmucosal healing, nine males and eight females with a median age of 62 years (42 min, 84 max) were followed up for a median period of 10.5 y (min 10.1 max 11.5). The 10-year implant survival rate was 100%. Multivariate regression analysis revealed a correlation of the IS-BIC 10y , controlled for age and gender, with four parameters: HDW BL (P = 0.03), KM BL-10 (P = 0.02), BT 10 4 mm (P = 0.01), and BT 10 6 mm (P = 0.01). Conclusion: Within the conditions of the present study, the horizontal defect width was the main indicator for the vertical dimension of the facial bone. The facial bone dimension was further associated with a reduction in the width of the keratinized mucosa and the dimension of the buccal bone.

The use of guided bone regeneration (GBR) has been gaining more and more ground in the field of implant dentistry, due to higher confidence in the materials available. As this is a highly versatile technique, the same biological basis-cell exclusion-can be used to treat any type of defect. Vertical augmentation in the alveolar ridge is currently treated by the GBR principle, predictably and with high success rates, using a rigid framework associated with a mix of hydroxyapatite and autogenous bone. Lyophilized bovine bone is the hydroxyapatite of choice for this condition because it allows bone volume to be maintained over a long period of time, due to its slow resorption.