POSTER

N°67Regeneration in aesthetic area with Autologus Bone

Ring Technique: protocol, timing and work flow

1- Albrektsson, T., Zarb, G., Whortington, P. & Eriksson, A.R. (1986) The long term efficacy of currently used dental implants: a review and proposed criteria of success. International Journal of Oral and Maxillo- facial Implants 1: 1–25.

2- Buser, D., Bragger, U., Lang, N.P. & Nyman, S. (1990) Regeneration and enlargement of jaw bone using guided tissue regeneration. Clinical Oral Implants Research 1: 22–32.

3- Misch, C.M. (1997) Comparison of intraoral donor sites for onlay grafting prior to implant placement. International Journal of Oral and Maxillofacial Implants 12: 767–776.

4- Khoury F, Antoun A, Missika P. Bone Augmentation in Oral Implanto- logy. Berlin, London: Quintessenz, 2007.

5-Mark R. Stevens, Hany A, Mahmoud E, Mohamed S.Implant Bone Rings. One-Stage. Three-Dimensional Bone Transplant Technique: A Case Report. Journal of Implantology Vol xxxvi N. one 2010.

Image 1 shows the first quadrant sector after

extraction of tooth 1.4 which was fractured due

to overloading after trauma. The radiograph

shows a wide horizontal atrophy of the maxilla in

region 1.4. The patient had optimal conditions

for implant placement and bone augmentation.

One of the methods to achieve primary implant

stability is the "Bone Ring Technique". In this

case the palatal zone above the incisor was an

appropriate donor site. Premedication was

performed using antibiotics (Augmentin, 2 g,

GlaxoSmithkline) 2 hours before surgery and a

preoperative rinse with 0,2% chlorexidine

solution (Corsodyl, GlaxoSmithkline). After a

full-thickness flap was released, implant site

preparation was performed using conventional

twist drills. The bone ring was harvested from

the palatal region using a trephine bur. One

implant (external 4.1mm Shape1 hybrid, I-RES)

was placed together with the bone ring graft.

The coincident placement of the implant and the

bone ring graft stabilizes the implant and the

bone graft simultaneosly. The gap around the

bone ring was augmented with hydroxyapatite

particulate bone graft (Osbond Curasan) and

covered with resorbable porcine membrane. The

mucoperiosteal flap was sutured with horizontal

mattress and simple sutures using 4/0 PTFE.

CASE PRESENTATION

BIBLIOGRAPHY

CONCLUSIONS

In the present case, immediate implant

placement and simultaneous bone augmentation

was successfully achieved. This technique

reduced the period of therapeutic time from 12

to 6 months in comparison to classic bone

augmentation techniques. Furthermore, patient

morbidity and treatment costs can be reduced,

since less surgical procedures are required.

Further long-term controlled studies are needed

to confirm the benefits of the autologous "Bone

Ring Technique" in esthetic zone.

BACKGROUNDThe reconstruction of alveolar defects after

tooth loss is one of the major challenges in

implant dentistry. Autogenous bone grafts are

osteoinductive, osteogenic and osteoconductive

with significant higher regenerative capability in

comparison to all other grafts. This is why

autogenous bone, especially for larger lateral or

vertical defects, remains the gold standard for

augmentation.

*Vittorio Siro Leone Farina D.D.S. Adriano Azaripour D.D.S. PhD Department of Periodontology University of Mainz (Germany)

Foto 1: Show the initial situation after 2 month tooth

extraction and rx

Foto 2: After mucoperiosteal flap elevation,

before surgery Bone defect

Foto 3: Shape palatal Bone Ring by kit trephine

(Zept Germany)

Foto 4: Shape bone defect before insert bone ringFoto 5: Stabilize bone ring by implant (Shape1 Hybrid I-RES)

4.1 x 13mm

Foto 6: GBR with hydroxiapatite(Osbone, Curasan) and porcine

membrane(Osgide, Curasan)

Foto 7: After 3 month show new bone around implant

Foto 8: Prosthetic implant rehabilitation and finally

esthetic result after 1 yr and rx