title: Single stage surgery combining transmucosal implant placement with guided bone regeneration and bioresorbable materials.
abstract: The aim of the present clinical study was to test whether peri-implant bone defects can successfully be filled with bone by applying bioresorbable materials for guided bone regeneration (GBR) procedures in conjunction with implants in the transmucosal healing position. Three women and 7 men ranging in age from 32 to 68 years (median 54.5) needed tooth replacement with dental implants. Eight to 14 weeks following careful tooth extraction, implants of the ITI Dental Implant System were placed at the extraction sites. At this time, all implants presented dehiscence defects of the alveolar bone partly exposing the rough titanium plasma sprayed (TPS) surfaces. GBR procedures were performed using deproteinized bovine bone mineral (Bio-Oss) as a membrane-supporting material and a bioresorbable collagen membrane (Bio-Gide) as a barrier. The membranes and the flaps were adjusted to fit around the necks of the implants, thus leaving the implants extending transmucosally into the oral cavity. Clinical measurements were taken at 6 sites around each implant (mesio-buccal, buccal, disto-buccal, disto-lingual, lingual, mesio-lingual) using a calibrated periodontal probe. These included: i) defect depth measured from the shoulder of the implant to the first bone-to-implant contact, ii) infrabony defect component measured from the bone crest to the first bone-to-implant contact, iii) defect width measured from the crest to the implant body in a direction perpendicular to the long axis of the implant. The Wilcoxon Matched Pairs Signed Rank Test was applied to detect differences over time. At baseline, the mean defect depth per patient amounted to 3.6 mm (Standard Deviation 1.6 mm, range 1.8-6.8 mm). The deepest extensions of the defects were located at the buccal aspects (mean 7.8 mm, SD 1.9 mm). At re-entry, the mean defect had decreased to 2.5 mm (SD 0.6 mm). This difference was statistically significant (P < 0.01). Initially, in 62% of sites the depth ranged from 0-3 mm, in 23% it ranged from 2-4 mm, and in 15% it amounted to more than 6 mm. Six to 7 months later, at re-entry, 95% of sites were 3 mm and less in depth and 5% ranged from 4-6 mm. Defect resolution, as assessed by the amount of coverage of the initially exposed rough implant surface, reached a mean value of 86% (SD 33%). One hundred percent resolution was accomplished at 8 out of 10 implants, 60% at one and 0% at another implant. The tissue at the latter implant showed signs of infection and inflammation during the healing phase. It is concluded that bioresorbable materials in GBR procedures at transmucosal implants can lead to successful bone regeneration into peri-implant defects.
authors.affiliation: Department of Periodontology and Fixed Prosthodontics, School of Dental Medicine, University of Bern, Switzerland. HAMMERLE@zmk.unibe.ch
authors.forename: C H
authors.initials: CH
authors.lastname: Hämmerle
authors.forename: N P
authors.initials: NP
authors.lastname: Lang
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000145:classification / Q000601:surgery; D000539:Alveolar Process / Q000473:pathology; D000818:Animals; D001857:Bone Matrix / Q000637:transplantation; D001861:Bone Regeneration / Q000502:physiology; D018786:Bone Substitutes / Q000627:therapeutic use; D002417:Cattle; D020099:Coated Materials, Biocompatible; D003094:Collagen; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D005260:Female; D005500:Follow-Up Studies; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use; D010000:Osteitis / Q000209:etiology; D010517:Periodontics / Q000295:instrumentation; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000209:etiology; D014025:Titanium; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: C077540:Bio-Oss; D018786:Bone Substitutes; D020099:Coated Materials, Biocompatible; D015921:Dental Implants; D008567:Membranes, Artificial; D008903:Minerals; D003094:Collagen; D014025:Titanium