Objectives: To evaluate the application of BioOss with free gingival graft for maintaining the socket contour in immediate placement of implants. Methods: After extraction of a fractured 21# tooth in a 50-year-old male patient, with thick gingival biotype, a flapless immediate placement implant (4.1 mm x 12mm Straumänn SLA was inserted to the tissue level of a standard implant, and covered with an insertion screw. Grafting was with 0.25g Bio-Oss small particles, using free gingiva graft from palatal epithelium to close the socket. The natural tooth was cemented with a crown for immediate restoration . After 3 months, the second-stage soft tissue was shaped with provisional restoration by temporary abutment and the natural crown. After another 6 weeks, impressions were taken and the final PFM (porcelain-fused-to-metal) crown was fixed with screw retention. Results: Within 4 years, the soft and hard tissue levels around the implant were stable, and the crown was supported by the implant with a natural profile with the neighbouring teeth. Conclusion: Immediate implant placement covered with BioOss and free gingiva graft can result in a long-term stable aesthetic outcome in patients with thick gingiva sites.

Mit diesem Beitrag wollen wir die Einführung des PSI, "Parodontal Screening Index", unterstützen. PSI ist ein Blutungsindex, der in vielen Ländern offiziell empfohlen und angewendet wird. Auch in Deutschland haben sich die Standesorganisationen sehr erfolgreich dieser Aufgabe gewidmet, so daß die WHO-Sonde wochenlang ausverkauft war. Bei der starken Verbreitung von Parodontitis in allen Schichten und Alterstufen der Bevölkerung erscheint die Einführung eines Index als Bestandteil der zahnärztlichen Diagnostiknatürlich als sehr hilfreich. Schließlich ist die Parodontitis die am weitesten verbreitete Krankheit überhaupt. Soll sich ein Index in der Alltagspraxis durchsetzen, so muß er einfach und schnell zu erheben ein. Dies ist hier nach übereinstimmender Beurteilung der Fall. Unser Bericht macht sie mit dem PSI und seiner Anwendung vertraut.

Objectives: To report a case of a severe horizontal defect in a maxillary lateral incisor in which GBR was applied with adjunctive use of autologous (mandibular body cortical) bone and xenogeneic bone graft (BioOss[TM]), combined with titanium mesh, to improve clinical and aesthetic effectiveness, with a two-year follow-up. Methods: A 30-year-old non-smoking female patient with an uneventful medical history was referred to the Implantology Clinic at Paulista University, São Paulo, with a compromised maxillary lateral incisor, and complaining of masticatory parafunction and aesthetic issues. Despite satisfactory oral hygiene, intraoral examination showed advanced local tissue destruction with severe alveolar bone loss and dental mobility. A large buccal plate dehiscence was detected clinically and radiographically. A non-traumatic surgical approach under local anaesthesia consisted of simple manual tooth removal, requiring no forceps or elevators. After 30 days of healing, a cone beam CT showed lingual bone width of 3mm. An implant (3.25 x 13mm Biomet-3i) was installed in the basal bone adjunctively with a mixture of particulate autologous bone graft harvested from mandibular body cortical bone and BioOss[tm] xenogeneic bone graft (to reconstruct the horizontal defect). A preadapted titanium mesh (Neobiotech[TM]) and resorbable collagen barrier (BioGide[TM]) were placed over the grafted region to help maintain bone volume and prevent any exposures. During a six-month healing period, the patient used a provisional removable partial denture. Then the titanium mesh was removed and a provisional crown was fabricated to optimise the emergence profile. Results: No bone exposure was observed in the grafted area and no complications occurred in the donor site. Postoperative clinical and CT examinations at 6, 12 and 24 months showed sufficient and satisfactory bone formation. Besides the limited torque (15N/cm) during implant placement, the final prosthetic design was successful. At two-year follow-up, volumetric stability and satisfactory functional and aesthetic results were achieved. Conclusion: Mixed bone grafts combined with titanium mesh appear to be an effective and advantageous procedure for horizontal bone defects in aesthetic zones, providing volumetric stability and satisfactory functional and aesthetic results.