Procedure Case description: -Class II furcation defect at teeth 46 and 47 and gingival recessions at teeth 43 and 44 - Root planing using PerioSet - Incision technique - Cleaning furcation defect at tooth 46 - Pref Gel application, rinsing and Emdogain application - Insertion of Bio-Oss into the furcation space with an amalgam plugger after hydration - Condensation of the bone replacement material and application of an absorbable membrane (Bio-Gide) - Atraumatic suture closure using 6/0 Seralene Contents: This video demonstration shows the simultaneous treatment of recessions at teeth 43 and 44 and of class II furcation defects at teeth 46 and 47. After a brief case description, root planning is done using PerioSet. Next, an incision is made and the furcation defects are very carefully cleaned using hand instruments and ultrasonic scalers (Soniflex). The cleaned root surfaces and furcation defects are conditioned with Pref Gel (Straumann) for two minutes. The objective of conditioning is to remove the smear layer, to open the dentine tubules, and to enable surface demineralization. Moreover, this measure serves to optimize the contact between Emdogain and the root surface. After two minutes, the EDTA suspension is removed using physiological saline solution or water spray. Immediately afterwards, Emdogain is applied to the blood and saliva-free root surface. This procedure was also used to treat the furcation defect at tooth 47. Regenerative treatment of tooth 46 was performed since that tooth had a very extensive furcation defect. The defect was filled with Bio-Oss, which was applied using an amalgam plugger. Absorbable Bio-Gide was used for coverage of the furcation entrance. Finally, the wound was closed using loop sutures and single interrupted sutures.

Objectives: This study aimed to evaluate clinically and histologically the healing of deep intrabony defects after reconstructive surgery using a natural bovine xenograft (BDX) combined with a native collagen membrane (CM). Methods: Eight patients with severe chronic periodontitis and at least one tooth scheduled for extraction because of periodontal or prosthetic issues were included. Following local anaesthesia, full-thickness flaps were raised, and intrabony defects were exposed. Granulation tissue was removed from the defects and the roots were thoroughly scaled and root-planed by hand and ultrasonic instruments. A notch was placed in the root surface at the level of the calculus or the most apical point of the debrided root surface (if no calculus was present). Defects were filled with BDX (Cerabone[tm]) and covered with CM (Collprotect[tm]). Probing pocket depth (PD), clinical attachment level (CAL) and vertical probing bone level (PBL) were recoreded before and 9 months after reconstructive surgery. At 9 months, the teeth and surrounding soft and hard tissues were removed, fixed in buffered formalin and processed for histological analysis. Ground sections of 100µm thickness were cut and stained with toluidine blue and fuchsin and analysed under a light microscope. Results: All eight treated teeth presented deep (7.57 ± 1.16mm) one-wall intrabony defects. After 9 months, a reduction in PD (1.45 ± 1.35mm) and a gain in CAL (1.68 ± 0.62mm) was noted for all teeth. No adverse events related to the graft material or CM were observed in any biopsy tissue. Histology revealed the formation of cementum with inserting collagen fibers in the entire notch area in two cases, and new cementum at the apical extent of the notch in one case. Long junctional epithelium and biofilm formation were observed to varying extents in all cases; furthermore, graft particles were still present and encapsulated in connective tissue. There was some minute formation of bone in three biopsies, and three teeth showed signs of root resorption. Conclusion: In teeth with a poor prognosis, reconstructive surgery of intrabony defects using BDX and CM resulted in minimal or no periodontal regeneration.

Autor: Dr. Stefan Neumeyer, Eschlkam. Inhalt: Sie lernen hier ein neues Implantatsystem kennen, mit einem sehr konzentriertem Instrumentarium und Prothetikkappen aus Zirkoniumoxidkeramik. Die Implantate heißen Aesthura. Sie werden von Nemris vertrieben. Für diesen Bericht wurde ein Fall ausgewählt mit Einzelzahnimplantaten, auf denen sofort eine provisorische Versorgung verankert wird.