Objectives: In clinical cases where a severe horizontal bone deficiency is present, it is very difficult to install implants in the perfect position for achieving optimum aesthetics and functional rehabilitation. The split-crest technique leads to reduced waiting times for installation of implants for maxillary defects of less than 3mm. The cases reported here underwent the split-crest technique with interposition of Bio-Oss biomaterial and were reopened for implant placement after five months. Methods: Patients were selected with a horizontal bone deficiency in the maxilla of 1.6–2.3mm. Both were fit for surgery. The preoperative assessment consisted of blood tests, CT scans and antibiotic prophylaxis and full treatment plans were presented to the patients. Infiltrative terminal anesthesia was applied until satisfactory tissue ischaemia was produced. An incision was made above the crystal with 15c blades and mesiodistal relaxing incisions. After total detachment and bone mucoperiostal exposure, a tag 701 was made with a surgical drill at the cortical level, completed with a metal disc osteotomy. A chisel was used between the markings to achieve total displacement of cortical , to achieve sufficient expansion and an intact nasal spine . Screws were placed at the base of each fracture, preventing vestibular cortical blades from moving during bone maturation. Gaps and remaining spaces were filled with Bio-Oss. Bio-Gide membranes were applied, the flap repositioned and the wound was closed by suturing without tension. Results: CT scans four months postoperatively showed increased bone width of approximately 5.2mm. There were no complications and both patients reported little discomfort after surgery. Both underwent further surgery for implant placement after five months. Primary stability of all implants was achieved and manufacturing the prostheses. Conclusion: The split-crest technique is a feasible option. Using Bio-Oss with a Bio-Gide membrane increased the maxillary bone thickness, which facilitated rehabilitation with dental implants.

Objectives: Controlling oral biofilms by applying a metal nanoparticle coating is a very promising approach that relates to their potent antibacterial effect and superior impact on epithelial and connective tissue adhesion, leading to improved soft tissue regeneration. This study evaluated the antimicrobial effect and epithelial and fibroblast adhesion properties of silver nanoparticle-coated titanium surfaces, compared to untreated titanium and zirconia surfaces. Methods: To simulate abutment surfaces, disc-shaped samples were fabricated using zirconia, titanium, and titanium with a coating of nano-silver, deposited using splutter-coating technology. Three groups of samples were made and surface characterisation was carried out to assess surface morphology, thickness of the silver layer, and surface chemical content. To asses antimicrobial activity, samples in each group were placed in twelve- or twenty-four-well polystyrene culture plates and inoculated with bacterial cultures, and assessed for viable counts associated with the surface by obtaining total viable counts on TY/LB agar plates. Live and dead cells were quantified using a Backlight[tm] bacterial detection kit, and were imaged by confocal microscopy. To assess fibroblast adherence, oral fibroblasts were isolated from biopsy samples and grown in media (such as Dulbecco’s modified Eagle’s medium; DMEM) supplemented with serum and essential growth factors. Cells were added to achieve a density of 1 x105 cells/mL and placed in an incubator at 37° C and 5%carbon dioxide for 24 hours, to allow the cells to attach. Cell growth was assessed after 48 hours by MTT assay and compared to the control group. The amount of colour produced was directly proportional to the number of viable cells. All experiments were carried out in triplicates to negate any procedural error. Data were analysed by ANOVA with Duncan's multi-comparison procedure at a 5% confidence level. Results: Silver was deposited by sputtering silver ions on titanium surfaces, pretreated with emery paper and Piranha’s solution, to a final thickness of 6 mug/mm after 5 minutes. The silver ion release profile was studied over 28 days. The maximum cumulative silver concentration was 4 [mu]g/mL up to day 7 and thereafter underwent sustained release (with a similar rate to that of bioactive drugs from a matrix). Cytocompatibility assay showed time-dependant cell proliferation near the test samples that was inversely proportional to the amount of silver released. The silver-coated surfaces had a remarkable antibacterial effect against Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus mutans compared to untreated titanium and zirconia discs. The MTT assay revealed significantly higher fibroblast growth and proliferation in the presence of nanosilver-coated surfaces compared with untreated surfaces. Conclusion:Titanium surfaces can be modified by coating with silver nanoparticles using the sputtering technique. The modified surface show potent antibacterial action against a range of oral pathogens. Silver nanoparticle-coated surfaces may be used in regenerative therapy by virtue of their ability to promote increased adherence of gingival fibroblasts.

Zielsetzung: Rezessionsdeckung an Zahn 23 und Verstärkung der Gingiva durch ein Bindegewebstransplantat. Inhalt: 1. Schnittführung in regio 23, intrasulkuläre Präparation, Mobilisation der Koronalverschiebelappen, Präparation eines Vorflap. 2. Wurzelglättung, Reduktion der Grundkavität mit Diamanten aus dem Perioset-System. 3. Präparation und Entnahme des Bindegwebstransplantats aus dem Palatinum, Applikation von Emdogain und Wundverschluss. 4. Fixierung und Vernähen des Bindegewebstransplantats durch interdentale Knopfnähte.