Heft 19 - Herbst 2001.pdf - Neue Gruppe

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22. Mericske-Stern RD, Taylor TD, Belser
U. Management of the edentulous
patient. Clin Oral Impl Res 2000;
Regenerative
Parodontaltherapie
mit Schmelzmatrixproteinen
(Emdogain ® )
von
Brigitte Simon
Stuttgart
16
SPECIAL CONSIDERATIONS: MULTIPLE ADJACENT MISSING TEETH AND
THE FULLY EDENTULOUS MAXILLA
The replacement of multiple, adjacent missing teeth in the esthetic zone with
dental implants is far more complex and challenging than the re p l a c e m e n t
of single teeth. This complexity is due to the flattening of the ridge after loss
of multiple teeth and the associated difficulty in re-establishing a naturally
appearing inter-implant papilla between two adjacent implants. Although
a comprehensive treatment plan based on biological and scientific principles
and the careful coordination of the appropriate surgical and re s t o r ative
techniques can usually lead to satisfactory results for both the patient
and the involved clinicians, it should be anticipated that a perfect esthetic
result is not possible in these cases due to the current biological limitations
(5). The situation is even more challenging and complex in cases of fully
edentulous maxillae. To avoid possible esthetic and phonetic problems due
to the severe atrophy of the fully edentulous maxillary ridge, an implants
u p p o rted overd e n t u re should be re g a rded as the treatment of choice in
these cases (21). An implant-retained overd e n t u re without palatal coverage
supported by 6-8 implants usually compensates adequately for the vertical
and horizontal resorption after total maxillary tooth loss and leads to
satisfying esthetic results (22). Although technically more challenging, a
fixed hybrid re c o n s t ruction with an extended buccal prosthesis flange and
s u p p o rted by 6-8 implants can be considered as well. The disadvantage
of this restorative option is the limitation on optimal plaque control posed
by the extended buccal flange design (22). A fixed partial denture bridgework
design divided into 2-3 segments should only be considered in
cases with adequate hard and soft tissue volume (21).
Infolge einer Parodontitis kommt es zum Verlust des gesamten Zahnhalteapparates
bestehend aus azellulärem Zement, parodontalem Ligament
und Alveolarknochen. Das Ziel der regenerativen Paro d o n t a l b e h a n d l u n g
ist es, eine Neubildung dieser verlorengegangenen Gewebe zu bewirken.
Dieses Ziel wurde erstmals mit der Guided tissue regeneration erre i c h t .
Die Membranen sollen mechanisch ein Tiefenwachstum des gingivalen
Epithels verh i n d e rn und damit den langsamer wachsenden Zellen des
P a rodontes Gelegenheit geben, auf der Wu rz e l o b e rfläche des Zahnes
ein neues funktionelles Attachment zu bilden.
Bei dreiwandigen Knochentaschen und Furkationen II. Grades im Unterkiefer
werden voraussagbare Ergebnisse erreicht, wenn es gelingt die
Membranen ausreichend lange mit Gingiva bedeckt zu halten. Bei einund
zweiwandigen Knochentaschen und Furkationen sind die Erg e b n i s s e
deutlich schlechter.
Als Guided bone regeneration im Zusammenhang mit Kieferkammaugmentationen
sowie Implantationen, wo nur Knochen re g e n e r i e rt werd e n
muss, führt die Membrantechnik jedoch zu bedeutend besseren Erg e bnissen,
die hier auch vorhersehbar sind.
Mit den Schmelzmatrixproteinen wird ein anderer Weg zur paro d o n t a l e n
Regeneration beschritten. So soll durch Nachahmung der Prozesse, die