Dental Asia November/December 2022

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USER REPORT GBR around implant using porcine-derived carbonate apatite xenograft to optimise pink aesthetics Dr Akshay Kumarswamy elaborates on the use of RegenerOss resorbable xenograft for guided bone regeneration (GBR) procedure. A 40-year-old female presented to us was unhappy about her longstanding existing two-unit cantilever bridge with tooth 25 being the abutment tooth and tooth 24 as the pontic. She wished to get rid of the pontic and hoped for something more aesthetic. Fig. 1 Fig. 2 After a thorough examination – the crown on tooth 25 seemed to have good margins and could be salvaged. The initial picture (Fig. 1) was taken after the pontic was cut off from tooth 25. The pontic had created an ideal soft tissue profile. A buccal defect was noted in tooth 24 region. Implant placement with guided bone regeneration (GBR) followed by a screw-retained restoration was planned at that site. TREATMENT PLAN The initial plan consisted of placing the implant in its most ideal position Fig. 3 Fig. 4 Fig. 5 Fig. 1: Cantilever pontic cut from parent prosthesis and soft tissue profile created by it Fig. 2: Buccal defect seen – 4.1x10mm implant placed in ideal position keeping in mind future screw-retained restoration Fig. 3: Buccal view of the buccal defect and thin bone around the implant Fig. 4: RegenerOss resorbable xenograft placed at the site Fig. 5: Membrane cut to desired shape and placed over the bone graft 40 DENTAL ASIA NOVEMBER / DECEMBER 2022
USER REPORT Fig. 6a Fig. 6b Fig. 7a Fig. 7b Fig. 8 Fig. 9a ABOUT THE AUTHOR Fig. 9b Figs. 6a-b: Flap mobilised and sutures were placed with no tension Fig. 7a-b: Second stage surgery after four months and placing of healing abutment to facilitate a screw-retained restoration. This would also involve GBR with the help of a xenograft material (RegenerOss, ZimVie) and a collagen membrane to ensure that the lost buccal bone was regenerated. Since it was a premolar site, a 4.1x10mm implant was planned. The ideal depth of placement was 3mm below the buccal CEJ of the adjacent tooth. This would help in an ideal emergence profile of the future restoration. CONCLUSION GBR with an implant can have great results — both functional and aesthetic. The following points need to be kept in mind: • Primary closure of the grafted site is of prime importance Fig. 10 Fig. 8: Emergence profile post healing Figs. 9a-b: Screw retained crown placed Fig. 10: Final restoration • Placement of implant in the most ideal position is paramount to achieve a good aesthetic and functional restoration. In case the bone is absent, it needs to be built before implant placement. In the case above, the bone was adequate enough to facilitate the placement of an implant with good primary stability which in turn helped us to graft the buccal defect at the same time as implant placement. The handling properties of RegenerOss Resorbable Xenograft are excellent. I hydrate them in normal saline for about 10 minutes before placing them in the desired site. I have had great results when I use them in GBR procedures. DA Dr Akshay Kumarswamy is a diplomate of the American Board of Periodontology and is board certified in periodontics and implant surgery. He completed his graduation from the College of Dental Sciences, Davangere, Karnataka. He pursued Advanced Education in General Dentistry (AEGD) from Boston University Goldman School of Dental Medicine, US, and completed his Master of Science in Periodontics from the University of North Carolina at Chapel Hill School of Dentistry, US. Dr Akshay is also a fellow and diplomate of the International Congress of Oral Implantologists (ICOI) and was awarded the American Academy of Periodontology Educator Award in 2016 and the American Academy of Periodontology (AAP) Foundation scholarship for the year 2012. Currently, he is a consultant periodontist and implantologist at Dr Kumarswamy’s PerioFamily Advanced Dentistry Clinic in Mumbai, India. DENTAL ASIA NOVEMBER/ DECEMBER 2022 41
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Dental Asia November/December 2022

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