Dental Asia March/April 2023

CLINICAL FEATURE
used later. Into this wet mix, the Anyridge
3.5x11.5mm implant (Fig. 11) was then placed
with very low primary stability because
of the shallow osteotomy. The remaining
EthOss is then mixed with saline, but now
a minimum was used to create a “drier” mix
which is then applied over the site and a
dry gauze is placed over the material. Thus,
it was held by the assistant for 3-5 mins to
allow for the setting of the graft.
Once set, the granulation tissue was then
placed over the graft to improve soft tissue
healing (Fig. 12). The flap was sutured
closed using 4.0 PTFE, Coreflon (Coreflon
Poznan, Poland) suture. This procedure with
the granulation tissue is not the routine
protocol, but a one-off for this case and has
been used occasionally over the last 15 years.
Radiographically, the site looks well grafted
(Fig. 13) but remember as the CS element
resorbs, the x-ray will look less “white”.
Fig. 11: Insertion of Anyridge implant 3.5x11.5mm
into the “wet” EthOss
Fig. 12: Drier mix of EthOss, placed over the
implant and the granulation tissue placed over
the site
Ten weeks later and the site is now ready to
be restored. We see a healthy site, but we
have recession on tooth 26 (Fig. 14), possibly
a better flap design would have reduced
this. Radiographically, the material has
now turned over to host bone (Fig. 15) and
as stated, human bone does not show that
well radiographically especially on the early
phases as the organic component is not
radiopaque. Thus, it appears that the area
distal to the implant shows reduced bone
but in fact this will improve. A stock healing
cap was then fitted and a week later the site
was ready for an open tray impression (Fig.
16) with a restored profile.
Fig. 13: Radiograph showing implant in EthOss
grafted site
Fig. 14: Ten weeks post-op
One year later, we see the improved
outcome radiographically (Fig. 17). The distal
area is now looking well regenerated as the
new bone and periodontal ligament on the
first premolar. Clinically, the site is adequate
(Fig. 18) and will continue to be so. By now,
all the graft material would be resorbed, and
the new host bone will ensure good attached
host keratinised soft tissue. The site was
then scanned using a CBCT to assess the
area of teeth 26 and 27. At 18 months, we can
see bone regeneration both on the palatal
and buccal sides of the implant on tooth 25
(Fig. 19).
Fig. 15: Radiograph at 10 weeks post-op
Fig. 17-18: One year follow up showing good signs of healing
Fig. 16: Ready to load at 11 weeks
Fig. 19: CBCT scan at
18 months showing
new bone regeneration
28 DENTAL ASIA MARCH / APRIL 2023