Placement of a dental implant in optimal position with guided bone regeneration

Guided bone regeneration is the most predictable surgical procedure for the treatment of peri-implant bone defects. The surgical procedure and the results obtained are explained below.

The placement of implants in the jaws and their subsequent integration is a widely known fact. The treatment assumes osseointegration and the objective is not only functional but also esthetic, regardless of the amount of bone present in the patient and the state of the soft tissues, in order to ensure long-term stability.

To achieve the desired esthetic appearance, excellent prosthodontic treatment (color, crown shape, etc.) is not always sufficient; the implant must be placed in an “optimal position” with respect to the prosthesis to be created, so that the implant-supported crown has a harmonious gingival appearance with respect to the neighboring teeth, ensuring a natural appearance of the implant-supported crowns.

It is important that, in order for the gingival margins to remain stable over time, the implant has a 2mm thick bone table throughout the implant, especially in the critical area. This will ensure the stability of the soft tissues around the implant and the implant itself. However, the main obstacle to achieve this goal is the absence of sufficient bone in the alveolar ridge. If there is not a correct crest, it will make it difficult to place the implant in optimal position and, when it can be done, a dehiscence (bone defect) will occur.

Surgical technique: Guided bone regeneration
Guided bone regeneration is the appropriate method to solve this type of complications.
In cases in which when placing the implant stably in its ideal position a bone defect occurs, it is possible to perform guided bone regeneration simultaneously with implant placement. This is simultaneous bone regeneration of peri-implant bone defects (dehiscence), using resorbable collagen membrane and autogenous bone.

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Clinical Case
This technique was used in this case of a patient operated with a single implant. To solve the large dehiscence produced by lack of bone caused, in turn, by severe periodontal disease, guided bone regeneration with resorbable membrane and autogenous bone of the maxillary tuberosity is performed by the expert in Dentistry and Stomatology.

Surgical intervention of guided bone regeneration and results obtained
Due to the small amount of the patient’s bone, the placement of the implant in its ideal position implied the need to cover a severe dehiscence. To solve this problem, an autogenous bone graft was placed in the area of the maxillary tuberosity. This graft was placed on the vestibular surface of the implant and, to ensure its correct integration, the graft was covered with resorbable collagen membrane. Likewise, to ensure the mechanical stability of the graft and the membrane, the latter was fixed to the adjacent bone with titanium pins and sutured.

Healing went smoothly and six months later a second surgical intervention was performed to remove the titanium pins. In this intervention, complete bone regeneration was observed on the vestibular surface of the implant, with a vestibular table thickness of more than 2mm, which will ensure the maintenance over time of the marginal gingival levels of the implant-supported crown.

After checking the periodontal stability of the remaining teeth and the stability of the hard and soft tissues around the implant, an implant-supported ceramic crown and ceramic veneers were placed on the adjacent teeth.