In the first case, two bar-supporting implants have an advanced, combined (supra- and intraosseous) defect configuration with vestibular dehiscences and a supracrestal exposed screw thread (>1 mm). In such cases, after completely removing the granulation tissue, we start out by performing plastic surgery on the implant to smooth the implant body in the supracrestal and buccal defect region. The portions of the implant surface facing the defect are structurally preserved and decontaminated (e.g., with a curette, Er:YAG laser and sterile saline solution).
The intraosseous defect components are then augmented with a slowly resorbing bone replacement material. This is covered with a collagen membrane before the soft tissue flap is adapted tightly around the implants.
The second case involves circumferential intraosseous defects with a supracrestal component (<1 mm) on two adjacent implants. Such defects can be regenerated using bone grafting without implantoplasty.
Bleeding and purulence on two implants in regio 33 and 34.
The radiograph shows supracrestally exposed implant components.
An advanced supra- and intraosseous defect is visible.
Condition after implantoplasty for smoothing the implant body in the supracrestal and buccal defect region.
The intraosseous defect area is filled with Geistlich Bio-Oss®.
The Geistlich Bio-Gide® collagen membrane cut to size in situ.
The edges of the wound are adapted tightly around the implants.
Clinical situation free of inflammation at 18-months.
Radiograph after 12-months – the structured implant components are covered at the bone level (Photos: Frank Schwarz).
Circumferential intraosseous defects with a supracrestal component about 1 mm in size.
After removing the granulation tissue and decontaminating the implant surface, the defect is filled with Geistlich Bio-Oss® and covered with Geistlich Bio-Gide®.
The radiograph 8-years after therapy proves the long-term stability and shows complete filling of the bone defect (Photos: Frank Schwarz).
Your Comment