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Case study

Implant placement with GBR

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Circumferential bone anchorage in the alveolar ridge is key to the long-term success of an implant. Therefore, bone defects at the implant site have to be corrected by means of GBR.

Prof. Daniel Buser | Switzerland

The same surgical technique with simultaneous GBR therapy presented in this case report has been used at our clinic since the turn of the century. In addition, the long-term result after 11.5 years is presented.


GBR with bone, biomaterial and membrane

The patient was referred after the extraction of two molars (36 and 37). The result was a local bone defect in region 36. The implant surgery took place about four months later. This involved a 10 mm long tissue level implant (Straumann AG, Basel) inserted in the correct prosthetic position with good primary stability. There was a medium-sized buccal bone defect with a favorable 2-wall defect morphology. This defect was filled initially with locally harvested, autologous bone chips and then covered with Geistlich Bio-Oss® granules. The graft was covered with a Geistlich Bio-Gide® membrane applied in a double layer. After the periosteal incision, the tension-free primary wound closure concluded the procedure. Five months later the implant was uncovered and prosthetic restoration was performed by the referring colleague.

The clinical examination after 11.5 years revealed a peri-implant mucosa that was free of inflammation, and the radiograph showed stable bone crest levels. A Cone Beam CT confirmed the existence of an intact buccal bone wall. 

What makes the method work so well?

Two long-term studies with CBCT imaging showed excellent results with regeneration of a buccal bone wall. These results can be attributed primarily to the applied biomaterials that complement one another optimally. The locally harvested autologous bone chips stimulate new bone formation across the defect area in the early phase of healing. This stimulation is caused by growth factors in the bone matrix that are passed into the surrounding blood clot. The Geistlich Bio-Oss® granules applied have the critical function of preserving the regenerated bone volume long-term.

Various histological studies have indicated that Geistlich Bio-Oss® has a very low substitution rate. Geistlich Bio-Gide® membrane made from non-cross-linked collagen is simple to apply, has few complications and acts as a barrier. And it does not have to be removed, because it is slowly absorbed by tissue. 

Prof. Daniel Buser

Prof. Daniel Buser | Switzerland

Department of Oral Surgery and Stomatology
School of Dental Medicine, University of Berne

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