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In-Situ-Grafting Procedure |
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In order to make implant
restorations look natural, we have to know prior
to surgery where in the 3-dimansional space the
future tooth needs to be, in order to satisfy
esthetic as well as functional requirements.
This sometimes forces us to employ grafting
techniques of one form or another, especially
when there is not sufficient bone available (due
to resorption) to place the implant properly.
Below is an example, where an implant was placed
and a localized In-Situ grafting procedure done
at the same time. Again, please bear in
mind that the images are somewhat graphic in
nature. |
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In the pre-operative picture on the left
you can see that this patient is missing a central
incisor. Clinically there appears to be just a minor
defect, hinting a straightforward placement of the
implant. The image on the right shows the initial
incision. |
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To the left we see the bony
ridge after the tissues are reflected somewhat.
From this angle the ridge seems to be adequate.
However, when we place an indicator pin (used to
gauge the angulation after the initial pilot
hole is drilled) and shift the angle so that we
look directly onto the incisal edges of the
teeth, we see that the bone ridge is very thin
(arrow). |
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Once the implant is inserted
into the bone it has threads exposed, as you can
see on the left image (arrow). Sometimes we
have to take this into account in order to place
the implant in the proper position. If we
placed it a little more to the inside (where
there is plenty of bone) the future esthetics
and the implant’s biomechanical loading
characteristics would have been compromised.
The exposed threads are covered with some
Autogenous Bone (collected from the bone
drills) and the graft site is then covered with
a membrane (white). |
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On the left an right are
clinical images at 3-month post-op. Notice the
exceptional healing of the tissues. |
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To the left you can see the
implant during the
Uncovery
Procedure, where a the membrane is removed
and a healing collar placed. Here you can see
the membrane still in place (arrow). On the
right you can see the implant with the healing
collar in place and the membrane removed.
Notice that the threads are now covered (arrow)
with a bony substance (still very immature bone,
which will mature in the future). |
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The image on the left shows
the tissues sutured around the healing collar.
Prior to actually placing the healing collar, an
impression was taken for a temporary crown,
which will be fixed to the implant at the time
of suture removal, ten days later. To the right
is a clinical image of the site ten days after
the uncovery. At this point the sutures and the
healing collar are removed and the temporary
crown is placed. |
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The
picture above shows
the soft tissue condition after the temporary
(acrylic) crown had been in place for about
eight weeks. At this time the tissues were
mature enough for a final impression to be taken
and a permanent porcelain crown to be made. To
the left you can see the final porcelain crown
in place. Notice how we achieved even gum
architecture around the implant, blending in
fairly well with that of the natural teeth. |
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