An ideal vehicle is one that comfortably handles the easy path, but also the perils of rough terrain – this idea is not unlike solutions in augmentation. While hard barriers are excellent for structure, they may not be ideal under the delicate crestal gingiva – an area that must not be compromised in early healing. patient compliance, soft tissue tension or movement, and other risk factors are not rare in preprosthetic surgery.
For this reason, the resorb x® foil or resorb x® membrane is constructed into one or two walls to create a 4-wall defect. A collagen membrane is used to cover the hard tissue aug- mentation zone. Such collagen membranes offer the best soft tissue tolerance. This ‘shell technique’ pioneered by Dr. Gerhard Iglhaut has been used successfully in many applications since 2007. It is similar to the proven autogenous bone shell technique described by Dr. Fouad Khoury, which has been in use for horizontal and vertical augmentation for many years.
Augmentation with the Resorb x® alveolar protector are done according to the same principle as the shell technique. The innovation thereby is the alveolar protector itself, which recreates an exaggerated buccal wall - creating the 2mm goal around the implant neck. Since it is already shaped perfectly and three dimensionally stable, you only need to ensure there is sufficient bone on either side of the defect to secure a SonicPin Rx.
1 Soft tissue may require augmentation pre-operatively if tissue type is poor. The soft tissue management is the limiting factor to augmentations, and tension free closure is a must. Consider a crestal incision pattern, with vertical incisions only in the anterior region to avoid interrupted blood supply to the wound.
2 Predrill each hole immediately adjacent to the defect. If there is not enough space, you can move to the bone in between the next two teeth.
3 Place two to four Sonicpins rx® around the defect on the buccal side.
4 It is easier to create a curve in the barrier if you weld one side apical and crestal, then place the instrument in the defect. Next weld the apical pin on the other side without attempting to push the barrier against the crest. It will come easily to the bone in a curved shape on the final weld.
Alternatively, you may use a template and the waterbath to thermoplastically shape the barrier into any desired form.
5 Use the flat sonotrode surfaces for welding and smoothing rough edges. The round large sonotrode is for smoothing edges with the radius - this radius will make it more difficult to weld precisely.
6 After smoothing rough edges, overfill the defect with bone until it is dome-shaped. Next drape a collagen barrier over the crest.
Flap edges must come together without tension from the sutures. Consider two levels of suturing – a deep mattress suture to eliminate movement in a wide area of the augmentation zone, and then suturing of the flap edge.
Primary healing is critical and assisted by the diffusion-open collagen membrane that covers and cushions the augmentation and provides an additional barrier under the incision.
For more information on information from expert preprosthetic clinicians, see KLS Martin sponsored content on DentalXP, or during lectures or courses listed on our events calendar.
The information presented on this page is intended to demonstrate a KLS Martin® LP product. Please refer to package insert for the full list of indications, contraindications, warnings, precautions, and sterilization information. Always refer to the package insert before using any KLS Martin® L.P. product. Surgeons must always rely on their own clinical judgment when deciding which products and techniques to use with their patients.
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