Читать книгу Bone and Soft Tissue Augmentation in Implantology - Группа авторов - Страница 48

Pretreatment in the field of cariology, endodontics, and periodontics should be provided to the extent that the medium-term maintenance of the natural abutment is guaranteed. Where the abutment teeth have a limited prognosis, what must be carefully considered is whether the remaining teeth should be used for anchoring the prosthesis in the interim phase. Alternatively, a corresponding increase in patient comfort can be achieved by an immediate restoration on temporary or permanent implants.

If the cause of tooth loss is periodontal disease, the simple hygienic ability of a prosthetic superstructure should insure against it to some extent in the future, as it has been proven that a higher risk of peri-implantitis is present in edentulous patients.⁸⁴

In the case of a deep bite, a possible vertical reconstruction should be evaluated by functional bite plane treatment before starting the grafting procedures. This can prevent further complications during the prosthetic restoration. After determination of the ideal vertical height, the amount of vertical reconstruction should follow in such a way as to avoid a limited maxillomandibular relationship. A simulation of the prosthetic result using a wax-up may assist decision making, especially after traumatic looseness of the teeth and bone, which creates an open bite situation that complicates the finding of an adequate solution (Fig 2-11a to c).

Fig 2-10a Large bone defect with severe soft tissue scarring after several augmentation experiments with xenogenic material.

Fig 2-10b Failed augmentation with bovine bone substitute material. Part of the material spontaneously perforated the soft tissue.

Fig 2-10c Partially regenerated bone substitute material but with important infiltration in the soft tissue area.

Fig 2-11a Panoramic radiograph after treatment of a complex midfacial fracture with multiple osteosynthesis in the maxilla and the remains of an important bony defect in the anterior tooth area.

Fig 2-11b Fracture-related open bite.

Fig 2-11c Wax-up of the desired prosthetic result for the planning of a bone reconstruction with an autogenous graft.