EpiGuide Case Reports
Cases by: Dr Frederic Hermann, AZZ Ambulantes Zahnmedizinisches Zentrum
Case #1: Periodontological Indication
The patient was 39 years old at baseline. Her general health was good. Extraoral examination did not reveal any pathological findings. The intraoral situation was characterized by soft and hard supragingival concrements. All teeth exhibited positive sensitivity. The gingival margin in all quadrants exhibited only moderate localized inflammatory changes. A swollen and reddened interdental papilla was found between teeth 15 and 16. Probing depths were between 2 and 4 mm, locally reaching 8 mm at 15 and 16. No pathological tooth mobility was present.
The radiological examination showed pronounced radical bone defect reaching the apical third (Figures 2 and 3, pre- and postoperative radiographs).
The microbiological examination of the subgingival plaque demonstrated the presence of Actinobacil lus actinomycetemcomitans and, in connection with the clinical findings, motivated a diagnosis of localized aggressive periodontitis.
Treatment
The surgical therapy was preceded by anti-infectious therapy, consisting of closed subgingival curettage accompanied by antibiotics (amoxicillin + metronidazole; Van Winkelhoff, 1989) and 0.12% chlorhexidine digluconate rinses. When the result of the treatment was assessed 10 weeks later, probing depths of 7 mm persisted at teeth 15 and 16. Subsequent surgical therapy provided for the regeneration of the intraosseous defect using the new resorbable Epi-Guide® barrier matrix (curasan AG, Kleinostheim, Germany) for guided tissue regeneration. Based on the morphology of the defect as uncovered intraoperatively (two-walled defect), additional support was consciously provided by applying a bone regeneration material (B-TCP/Cerasorb® M, 500–1,000 µm, curasan AG) to preserve the cavity. The surgical procedure is illustrated in Figures 4 to 11. The membrane and flap were additionally stabilized by an offset suture with resorbable suture material above the defect area. Vertical interrupted sutures were used to reposition the papilla.
Outcome
The wound healing process was free of complications. An attachment gain of 2.5 mm was subsequently measured. A slight papillary recession of 1 to 3 mm in the regeneration area is frequently seen and could not be predictably avoided even in this case despite the use of microsurgical methods and papilla preservation techniques. The patient should always be fully informed of this risk ahead of the operation, especially in the case of procedures in the esthetic zone. Probing depth decreased to 3 mm, which is a level that the patient can easily maintain, yielding a favorable long-term prognosis of freedom from inflammation if regular recalls are made.
Case #2: Implantological Indication
The patient was 67 years old at baseline. His general health was good. Extraoral examination did not reveal any pathological findings. The alveolar range between teeth 13 and 23 showed moderate vertical and pronounced horizontal atrophy. Following periodontological pretreatment, the existing maxillary telescopic restoration increasingly lost its retention, and it was decided to add abutments by implantological means. In addition, the patient requested a fixed restoration without a palatal bar.
Treatment
Following a minimally invasive incision along the top of the alveolar ridge (13–21) and mobilization of a mucoperiosteal flap, placement of a Revois® implant was accompanied by concurrent widening of the alveolar ridge using the bone-splitting technique. Following placement of the implant, the crestal aspect of the vestibular bony lamella fractured and developed a dehiscence, which was augmented with B-TCP (Cerasorb® M, 500–1,000 µm, curasan AG) and covered with a resorbable membrane (Epi-Guide®, curasan AG; see Figures 12 to18).
Outcome
After tension-free primary wound closure, wound healing proceeded without complications, with no membrane exposure or inflammatory reactions. The vestibular contours of the alveolar ridge could be restored in their entirety.
1. Use of biodegradable polylactic acid barrier materials in the treatment of grade II periodontal furcation defects in humans–Part I: A multicenter investigative clinical study. Int J Periodontics Restorative Dent. 1998 Dec;18(6):572-85. Vernino AR et. al.
2. Guidor is a registered trademark of Sunstar Americas, Inc.
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