Journal of Oral Implantology June 2013 - (Page 355)

CASE REPORT Bone Regeneration Around Immediate Implants Utilizing a Dense Polytetrafluoroethylene Membrane Without Primary Closure: A Report of 3 Cases Jonathan Waasdorp, DMD, MS1* Sylvan Feldman, DDS, MLA2 Case reports document successful use of a high-density polytetrafluorethylene membrane to augment horizontal defects associated with immediately placed implants. This membrane, which is designed to withstand exposure (not require primary closure) to the oral cavity because it is impervious to bacteria, reduces the need for advanced flap management to attain primary closure. Thus, the surgical aspect is less complex and the mucogingival architecture of the area can be maintained. These cases demonstrate successful use of this application and provide evidence for controlled clinical trials to further evaluate this technique. Key Words: dental implant, bone, alveolar ridge augmentation, membranes INTRODUCTION T he immediate placement of dental implants into extraction sites is a predictable, successful procedure.1,2 After insertion of the implant, the horizontal distance between the walls of the socket and surface of the implant may require augmentation and/or soft tissue exclusion to predictably achieve bone-implant contact3,4 and prevent soft tissue ingrowth associated with natural socket healing.5 Socket healing begins with clot formation, which then supports development of granulation and connective tissue, followed by osteoid formation and bone maturation.5,6 Bone formation begins at the apical and lateral socket walls, and epithelial downgrowth occurs at the coronal aspect of the socket fundus. Various barrier techniques have been used to inhibit epithelial migration and soft tissue formation on the coronal aspect of the implant through augmentation of the horizontal defect and/or soft 1 University of Pennsylvania, Philadelphia, Pa. University of Maryland, Baltimore, Md. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-10-00128 2 tissue exclusion;7,8 evidence suggests that expanded polytetrafluoroethylene (ePTFE),8,9 collagen,10 and autogenous connective tissue barriers11 can be successfully used. Typically, primary closure is much desired with guided bone regeneration using collagen and ePTFE membranes,12 a technique that increases surgical complexity, increases patient morbidity, and disrupts the soft tissue architecture of the area. Furthermore, the occurrence of wound dehiscence has been shown to be detrimental to bone formation,12 and resorption patterns of exposed resorbable barriers can be unpredictable.13 To overcome this limitation, membranes made of high-density polytetrafluoroethylene (dPTFE), which are nonresorbable and designed to withstand exposure to the oral cavity because of their microporosity, can be a useful alternative because their pore size makes them impenetrable to bacteria and epithelial cells. Limited evidence suggests that these membranes are efficacious in bone augmentation and socket grafting applications.14–17 Hoffman et al,18 in a retrospective human study, found that intentionally exposed dPTFE membranes, left in place for 4 weeks, predictably preserved the hard and soft tissue in extraction sites and supported socket bone Journal of Oral Implantology 355

Table of Contents for the Digital Edition of Journal of Oral Implantology June 2013

Congratulations to Duke Heller, DDS, MS—Pioneer, Teacher, and Mentor
In Vitro Analysis of Resistance to Cyclic Load and Preload Distribution of Two Implant/ Abutment Screwed Connections
Mandibular Implant-Supported Overdenture: An In Vitro Comparison of Ball, Bar, and Magnetic Attachments
An Exploratory Study on Assessment of Gingival Biotype and Crown Dimensions as Predictors for Implant Esthetics Comparing Caucasian and Indian Subjects
A New Approach to the All-on-Four Treatment Concept Using Narrow Platform NobelActive Implants
Regular and Switching Platform: Bone Stress Analysis With Varying Implant Diameter
Comparison Between Immediate and Delayed Laser-Treated Implants Surface With Switching Platform: A Clinical Retrospective Study
Effect of a Multiporous Beta–Tricalicum Phosphate on Bone Density Around Dental Implants Inserted Into Fresh Extraction Sockets
The Effect of Varying Implant Position in Immediately Loaded Implant-Supported Mandibular Overdentures
Bone Regeneration Around Immediate Implants Utilizing a Dense Polytetrafluoroethylene Membrane Without Primary Closure: A Report of 3 Cases
Socket Preservation and Sinus Augmentation Using a Medical Grade Calcium Sulfate Hemihydrate and Mineralized Irradiated Cancellous Bone Allograft Composite
Implant Placement and Immediate Loading With Fixed Restorations in Augmented Sockets. Five-Year Results. A Case Report
Immediate Placement and Provisionalization With Buccal Plate Preservation: A Case Report of a New Technique
Clinical Importance of Recipient Site Characteristics for Vertical Ridge Augmentation: A Systematic Review of Literature and Proposal of a Classification
Postextraction Implant in Sites With Endodontic Infection as an Alternative to Endodontic Retreatment: A Review of Literature
Letter to the Editor

Journal of Oral Implantology June 2013