Journal of Oral Implantology August 2013 - (Page 409)

RESEARCH Rehabilitation of Surgically Relocated Integrated Dental ImplantsWithandWithoutBoneMorphogenesisProtein-2 Gilbert Tremblay, DMD* In the following case report, three osseointegrated implants placed in a dysfunctional and nonaesthetic position were successfully relocated with innovative surgical techniques were followed by a comprehensive dental rehabilitation. The goal of this report is to communicate the surgical techniques used to successfully relocate dental implants rather than replace them. Two techniques were used for these implants relocation. One technique consisted of displacing the integrated implant with some similarity to the alveolar distraction osteogenesis but without using the distraction device. The second surgical technique involved the displacement of the 2 adjacent implants, similarly to the first approach, except that an osseoinductive molecule, recombinant human bone morphogenetic protein-2, was used for guided bone growth. It was possible to relocate dental implants within bone blocs and rehabilitate them to adopt new dental abilities by complying with bone regeneration parameters. However, advanced treatment planning with computerized tomography scans, parametric software, and stereolithography models as well as guided surgery and bone regeneration products were used. Key Words: dental implant, bone graft, recombinant human bone morphogenetic protein-2, guided surgery, implant relocation, dental rehabilitation, osteotomy, segmentation, parametric software, stereolithography INTRODUCTION R elocating failing integrated dental implants can be a challenging procedure that involves some surgical risks. Conventionally, failing implants can be retrieved, bone grafted, and replaced. Poor positioning of integrated implants can be salvaged by complex abutment design or relocated by distraction-osteogenesis.1 This case study involves multiple implant complications that includes poor implant location with bone dehiscence, occlusion, and phonation concerns as well as aesthetic issues. An innovative approach was developed involving meticulous computerized tomography (CT) scan planning and guided surgery combined with biomolecular biology. Planning with a parametric software and stereolithography maxillary model, performing surgery with osteotomy Quebec Dental Implant Institute, Pierrefonds (Montreal), Quebec, Canada. * Corresponding author, e-mail: implant@bellnet.ca DOI: 10.1563/AAID-JOI-D-13-00077 guides and implant relocation guides, and using osteoinductive molecules enhance the guided bone remodelling and the surgical outcomes. This case also includes soft tissue engineering and predictable prosthetics. METHODS Clinical evaluation The patient described in this study is a 55-year-old woman with severe complications associated to her dental implant restorations. Her main complaints were that she cannot speak properly or chew with her restored dental implants. She also states having a tooth (#8) located ‘‘at the back of her dental arch’’ causing her discomfort and concerns about poor esthetics (Figure 1). The clinical exam reveals 7 dental implants located in the edentulous space of teeth #4–#10. Implant #8 is in fact positioned on the palate and is lying against the floor of the nasal cavity, restored with a porcelain fused to metal single crown, and Journal of Oral Implantology 409

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

Literary Responsibility—Everyone Has a Role to Play
Rehabilitation of Surgically Relocated Integrated Dental Implants With and Without Bone Morphogenesis Protein-2
Erratum
Marginal Fit of Implant-Supported All-Ceramic Zirconia Frameworks
Influence of the Implant Diameter With Different Sizes of Hexagon: Analysis by 3-Dimensional Finite Element Method
Autologous Dental Pulp Stem Cells in Regeneration of Defect Created in Canine Periodontal Tissue
Histologic and Biomechanical Evaluation of 2 Resorbable-Blasting Media Implant Surfaces at Early Implantation Times
Efficacy of Guided Bone Regeneration Using Composite Bone Graft and Resorbable Collagen Membrane in Seibert’s Class I Ridge Defects: Radiological Evaluation
Minimal Iliac Bone Harvesting in Sinus Lift Surgery
Functional Load in Oblique Bicortical Implants: Parasinusal Implants and Palatine Implants
Ultrasonic Oscillations for Conservative Retrieval of a Rare Fracture of Implant Healing Abutment
Craniofacial Implant-Retained Auricular Prosthesis: A Case Report
Gingival Conditioning in an Implant-Supported Prosthesis: A Clinical Report
An Early Loaded Implant-Supported Mandibular Complete Arch Fixed Prosthesis in a Young Completely Edentulous Patient: A Case Report
Computer Guided Surgery for Implant Placement and Dental Rehabilitation in a Patient Undergoing Sub-Total Mandibulectomy and Microvascular Free Flap Reconstruction
Guided Bone Regeneration for Socket Preservation in Molar Extraction Sites: Histomorphometric and 3D Computerized Tomography Analysis
Osseointegration of Dental Implants and Osteonecrosis of the Jaw in Patients Treated With Bisphosphonate Therapy: A Systematic Review
Review of Current Literature

Journal of Oral Implantology August 2013