logo 17 • CAMLOG Partner Magazine • March 2018 20 Dr. Alexander Volkmann, Jena INSERTION OF TWO-PIECE CERAMIC IMPLANTS WITH SIMULTANEOUS GBR – A SUCCESSFUL PROCEDURE WITH COORDINATED COMPONENTS Fig. 3: Mixing the bone augmentation material MinerOss®-X with autologous bone chips and autologous blood of the patient. Edentulous gaps in older patients are usually associated with atrophied alveolar ridges. In such cases, bone augmentation measures are usually required in order to align the implants correctly for the prosthesis and thus maintain function and esthetics over the long term. Membrane-protected Guided Bone Regeneration (GBR) is an extensively documented procedure for the restoration of sufficient and stable bone volume [1,3]. Inorganic alloplastic granules such as MinerOss®-X and resorbable membranes such as Mem LOK Pliable (both BioHorizons from CAMLOG, Wimsheim) have a proven track record and are the clinical standard. Implant prosthetic restorations with ceramic implants require a strictly planned and considered procedure in all respects. This applies not only to the selection of a suitable implant system but also to the use of a suitably matched material for bone augmentation. Only an augmentation material with an absorption rate more or less equal to bone growth results in the desired bone regeneration by essentially degrading completely, allowing newly formed bone to attach to the implant surface and produce the necessary BIC. The augmentation material is stabilized with an absorbable barrier membrane. The bone augmentation material MinerOss®-X from BioHorizons (CAMLOG, Wimsheim) is extracted from bovine bone and has a mineral structure similar to that of human hard tissue. During the production process, all protein structures are removed, leaving behind a de-proteinized inorganic matrix with no cellular or organic components. The resulting hydroxyapatite skeleton has a purely osteoconductive effect. As the formation of new bone is linked to blood vessels, endothelial cells and preosteoblasts can grow or revascularize into the framework from adjacent tissue (angiogenesis and ossification). Implantation with simultaneous GBR The atrophied bone is exposed using a mucoperiosteal flap and the implantation is performed according to the protocol. Three CERALOG® Hexalobe ceramic implants, each with a diameter of 4 mm, were placed subgingivally in regions 16, 14 and 13 at 12–30 Ncm. The two-piece ceramic implant has a reduced roughness in the neck area of 0.5 µm RA compared to the endosteal area with a roughness of 1.6 µm RA. This optimizes attachment of peri-implant soft tissue and bone cells. Before filling with the bone augmentation material MinerOss®-X, the implants are covered with a cover cap for submerged healing. In order to fill the buccal bone deficit, MinerOss®-X cancellous bone granules are mixed with autologous bone chips extracted from the drilled shafts as well as with the patient’s blood. In order to promote optimal ossification, the bone augmentation material should only be applied in direct contact to well-vascularized bone. The membrane for covering the augmentation material is first inserted from the palatal side. (Figs. 1 to 6) Fig. 2: Inserted CERALOG® Hexalobe ceramic implants in regio 16, 14 and 13 with buccal fenestration in regio 14. Fig. 1: Exposure of the bone defect with a mucosal flap. CASE STUDY
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