Guided bone regeneration on a single tooth with horizontal and vertical bone loss Ji-Eun Song, Ji-Youn Hong, Chang-Sung Kim, Kyoo-Sung Cho, Chong-Kwan Kim, Seong-Ho Choi Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University bstract The presence of adequate bone width and height is an important requisite for the proper placement of dental implants according to the concept of restoration-driven implant. Guided bone regeneration(gr) technique has been widely used to correct ridge deformities. lthough the use of non-resorbable e-ptfe membrane in GR leads to a larger amount of bone formation the membrane can be prematurely exposed and infection can occur. In these cases, GR were performed with or without implant using the non-absorbable membranes. There were wide fenestrations of soft tissue and membranes were exposed, which are possibly associated with the patients heavy smoking. Dressing with chlorhexidine and medication was done for 4-5 weeks before membrane removal. Even though the quality and quantity of the regenerated bone was not as great as expected, it provided sufficient initial stability and support for the implants. In conclusion, GR is an effective treatment option for correcting horizontal and vertical ridge deformities. The prevention and proper management of complications can lead to improved results of GR. Key Words : guided bone regeneration, membrane exposure, smoking 96 Implantology Vol. 13, No. 2 2009
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case report 98 Implantology Vol. 13, No. 2 2009
Fig. 3. Preoperative clinical photographs (Lt: occlusal view, Rt: buccal view). 치 후에 당뇨와 흡연 등의 전신 요소와 관련하여 치유 과정이 Inc., Flagstaff, rizona)을 트리밍하여 구개측에 봉합하여 매우 불량했고, 협측골의 흡수를 보여 추후 임플란트 식립 시 고정하였다. 또한 부피 증강을 위하여 자가골의 표면측에 에 수평적 골재생술식이 필요할 것을 예측할 수 있었다(Fig. FD(Freezed dried bone)인 OraGRFT (LifeNet 3). 2개월의 치유 과정을 거친 후, 술전 진단 모형 및 방사선 HealthTM, US) 0.25g을 추가로 이식하였다. 차폐막은 사진을 통해, 구개측 골은 존재하지만 협측으로 수평 골소실 Frios pin(dentsply, Tulsa, Oklahoma)으로 협측골에 고 을 보이는 Seibert의 골결손부 분류 Class I defect 로 진단 정하고 봉합은 Gore-Tex silk를 사용하였다(Fig. 4~G). 하고, 임플란트 식립과 동시에 비흡수성 차폐막과 골이식재 를 사용한 GR을 계획하였다. 술 후 12일 째에 내원하였을 때에 차폐막이 노출되어 표면 에 치태가 침착된 양상을 보였다. 환자분 사정상 매일 내원할 직경 4.3mm, 길이 12mm의 Implantium (Dentium, 수 없어서, 3일에 한번 간격으로 chlorhexidine irrigation하 Korea) fixture의 식립 후에 예상대로 dehiscence가 5mm 고 Minocline(동국제약, Korea)을 주입하였다. 환자에게 지 정도 발생하였다. 이식 부위의 재혈관화 및 혈액 공급을 위하 속적으로 금연에 대해 강조하였으나 협조도가 좋지 않았다. 여 협측의 피질골 상에 decortication을 시행하고, bone 술 후 18일째에, 치태 침착을 줄이기 위해 노출된 차폐막의 일 scraper를 사용하여 주위에서 자가골을 채취하여 임플란트 부를 절제하였다. 다행히 창상 부위의 크기가 다소 감소하여, 표면에 이식하였다. 공간 형성 및 유지를 위하여 TR4Y e- 차폐막의 기능 유지를 위해 4주 정도 disinfection을 시행하 PTFE Gore-Tex membrane(w.l. Gore & ssociates, 였다(Fig. 5~C). 대한구강악안면임프란트학회 13권 2호, 2009 99
case report C D E F Fig. 4.. Dehiscence after the installation( 5mm).. utobone graft on buccal dehiscence and the fixation of e-ptfe membrane with a suture on palatal side. C. OraGRFT D. pplication of OraGRFT on buccal side. E. Fixation of e-ptfe membrane with pins. F. fter the suture. G. Postoperative periapical radiograph. Ji-Eun Song et al: Guided bone regeneration on a single tooth with horizontal and vertical bone loss. Implantology 2009 G 100 Implantology Vol. 13, No. 2 2009
Fig. 5.. Post-op. 12 days.. Post-op. 18 days. C C. Post-op. 4 weeks Fig. 6. Post-op. 4 weeks. one-like tissue under the membrane. 술후 4주까지 차폐막의 기능을 유지한 후 제거하였을 때, 차 봉합이 잘 유지되고 있음을 확인할 수 있었다(Fig. 7). 비교적 깨끗한 표면 연조직층을 관찰할 수 있었고, 차폐막 노 3개월 후에, 이차 수술을 시행하고 최종 보철물을 장착하였 출 부위의 직하방은 육아 조직을 보였으나, 노출되지 않았던 다. 수술 부위가 수평적 그리고 수직적으로 인접치아 및 치조 협측 부위는 골과 유사한 재생 조직을 보였다(Fig. 6). 골과 유사한 외형을 유지하고 있음을 확인할 수 있었고, 환자 일차 봉합을 얻기 위하여 구개측에서 vascularized interpositional palatal connective tissue(vip-ct) graft를 시 도 특별한 불편감 없이, 기능적, 심미적으로 만족스러운 결과 를 얻을 수 있었다(Fig. 8). 행하고 봉합하였다. 발사 당시 이식된 결합 조직편에 의해 일 대한구강악안면임프란트학회 13권 2호, 2009 101
case report Ji-Eun Song et al: Guided bone regeneration on a single tooth with horizontal and vertical bone loss. Implantology 2009 102 Implantology Vol. 13, No. 2 2009
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case report C D E Fig. 11.. Preoperative clinical photograph (Lt: buccal view, Rt: occlusal view).. fter the flap elevation. C. Fixation of e-ptfe membrane on palatal flap with suture. D. utogenous bone from Mn. Ramus with trephine. E. Fixation of e-ptfe membrane. 104 Implantology Vol. 13, No. 2 2009
F G Fig. 11.(계속) F. fter the suture. G. fter the suture (Mn. ramus area). H. Post-operative periapical radiograph. Ji-Eun Song et al: Guided bone regeneration on a single tooth with horizontal and vertical bone loss. Implantology 2009 H Fig. 12.. Post-op. 11 days. Post-op. 13 days C C. Post-op. 5 weeks 대한구강악안면임프란트학회 13권 2호, 2009 105
case report C Fig. 13.. Membrane removal.. Granulation tissue under the membrane. C. Removed membrane. Fig. 14.. VIP CT graft C. suture C. stitch-out D D. Post-op. 3 weeks. 여 얻어진 경조직이 8개월 후 임플란트 식립 시에도 인접골과 를 식립하였다. Final torque는 50N으로, 초기 고정을 얻는 유사한 골질로 잘 유지되고 있는 모습을 확인할 수 있었다 데 문제가 없었고, 보철물 완성 후에도 기능 및 심미면에서 별 (Fig. 15). 술 후 8개월 째에 Implantium 4.3mm 12mm 다른 불편감을 호소하지 않았다(Fig. 16). 106 Implantology Vol. 13, No. 2 2009
Fig. 15.. Installation of implant.. Periapical radiograph after the installation. Ji-Eun Song et al: Guided bone regeneration on a single tooth with horizontal and vertical bone loss. Implantology 2009 Fig. 16.. fter the final restoration. Follow-up (Lt: post-op. 12 months, Rt: post-op 17 months). Ji-Eun Song et al: Guided bone regeneration on a single tooth with horizontal and vertical bone loss. Implantology 2009 대한구강악안면임프란트학회 13권 2호, 2009 107
case report 108 Implantology Vol. 13, No. 2 2009
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