Immediate Implant Dentistry and the Selection of Biomaterial to Fill the Gap: Use of Xenografts with Incorporated Atelo-Collagen

Ferdinando D Avenia,Richard Miron

doi:10.21767/2471-3082.100044

Abstract

Immediate implant dentistry has become an effective treatment modality for many clinicians to shorten treatment times. Naturally, while these implants are placed more lingually/palatally and a gap is created between the buccal bone and implant surface, an oftenoverlooked parameter has been the choice of biomaterial/bone graft utilized to fill this void. In the present case study, the introduction of an atelo-collagen based bone grafting material is presented with superior biocompatibility owing to the reduction in immunogenic properties of animal-based collagen. Since xenograft bone biomaterials are commonly devoid of all collagen and growth factor content (reducing their potential for causing an immune response), the recent development of a natural bovine bone mineral containing atelo-collagen type I has favoured atelo-collagen-incorporation within the bone matrix of xenografts. In the present case report, a vertical root fracture on a previously endodonticallytreated right upper first premolar was extracted and an implant was immediately placed. The gap was then packed with an atelo-collagenized xenograft bone graft. A 20-month healing period is provided. This article aims to provide the clinician with a better understanding of the processing steps required to turn collagen into atelocollagen via atelopeptidation and lyophilization technologies and results in a modification to the immunecollagen component of collagen to non-immunogenic atelo-collagen.

Highlights

The placement of immediate implants into fresh extraction sockets has become routine for many surgically-based clinicians aiming to speed treatment modalities
If a proper selection criterion is not enforced, there is an increased risk of implant exposure to the midfacial implant surface from mucosal recession, which in certain clinical studies has been reported to occur as high as 40% of the time in immediate implant dentistry cases [8,9,10]
In the present case report, we demonstrate how the use of atelocollagen derived bone grafts and a barrier membrane were utilized in an immediate implant case to fill the implant gap

Summary

Introduction

The placement of immediate implants into fresh extraction sockets has become routine for many surgically-based clinicians aiming to speed treatment modalities. Many studies (both pre-clinical and clinical with/without implants) have found marked dimensional alterations occurring post extraction if no biomaterial is utilized [3,4,5]. First the presence of a thin buccal wall, often characterized as less than 1 mm, is more prone to resorption [3,4,6,7] This remains prominent especially in the esthetic zone where the buccal plate is often thinner than 1 mm [6,7]. If a proper selection criterion is not enforced, there is an increased risk of implant exposure to the midfacial implant surface from mucosal recession, which in certain clinical studies has been reported to occur as high as 40% of the time in immediate implant dentistry cases [8,9,10]. Plausible factors that may be responsible for these unsatisfactory esthetic outcomes include 1) facial bone wall thickness, 2) tissue biotype, 3) implant type, 4) implant size and 5) implant positioning [11,12]

Objectives

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Discussion

Conclusion