Planning the upper first molar regenerative therapy in siginificantly reduced hard and soft tissues - a case report

Napredovanjem tehnologije i produljenjem životnog vijeka ljudi razvila se potreba za pružanjem adekvatne medicinske skrbi kako bi se unaprijedilo zdravlje i poboljšao životni standard. Napredak znanosti i uvođenje novih tehnika i materijala doveli su i do razvoja u dentalnoj medicini. Zato se za nadomještanje izgubljenih žvačnih jedinica sve više koriste dentalni implantati. Dentalna implantologija kao grana stomatologije objedinjuje više stomatoloških područja. Sve započinje kliničkim i radiološkim pregledom, nakon čega se pristupa planiranju i dogovoru s pacijentom. Sljedeći koraci objedinjuju znanja iz kirurgije, parodontologije i protetike. Za konačni funkcionalni i estetski izgled izuzetno je bitna dobra komunikacija i suradnja sa zubotehničkim laboratorijem. U održavanju implantoprotetskog rada izuzetno su važni dobra oralna higijena i redoviti kontrolni pregledi. Svrha ovog rada je na kliničkom slučaju prikazati sve postupke koji prethode postavi implantata u području prvog gornjeg molara, ugradnju implantata i njegovu opskrbu protetskom komponentom. S obzirom na defekt bukalne kosti i pneumatizaciju sinusa koja je nastala nakon vađenja zuba najprije se pristupilo augmentaciji rezidualnog alveolarnog grebena i podizanju sinusa. Zbog nedostatka keratinizirane sluznice već pri prvom operativnom zahvatu stavljen je ksenogeni kolageni matriks kao zamjena za slobodni vezni transplantat. Nakon osam mjeseci dobivena je zadovoljavajuća količina nove kosti i mekog tkiva. U drugom operativnom zahvatu ugrađen je implantat. Nakon dva mjeseca postavljen je konfekcijski vijak za oblikovanje periimplantatne sluznice. Nakon toga uzet je otisak i izrađen te predan konačan funkcijski i estetski zadovoljavajući implantoprotetski rad. Kirurškim i protetskim postupcima postignuta je optimalna harmonija tvrdih i mekih tkiva te je vraćena žvačna funkcija. Vođenom regeneracijom kosti i mekih tkiva, ugradnjom dentalnog implantata i odabirom odgovarajućih materijala nadomješten je izgubljeni zub na kraju terapije.New technological developments and the increase of the human lifespan resulted in a greater need for more adequate medical care, which would better the overall health and improve the living standard. Scientific progress and the introduction of new techniques and materials have also led to new developments in dental medicine. Due to said developments, dental implants are used more and more to replace lost masticatory units. Dental implantology, as a branch of dentistry, encapsulates several fields of dentistry. The first steps are the clinical and radiological examinations, after which the next steps are planned and discussed with the patient. The next steps of the process involve expertise from the fields of surgery, periodontology and prosthodontics. Quality communication and cooperation with the dental laboratory is crucial for the final functional and aesthetic appearance of the teeth. Good oral hygiene and regular check-ups are vital for the maintenance of the implant prosthetics. The purpose of this paper is to portray, on a clinical case, all the procedures that precede the placement of the implants in the maxillary first molar area, the implant’s installation and its provision with a prosthetic component. Due to the buccal bone defect and sinus pneumatization which appeared after the tooth’s extraction, an augmentation of the residual alveolar ridge and a sinus lift were firstly performed. Due to the lack of a keratinized gingiva, the patient received a xenogenic collagen matrix during the first surgery, as it would serve as an alternative to connective tissue graft. After eight months, a satisfactory amount of new bone and soft tissue was achieved. An implant was installed during the second surgery. A prefabricated screw was installed two months later in order to shape the peri-implant tissue. After that, a cast was made and the final functionally and aesthetically satisfactory implant prosthetic work was submitted. The optimal harmony between hard and soft tissues was achieved and the masticatory function was restored through surgical and prosthetic procedures. By managing the bone and soft tissue regeneration, and through the installation of dental implants and the correct choice of materials, the lost tooth was successfully replaced