I have found that treatment concepts in modern dentistry are getting more complex and patients are now seeking not just a functional tooth replacement, but a more holistic approach that takes account of the ideal placement of the implant coupled with the desired aesthetic outcome. To achieve these goals, I find myself using grafting materials on a significant proportion of my cases, and to meet the challenges of each case, I need a complete range of integrated regenerative solutions, including bovine, synthetic, allografts, collagen, granules, blocks, membranes and soft tissue matrices, all with predictable outcomes.

We all know no single bone graft or soft tissue biomaterial is able to suit all medical needs, biologic situations and indications. A variety of factors (indication, age, hygiene, biotype, bone height, treatment plan) requires a sophisticated approach with different, coordinated products. However, for many of my cases I have used botiss maxgraft® which is a processed human allograft and has a matrix most similar to a patient’s own bone. It delivers strong structural support, rapid bone regeneration and volume preservation with a high osteoconductive potential. The maxgraft® product family is a safe and established alternative to autologous bone as the granules are 100% derived from living donor bone processed under pharmaceutical conditions by the Cells and Tissue Bank Austria (C+TBA).

Botiss maxgraft® comes in a number of formats, including granules, blocks and bonerings which covers most clinical situations. Granules are the ideal choice for ridge augmentation, ridge reconstruction and for filling osseous defects or extraction sockets and can be used for sinus floor elevation.

Bonering Technique

I have used the bone ring technique on a number of cases and the introduction of maxgraft® bonerings into the market has enabled me to reduce surgery time considerably. The significant benefits of this technique are that augmentation and implantation can be performed in a single step; it is significantly less invasive than most other augmentation techniques. This reduces the overall treatment time and costs.

I recently published a clinical case of a 71-year-old lady who presented with a loose upper front retained post crown, and she was concerned this would come out at any moment. The patient had medical complications as she suffered from atrial fibrillation and was a long-term warfarin patient. The INR was stable in a range of 2 – 2.5, but clearly we would need to manage the haematological complications that would ensue. See figs 1 & 2, below.


We decided to remove the upper central incisors and fit an immediate acrylic denture to remove the acute infection. We reassessed at 8 weeks following soft tissue closure, with a CBCT scan to evaluate the hard tissue healing post extraction and this confirmed the need for some form of hard tissue augmentation procedure to enable successful implant placement.

With the loss of the buccal plate it was agreed we needed a block grafting procedure and to prevent multiple surgical interventions, we discussed using the bonering technique which would enable simultaneous block grafting and implant placement. We also discussed using an allograft to prevent the need for a second donor site surgery and the complications this could entail – especially given the patient’s medical history and compromised clotting pathway.

Following successful implant placement and integration of the allograft bonering (botiss maxgraft® bonering) we successfully restored with screw retained individual crowns. Clearly the use of an allograft bone material as an alternative to harvesting a block graft in a medically compromised patient was a distinct advantage. The ability to combine implant placement and block grafting into a single visit again reduced invasiveness and healing times and consequently overall treatment time by approximately 2 months. See figs 3 & 4, below.

Fig 3 - final aesthetic result

 

Fig 4 X-ray shows excellent bone levels
Click here to view the full case.

Larger Grafts

When it comes to larger areas which would usually need the harvesting of autologous bone, maxgraft® bonebuilder is a good choice as it is individually designed and millled to the desired 3-dimensional bone contour. Based on planning data and clinician-approval, the bonebuilder is provided in a sterile condition ready for implantation. Designed to fit the site perfectly maxgraft® bonebuilder is easy to apply to the recipient site and provides maximum contact between graft and bone for improved vascularisation. The healing results of maxgraft® bonebuilder are impressive, providing enormous added value for patients and treatment providers.

I find patients very accepting of allograft and will only opt out if they have religious concerns or a simple personal preference. I typically go into detail about the materials I recommend and rarely does a patient reject the allograft once they understand how safe it is. The Straumann bone regeneration and biomaterials offer me predictable remodelling and resorption, so I can pick the product that best meets myspecific clinical needs.

The botiss regeneration system offers a unique systematic Bone and Tissue Regeneration (BTR) approach offering the complete regenerative biomaterial portfolio for implantology, oral surgery and periodontology from one company, which I find very beneficial.

Ross will be presenting an Advanced Guided Bone Regeneration Course on Friday 23rd June 2017 in Bristol.

This course is a lecture and hands-on day designed to deliver the essentials of Guided Bone Regeneration using the latest botiss materials and Advanced Bone Ring technique. The course is great value at £165 + VAT (Early bird before 31st May) or the Normal fee – £199 + VAT.

Click here to read more about Ross’s lecture.

To reserve your place, please call the Straumann Education Department on +44 (0) 1293 651270 or email events.uk@straumann.com

 

Dr Ross Cutts, BDS (Lond) Dip Imp Dent RCS (Eng)

Dr Ross Cutts

Dr Ross Cutts is the Principal Dentist at Cirencester Dental Practice and Stow-on-the-Wold Dental Practice


Ross graduated from Guy’s Hospital, London, in 2000 and has studied implant dentistry across the UK, Europe and North America and has a Diploma in Implant Dentistry from the Royal College of Surgeons, London. He is a committed fellow of the International Team for Implantology (ITI) – and is a Study Club Director and clinical mentor. As well as being a fellow of the ITI, he is also a member of the Association of Dental Implantology (ADI) and the Royal College of Surgeons (RCS). His commitment to Cosmetic Dentistry maintains his Full Membership of the British Academy of Cosmetic Dentistry (BACD). He lectures nationwide on a variety of topics but has a particular interest in Aesthetic Implant Dentistry.

Would you like to understand more about guided bone regeneration using botiss allograft materials & the bone ring technique? On Friday 23rd June 2017 at the Bristol Veterinary School Ross Cutts will present a lecture and hands-on day designed to deliver the essentials of guided bone regeneration using the latest botiss materials and advanced bone ring technique. The course is ideal for clinicians looking to improve/refresh their surgical skills and patient outcomes. It will cover more complex vertical and horizontal bone augmentation techniques with allogenic bone blocks and bone rings, in addition to techniques for a tension free wound closure.

Click here to read more about Ross’s lecture.

For more information or to reserve your place, please call the Straumann Education Department on +44 (0) 1293 651270 or email events.uk@straumann.com

To find out more about the Straumann range of biomaterials, contact Straumann on 01293 651270 or visit one of our sites:

straumann.co.uk

therevu.co.uk

Facebook: Straumann UK

Twitter: @StraumannUK

 

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