55668 ackermann-e
8.6.2006
9:29 Uhr
Seite 1
Background information
Bone augmentation only after the soft tissue healing has been completed
Karl-Ludwig Ackermann:
«When there is a large defect in the soft tissue situation, wound closure over the extraction wound is only possible with significant soft tissue manipulation, if it is possible at all.
Such manipulations can not only damage soft tissue esthetics, they also pose a high risk for
post-operative wound dehiscenses. Therefore, bone-regenerating procedures are not yet indicated at the time of extraction. This is because for an optimal bone augmentation, one
needs complete coverage and protection of the defect.»
Fig 7 The Bio-Gide® is sutured
Fig 8 An adhesive bridge serves as a securely-set, temporary tooth substitute.
Fig 9 2 weeks after extraction, granulation
tissue covers the socket.
Fig 10 6 months after extraction, the soft
tissue is in good condition.
Fig 11 After a flap procedure, one sees bony
tissue that has formed in the extraction
socket.
Fig 12 After implantation, one sees a fenestration defect that must be treated using
an augmentation procedure.
Fig 13 Positioning and fixation of a BioGide® Membrane. Resor-Pins® are used for
fixation.
Fig 14 Bio-Oss® and autologous bone are
applied over the fenestration defect. The
slowly-resorbing Bio-Oss® protects the augmented area from premature resorption
and thus ensures optimal soft tissue facial
esthetics.
Fig 15 The Bio-Gide® is placed over the
augmented area and 2 Resor-Pins® are additionally fixed on the lingual aspect. The
Bio-Gide® not only holds the granulates in
place, but also ensures that there is good
soft tissue healing.
Fig 16 The palatal incision and the vertical
relief cut are sutured to close the soft tissue flap.
Fig 17 1 year after extraction, the final
prosthetic reconstruction takes places.
Fig 18 13 months after tooth extraction,
one sees an optimal soft tissue course with
intact papillae.
2. Aims of the therapy
> Optimal healing of the keratinized gingiva with respect to its structure, thickness and contour.
With the follow-up operation, there is thus an ideal amount of soft tissue available for the implantation and the augmentation.
> Prevention of post-operative wound dehiscences
> However, the goal is not that the bone be augmented at the time of extraction. This is why the
defect is often not covered with a membrane or soft tissue. In the coronal area of the socket,
one finds that a connective tissue integration of the Bio-Oss® collagen material has usually occurred. Bone regenerative procedures likewise take place at the time of implantation when the
healing of the soft tissue has been completed.
3. Concept Dr. Karl-Ludwig Ackermann
Creating an optimal soft tissue structure over the extraction socket using a space-stabilizing matrix
that promotes wound-healing (Bio-Oss® Collagen), that heals open:
> Space maintenance thanks to Bio-Oss®
> Promotion of wound healing and easy handling due to the collagen portion of the material
> Thanks to the collagen, there is good adhesion in the defect with open healing until primary wound
closure has been achieved. In contrast, normal Bio-Oss® granules could escape from the defect.
4. Surgical procedure
Preparation: Manufacturing of an adhesive bridge, optional antibiotic treatment.
Fig 1 Clinical view of the front tooth 11 that
had to be removed due to a fracture.
Fig 2 The tooth extraction occurs without a
flap procedure in order to protect the soft
tissue as much as possible.
Fig 3 The socket after tooth extraction.
The granulation tissue is first thoroughly
removed.
Limitations, open questions
Fig 4 Using scissors and scalpel, Bio-Oss®
Collagen is tailored to the size of the alveolus and then carefully applied. The BioOss® Collagen blocks should not be compressed in too tightly so that ideal packing
density is maintained.
Fig 5 The Bio-Oss® Collagen completely
fills out the extraction socket.
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Fig 6 For covering, a Bio-Gide® Membrane
can be used.
> Bone regeneration can only be expected in the apical defect area. In the coronal area, one
usually sees that there has been a connective tissue integration of the matrix material
because no membrane was applied and the material healed in an open fashion. That is
why it is necessary to remove these particles during implantation.
> The method has been successfully clinically used in the Ackermann / Kirsch practice. The
proof of the efficacy, prognosis and the advantage of this method when compared to others has not yet been scientifically demonstrated in studies.
Fig 19 The x-rays show an osseointegrated implant where the crestal periimplant bone follows an ideal course.
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