Fig. 4 The bone is initially curetted taking
care not to over-instrument the surface of
the implants (except with non-metallic scalers) and then decontaminated, firstly by
packing gauze soaked in 0.12% chlorhexidine around the implants and into the defects which is left in situ for 5 minutes.
Fig. 5 Afterwards decontamination is proceeded by direct irrigation with a 1g in
20ml sterile saline solution of tetracycline.
Fig. 6 The resulting bone surface appears
clean and healthy and the implant surfaces
while showing some evidence of instrumentation are also free of debris.
Fig. 7 A Geistlich Bio-Gide® membrane is
prepared by punching holes through it, so
that it drapes accurately around the implants.
Fig. 8 Geistlich Bio-Oss® is now rehydrated in the tetracycline solution and packed
into the defects and around the implants.
Fig. 9 Geistlich Bio-Oss® in situ. The membrane is placed over the Geistlich Bio-Oss®.
Fig. 10 The membrane is then tucked under
the reflected flap to fully cover the grafted
area.
Fig. 11 Flaps are repositioned and sutured
and the milled bar secured back into place.
The patient was prescribed Azithromycin
500mg o.d. for 3 days.
Fig. 12 & 13 The pre- and 2-month postoperative radiographs demonstrate the
change in appearance at the defect site. Clinically there is an absence of any further
pain of purulence.
Fig. 14 Healthy clinical situation after 1
month.
Fig. 15 Clinical situation with final prosthetic restoration in place.
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