Neomem Sustained Collagen Membrane

Neomem Cases

Case 1: Implant Placement with Simultaneous Guided Bone Regeneration

Dr. Steven Faigan, Certified Specialist in Periodontics, Kelowna, British Columbia

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• Fig. 1: Resorption of the buccal bone
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• Fig 2: Grafted atrophic ridge
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• Fig 3: Neomem Resorbable collagen membrane
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• Fig 4: Regeneration of bone
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• Fig 5: Final restoration
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A 63 year old female patient presented requesting implants as a treatment modality to replace several missing posterior teeth in the lower left quadrant. Her natural teeth had been extracted 20 years earlier without replacement, resulting in a significant horizontal ridge deficiency. It was explained to the patient that although implants represented an ideal treatment option, it would be necessary to simultaneously augment the bone to allow for optimum bone integration and stability of the implants. The patient agreed to the proposed surgical and prosthetic treatment plan.

Two threaded, cylindrical, external hex Osseotite® implants (3I, Implant Innovations Inc., Palm Beach Gardens, FL) were placed into the areas of #35 and #37. With optimum implant positioning, and given the horizontal resorption of the host bone in the area, approximately 5-6 threads were exposed on the buccal surface of the implant in site #35 and 3-4 threads on the buccal surface of #37 (fig. 1).

1.0 cc of DynaGraft® II Putty (Citagenix Inc. Montreal, Quebec) was used to augment the deficient ridge and cover the exposed threads of the implants. DynaGraft® II is a bioassayed DFDBA offering the inductive capability required to achieve regeneration of vital bone. DynaGraft® II comes supplied pre-mixed in a

reverse phase medium allowing for ease of handling and accurate placement of the material. With simple finger manipulation, the material can be molded into the ideal three dimensional shape to augment the deficient area (Fig. 2). Once in position, the viscosity of DynaGraft® II reduces the risk of dislodgement during final placement, irrigation and flap closure.

A 30x40mm Neomem™ (Citagenix Inc., Montreal, Quebec) GBR resorbable membrane was placed over the graft to assist in bone graft containment and to eliminate connective tissue and epithelial invagination into the surgical site (Fig. 3).

Reapproximation of the flaps was achieved and tension free primary closure established utilizing 5-0 chromic gut sutures. A two stage submerged protocol was undertaken given the simultaneous GBR procedure.

Healing was uneventful and the implants were uncovered at 9 months. Clinical evaluation confirmed the apparent regeneration of bone on the buccal aspect of the mandible with coverage of the exposed implants threads (Fig. 4). At this time, the implants were stable and integrated and 3i’s emergence profile transitional healing abutments were placed. A soft tissue healing period followed for the next

6 weeks. Prefabricated, preparable GingiHue™ Post (3i) prosthetic abutments were inserted and the patient restored with a ceramometal cemented fixed bridge (Fig. 5).

Without the assistance of augmentation materials, endosseous implants would be limited to only those patients that presented with alveolar ridges with adequate bone volume. The predictability of guided bone regeneration techniques has increased the number of implant candidates and has facilitated prosthetically driven restorations.

Case 2: Autogenous Bone Graft Harvesting for Implant Dehiscence Defect

Dr. Doug-Seok Sohn, Associate Professor, Chair Department of Oral and Maxillofacial Surgery Daegu Catholic University Hospital, Daegu, South Korea

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• Fig. 1: Bridge in place before extractions
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• Fig 2: Osteotomies using MIS drill guide
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• Fig 3: Autogenous bone harvesting
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• Fig. 4: RotoGrafter filled with graft
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• Fig 5: Dehiscence defects around implants
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• Fig 6: Autogenous graft in place
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• Fig. 7: Neomem Collagen membrane to protect grafted bone
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• Fig 8:
• Tension free primary closure
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• Fig 9: Post-op radiograph

The patient presented with a fourunit bridge that was supported by the second premolar and third molar, which were both unsalvageable (Fig. 1). The bridge was removed, the two teeth were extracted and the site was allowed to heal for six weeks. In this case, no grafting material was used at the time of extraction.

The treatment plan included three endosseous implants to be placed posteriorly to the first premolar to support a fixed prosthesis. At the time of the implant placement surgery, significant horizontal bone loss was observed. Implant sites for three MIS implants were prepared using the MIS drill guide (Fig. 2). Following this and prior to implant placement, an autogenous bone graft was harvested at the implant surgical site using the RotoGrafter™. It was attached to a 16:1 contra-angle handpiece and the drill speed was set to 1000 RPM. The Rotografter was used to perforate the buccal plate inferior as well as distal to the implant sites, thus allowing bone to be collected without compromising implant placement (Fig. 3-5).

Upon insertion of the three root form implants, dehiscence defects were noted ranging from 2mm to 5mm buccally and coronally around the implants. The 100% autogenous bone graft collected from the RotoGrafter was placed in the deficient areas (Fig. 6). A resorbable collagen membrane (Neomem, Citagenix Inc.) was used to cover the graft site and a tension free suture technique was employed to achieve primary closure (Fig. 7-8).

*Cytoplast® is a registered trademark of Osteogenics Biomedical, Inc.