Socket Augmentation

Case Study 1

Treatment of periodontal defect

Panoramic X-ray showing infection around tooth # 26 in 60 years old female.

 

Clinical view shows gingival inflammation and suppuration area tooth #26

 

Periapical radiograph showing large bone defect around root # 26

 

Clinical view of the surgical site after reflection of the flap

 

Clinical image showing SCPC granules packed in extraction sockets # 23 and 24 as well as in the large defect area in site 26 in an attempt to fill in bone and rebuild the vertical bone height in site 26.

 

3 months postoperative Evaluation of bone filland SCPC resorption

 

Panoramic X-ray showing complete bone fill in sites # 23, 24 and 26 after three months healing time.

 

Clinical image of the grafted site after 3 months of healing before flap reflection and implant placement

 

Clinical image showing the grafted sites after 3 months. The defects were completely filled with new mature bone.

Periapical radiograph showing implant placement in site # 26

The high quality and complete fill of mature bone in the large defect grafted with SCPC granules after 3 months healing allowed for satisfactory implant stability. SCPC  granules have a strong stimulatory effect on bone cells and induction of new bone formation. New bone formation was associated with graft material resorption.

 

Periapical radiograph showing implant placement in site #23

 

Case Study 2

A 65 years old healthy white Caucasian female came with Broken bridge and sever decay of tooth #6

 

Panoramic view showing the decay of tooth number #6
Broken bridge at abutment #6

 

The black area is the remnant of the root and the yellow area is the remnant of dentine. The bridge was sectioned at distal abutment tooth #8

After extraction of tooth #6

 

Two implants were inserted in tooth #6 and #8. The graft is packed in the jumping distance between the implant surface and internal socket wall.
Implants placement in site #6 and #8

SCPC granules were soaked in sterile saline for 5 min before grafting.
SCPC granules were soaked for 5 min in sterile saline before grafting in the jumping space around the implants

 

 

 

  • SCPC particles were grafted around the two implants.

 

  • The SCPC graft is packed in the jumping distance between the implant surface and internal socket wall.

 

  • And SCPC was also placed on the ridge to increase the thickness of the ridge.

 

Immediate Temporization:

Immediate implant temporary crowns were fabricated chair side and delivered at the same visit for implant placement

Adequate bone formation around the implant. Stable bone crest:

 

Immediately postoperative
3 month post operative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case Study 3

Extraction of upper left maxillary molars (#14 and #15) in a 65 year old healthy white Caucasian female.

 

X-ray showing sub gingival decay in teeth #14 and #15 and can not be restored

 

Extraction of upper left maxillary molars #14 and #15

 

 

SCPC was used for ridge preservation without membrane

 

Panoramic radiograph showing immediately postoperative

 

 

4/9/2018 Bone fill in number 14 and 15 after 4 month of SCPC grafting

 

 

4/11/2018 at time of implant placement in site # 14 Excellent bone quality bone for implant fixation

 

Case Study 4

Ridge augmentation at the time of implant placement in Caucasian Male

 

Implant placed, bone decortication
SCPC grafted for bone augmentation

 

 

 

 

 

 

 

 

 

  • Site #30 needed an implant, but the site does not have enough width (the buccal lingual width is small)

 

  • After flab reflection, the site did not have enough bone in the buccal lingual width, so the plan was to place an implant and perform bone graft at the time of implant placement.

 

  • (left) the implant was placed and the ridge was prepared for bone grafting where decortication was made to facilitate blood supply and bone cells contact with the SCPC.

 

  • (Right) SCPC bone graft in place- implant can be seen in place

 

Non resorbable collagen membrane covered the SCPC graft material and the implant

 

Before implant placement in site # 30
Radiographic view at time of implant placement

 

 

 

 

 

 

 

 

 

Case Study 5

Socket Preservation in 24 year old male who has a perforated Root canal on #8.

 

Perforation through the tooth apex. The tooth can not be restored.

Periapical radiograph of the socket after tooth removal.

 

The arrow points at the SCPC granules filling the socket.

 

 

 

  • After tooth removal, the socket was immediately grafted with SCPC bioceramic granules. The SCPC granules were applied dry and loosely packed. The blood inside the socket wetted the SCPC granules

 

  • A resorbable collagen cellulose fibers (sure-stop), that transform into gel in contact with blood, was placed on the top of the SCPC granules.

 

 

 

 

 

 

 

 

 

CBCT

 

After 3 month, the implant was placed in the newly formed bone inside the SCPC-grafted socket.

 

 

 

After putting the crown.

 

 

 

 Case Study 6

 

 

 

 

 

  • 63 yo, female, has no medical conditions or medications

 

  • Preoperative radiograph tooth # 5

 

  • Localized sever chronic periodontitis (class 3 mobility)

 

 

 

 

 

Preoperative image edentulous site #2, 3 and 4

 

 

 

 

Final image after implants placement at sites #3 and #5
  • On site # 3 Shefabone SCPC was used to do indirect sinus lift

 

  • A Osteotomy was created and used to perform the indirect sinus lift with the SCPC then the implant was placed.

 

  • The arrows point to the new bone generated around the dental implanted

 

  • For tooth #5 no graft was used

 

 

 

 

 

 

 

Case Study 7

Male, 44 yo, no medications or medical conditions.

 

  • A resorbed extraction socket (vertical and buccal lingual) resorption of the extraction socket) in site # 28

 

  • The goal was to increase the bone vertical height and thickness.

 

  • Gingival flap to expose the site was made. Cortectomies were made to promote hemorrhaging to have a supply cells and PMP.

 

  • The site was grafted with SCPC particles (on the occlusal and buccal aspects. The Ti mesh was trimmed and placed to cover the grafted site.

 

 

 

 

 

 

 

 

  • Radiograph showing the increase in height and buccal lingual dimensions on Site 28 after SCPC grafting for 3 months

 

  • The implant was placed at site # 28

 

  • Bone density and bone quality both were enhanced

 

 

 

 

 

 

 

 

 

 

Case Study 8

 

 

 

  • Preoperative image of fractured tooth # 31 in a 50 yo, female, smoker history, non smoker for 15 years

 

  • Controlled diabetic patient

 

  • Allergy to amexocylin

 

  • She has a vertical root fracture

 

 

 

 

 

 

  • Radiograph showing the extraction socket of tooth # 31 immediately after grafting with SCPC granules.

 

  • A membrane is placed on top to keep the SCPC granules in place

 

 

 

 

 

 

 

 

 

 

  • After 3 months, osteotomy created and the implant was placed at site #31

 

  • Implant placed via computer guided procedures.

 

 

 

 

 

 

 

Digital implant planning report for site # 31

 

 

 

Case Study 9

 

 

 

 

SCPC grafting and wound closure

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Bone Healing 3 Months Postoperative and Implant Stabilization

 

 

 

Case Study 10

Implantation of SCPC into the extraction socket

Digital images of (A) the SCPC bone graft granules filling the extraction socket up to crestal bone, (B) gelatin sponge (gelatamp) was placed over the SCPC granules within the extraction socket, and (C) cross mattress suture stabilizes gelatamp in the extraction socket

Digital images showing wound healing of the extraction socket grafted with SCPC granules after (A) 2 weeks, (B) 3 months and (C) 6 months postoperatively.

X-ray radiographs showing (A) immediate postoperative image of  the extraction sockets and (B) after 6 month, the SCPC grafted sockets were filled with new bone which has comparable radio-opacity to the host bone. Note the complete resorption of the SCPC granules.

 

Case Study 11

(A) showing two extraction sockets before grafting, (B) the extraction sockets were filled with SCPC granules, (C)  Sutured wound after SCPC grafting in the socket.

Periapical radiograph showing  (A) the extraction sockets before SCPC grafter, (B) two weeks post-grafting SCPC granules showing new bone formation near the walls of the grafted sockets, and (C) After 6 weeks, the radio-opacity inside the grafted sockets became much closer to that of the host bone indicating significant bone formation inside the grafted sockets.

 

 

Case Study 12

Photomicrographs of bone biopsy taken from the core of extraction socket grafted with SCPC  (for 6 months) at the time of implant insertion.  Areas of mature bone with osteons and Haversian system are seen. The resting and reversal lines (yellow arrows) can be seen together with wide thin walled capillaries (green arrows). Areas with woven bone are also present.  Sample stained with H&E; magnification 100X.

Photomicrograph of bone biopsy taken from extraction socket grafted with SCPC  (for 6 months) at the time of implant insertion.  Areas of mature bone with osteons and Haversian system are seen together with areas with woven bone.  Sample stained with trichrome; magnification 100X.