From practitioner to practitioner - ZZI 02/2015

SonicWeld: A case report on bone grafting of severe lateral and vertical atrophy

Introduction: The present case report describes the successful alveolar ridge reconstruction in a patient with severe lateral and vertical bone atrophy.

Material and Method: After the traumatic loss of tooth 21 17 years ago, an implant was inserted and restored prosthetically to replace the lost tooth 21. The implant was positioned far to the cranial due to the lack of bone.

Results: 17 years after successful restoration, the implant broke in the apical third. Even before the remaining implant fragment was removed, it was obvious that the cranial implant position had caused severe lateral and vertical bone loss. Two months after explantation, the alveolar ridge defect was augmented with SonicWeld Rx, bone substitute material and autogenous bone. Four months later an implant could be inserted after the complete reconstruction of the alveolar ridge. Six months after the successful osseointegration of the implant a prosthetic restoration was placed.

Keywords: guided bone regeneration; implant; lateral and vertical atrophy; SonicWeld Rx system

Cite as: Korsch M, Walther W, Kasprzyk S: SonicWeld: Ein Fallbericht mit Rekonstruktion des Kieferkamms bei ausgeprägter lateraler und vertikaler Atrophie. Z Zahnärztl Implantol 2015;31:150–157

DOI 10.3238/ZZI.2015.0150–0157

Introduction

In cases of insufficient height and width of bone, the bony implant bed can be reconstructed by additive techniques. These include bone block grafts and GBR (Guided Bone Regenera-tion). The augmentation material for GBR is autogenous bone and/or bone substitute material. To cover and stabilize the augmented site, both resorbable and non-resorbable membranes can be used [23, 24]. Resorbable material offers the advantage that, after healing of the augmented site, no separate surgery is required for the removal of the material [3, 11, 21].

A special type of bone block grafting is the technique described by Khoury [12]. It consists of fixing a slice of bone at a distance from the atrophied bone by means of osteosynthesis screws. The newly formed hollow space between the bone slice and the local bone is then filled with particulate bone. The SonicWeld Rx procedure follows the same principle (SonicWeld Rx, KLS Martin Group, Tuttlingen, Germany) [10].

In the following, the individual steps of the procedure for the reconstruction of a combined severe lateral and vertical bone deficit will be described.

Case Presentation

After the traumatic loss of tooth 21 17 years ago, an implant was inserted and restored prosthetically to replace the lost tooth 21. The implant was positioned far to the cranial due to the lack of bone. 17 years after successful restoration, the implant broke in the apical third. Even before the remaining implant fragment was removed, it was obvious that the cranial implant position had caused severe lateral and vertical bone loss. Two months after explantation, the alveolar ridge defect was augmented with SonicWeld Rx. Four months later an implant could be inserted after the complete reconstruction of the alveolar ridge. Six months after the successful osseointegration of the implant a prosthetic restoration was placed.

Case History

General medical history

At the time of the implantological counseling and information session the 32 year old patient had no general medical disorders and did not take any medication.

Dental history

Tooth 21 had to be removed due to trauma when the patient was 15 years old. Three months after extraction a Frialit implant was inserted replacing tooth 21.

Dental findings before therapy

Fractured implant at the site of 21. There were no other anomalies.

Diagnosis

Alveolar ridge atrophy class 3 (according to Seibert) at tooth 21

Therapy/Surgical Phase

Augmentation at 21

Two months after explantation the site was augmented under local anesthesia. An alveolar ridge incision was made to expose the implantation site. Two cut-back incisions to the distal of 13 and 23 were made to ensure that any tension that might be caused by scar tissue would be outside the esthetic zone. With a pilot drill of the system described (SonicWeld Rx, KLS Martin Group, Tuttlingen, Germany) 3 holes were drilled interdentally on the labial aspect of 11/12 and 22/23. Two additional holes were drilled palatally also in the interdental region at 11/12 and 22/23. Then a pin (SonicPin Rx, diameter 1.6 mm, KLS Martin Group, Tuttlingen, Germany) was taken up with the
sonotrode tip of the ultrasonic generator and positioned next to each drill hole for the subsequent fixation of the resorbable foil. The ultrasonic generator was activated while in contact with the bone. This procedure changed the surface state of aggregation of the pins by melt-down from solid to liquid which allowed to easily place the pins into the previously prepared drill holes. When the ultrasonic frequency was switched off the pins hardened immediately and firmly adhered to the local bone (fig. 1). In each of the 5 drill holes one pin was placed. Then a resorbable foil (Resorb-x foil: size 25 x 25 mm, foil thickness 0.1 mm) was cut with scissors in two halves. Both halves were trimmed to a size that would ensure that the pins were completely covered after the subsequent fixation of the foil margins. The foils were welded to the pins labially and palatally with the sonotrode tip in the same way. Thus a hollow space was created between the two foil halves and teeth 11 and 22 (fig. 2).

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