Immediate implantation and peri-implant Natural Bone Regeneration (NBR) in the severely resorbed posterior mandible using Leukocyte- and Platelet-Rich Fibrin (L-PRF): a 4-year follow-up

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Published: Wednesday, 17 June 2015 10:21 Written by 

In the severely resorbed posterior mandible, the placement of dental implants in ideal position is often compromised by the significant post-extraction centrifuge alveolar bone resorption. The shape of the residual alveolar ridges and the residual bone height above the inferior alveolar nerve often make the area not suitable for direct implantation. Even if the use of short implants offers excellent results when the residual bone volumes are high and wide enough to receive these implants [1], there is no other solution than bone regeneration surgery prior to implant placement when the alveolar ridges are very thin [2]. However bone regeneration itself remains a challenge in this area, as the mandibular posterior residual alveolar ridges are always very cortical with a low vascularization and therefore not really adapted to the integration of bone grafting material or regeneration of bone cavities. Finally, the posterior mandible is a place of significant mechanical constraints applied on the bone and gingival tissues during the mastication function, and this can compromise the healing of a bone regeneration chamber, particularly through the risk of soft tissue dehiscence after the regeneration surgery.
To bypass these many traps and disadvantages, we tried to develop a new form of Guided Bone Regeneration (GBR) where both the bone and gingival compartments are reinforced and better controlled. The first element of this strategy is to use the dental implant
itself as a space maintainer [3] and as a regeneration pillar to reinforce, protect and guide the bone compartment under the GBR barrier. This concept is termed Screw-Guided Bone Regeneration (S-GBR), and the implant is considered as an optimized screw (in comparison to more traditional osteosynthesis screws that can be used in this strategy).

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