ABSTRACT
I present a case of horizontal ridge augmentation by F.I.R.S.T. (Fibrinogen-Induced Regeneration Sealing Technique) that I devised in 2016 and introduced at Global Bone Grafting Symposium of Phuket (Thailand) in 2018. The F.I.R.S.T. is a modification of the technique based on fibrin sealant of my Master Giuseppe Corrente [1-2] that I’ve been using for 23 years. The F.I.R.S.T., published by me in 2020, allows predictable regenerative results through a simple and fast surgical procedure. The Fibrin Sealant (more than 6,000 scientific works in general and specialistic surgery from 1975) is an added value in GBR for his osteogenic action [3] and his excellent adhesive property for the graft stability to bony defects . The “Bone Lamina Technique” of Wachtel H et Al. [4] also inspired the F.I.R.S.T. The novelty of the F.I.R.S.T. is the strong increase of the bone graft/lamina complex stability [5], a crucial pre-requisite for the neoangiogenesis and the newly formed bone. All through a simple and fast procedure that does not require the use of pins or screws.
CASE REPORT
Woman, 68 years old, non-smoker with periodontitis Stage III Grade B, had a buccal plate concavity of partially edentulous second quadrant with vestibular bone wall < 1 mm at implant planning. We know the high risk of threads exposure if the facial bone thickness isn’t at least 1.5-2 mm. After 2 months from non-surgical treatment of periodontitis and maintenance, I performed a horizontal ridge augmentation by F.I.R.S.T., along with the placement of two implants, well described in the clinical pictures. At the end, I show how the 4 mm thickness of new bone achieved at implants is stable after 3 years of loading. After 5 years of follow-up, the corticalization of new vestibular bone wall is evident at CBCT and it is the same as the native bone.
Periodontitis Stage III Grade B and partial edentulism of the second quadrant.
Buccal plate concavity.
At implant planning the thickness of facial bone is less than 1 mm. Considering the high risk of a future exposure of implant threads, with possible peri-implantitis, I propose to the patient a horizontal bone augmentation after implant placement in the area 25-26.
I choose the Bone Lamina Technique of Wachtel H et Al. – IJPRD 2013, modified by F.I.R.S.T. approach: collagenized heterologous bone mixed with Tisseel, no collagen membrane, no titanium pins.
Test of lamina soft “fine” 0.4/0.6 mm thickness. It must be idrated for 5 minutes before his placement.
Cortical holes by piezosurgery.
Bone concavity.
Mixture of Tisseel with collagenized porcine bone (GenOs). The sticky bone is hard and immobilized to defect after the polymerization 3 minutes later.
The lamina tends to detach due to his elastic memory. Fixing before the vestibular part and after the palatal part of the lamina with few drops of Tisseel.
After moderate compression for 2 minutes, the lamina remains glued and immobilized to the graft and to bony walls. Suspended Internal-External suture to break down the tension (De Stavola L, Tunkel J. – JOMI 2014).
Horizontal mattress suture removed after 2 weeks.
The new anatomy achieved after 6 months.
Concavity & Convexity.
CBCT before the re-entry. The new cortical at 6 months compared to old cortical of first surgery. The facial bone thickness achieved is 4 mm.
Removed hard tissue above the cover screw also for histological sampling. In the right a still image from surgical video after healing abutments placement.
Prosthetic restoration.
After 5 years of follow-up the corticalization of new vestibular wall is the same as the native bone.
CONCLUSION
The F.I.R.S.T. in this case has proved effective for the horizontal ridge augmentation with excellent and stable outcome after 5 years of follow-up. This technique also allows to speed up the surgical procedure for improved patient and team confort that cares of him.
REFERENCES
- Corrente G, Abundo R, Cardaropoli G, Martuscelli G, Trisi P. Supracrestal bone regeneration around dental implants using a calcium carbonate and a fibrin-fibronectin sealing system: clinical and histologic evidence. Int J Periodontics Restorative Dent. 1997 Apr;17(2):170-81.
- Corrente G, Abundo R, Cardaropoli D, Cardaropoli G, Martuscelli G. Long-term evaluation of osseointegrated implants in regenerated and nonregenerated bone. IJPRD 2000 Aug;20(4):390-7.
- Le Nihouannen D, Saffarzadeh A, Aguado E, Goyenvalle E, Gauthier O, Moreau F, Pilet P, Spaethe R, Daculsi G, Layrolle P. Osteogenic properties of calcium phosphate ceramics an fibrin glue based composites. J Mater Sci Mater Med. 2007 Feb;18(2):225-35.
- Wachtel H, Fickl S, Hinze M, Bolz W, Thalmair T. The bone lamina technique: a novel approach for lateral ridge augmentation: a case series. Int J Periodontics Restorative Dent. 2013 Jul-Aug; 33(4):491-7.
- Foti V, Rossi R. Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.). An Improvement and Modification of Traditional GBR: A Report of Two Cases. Mod Res Dent. 2020 July;5(2):476-485.
ACKNOWLEDGMENTS
I thank Zerodonto for giving me the opportunity to present the F.I.R.S.T. in the TOP-NOTCH. A special hug to my friends Fabio Cozzolino and Ciro Bocchetti.
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