HYADENT BG

Modified tunnel preparation:

Smartbrane (30 x 40 mm) (Regedent, Dettelbach Germany):

Coronally advanced tunnel with the Smartbrane inside:

Suturing of the folded Smartbrane with 4.0 PTFE (BioTex, Regedent, Germany) and Monocryl 6.0 (Ethicon, HH, Germany):

1a. Baseline:

1b. Tunnel:

2a. Mobilized Tunnel:

2b. Connective tissue graft (CTG):

3a. Application of HYADENT BG:

3b. Applied HYADENT BG in the tunnel:

4a. Connective tissue graft fi xed in the tunnel:

4b. Application of HYADENT BG on the connective tissue graft:

5a. Laterally closed tunnel:

5b. Outcome:

PRE-OPERATIVE

A recession defect of Miller Class II was observed in the lower right canine despite the patient’s good dental hygiene and regular dental treatment.

SURGERY

The recession was treated surgically. After fl ap preparation, the root surface was carefully cleaned.

The wound was closed with a Coronally Advanced Flap (CAF).

1 YEAR POST-OPERATIVE

The recession remains well covered with healthy soft tissue.

1. Pre-operative. Baseline:

2. Surgery. Open flap (CAF protocol):

3. Smartbrane coated with xHyA gel and folded:

4. Suturing on tooth surface of the folded Smartbrane coated with xHyA gel:

5. Suturing the flap:

6. Post-operative:

7. Post-operative:

8. 9 month post-operative:

9. Soft-tissue volume gain at 9 months post-op vs baseline:

10. Cross-section at 9 months post-op vs baseline:

1. Diagnosis

Multiple recession (RT1) and class I furcation

2. Application of the xHyA gel

Split-Full-Split flap design and application of surgical-grade xHyA gel. This gel mixes well with blood and stabilizes the blood clot on site

3. Surgery

The connective tissue graft is sutured and stabilized

4. Suturing

The wound is closed by coronally advancing the flap margin (without tension) by at least 1,5 mm to the cementoenamel junction (CEJ) with separated suspended sutures

5. Outcome

1 year after the operation: The recession remains well covered with healthy soft tissue and an aesthetic result with minimal scares

1. Initial Situation: PPD of 10 mm:

2. Initial Situation: PPD of 10 mm:

3. Situation after flap preparation and thorough degranulation of defect:

4. Defect filled with a mixture of xHyA and a bone filler:

5. Defect filled with a mixture of xHyA and a bone filler:

6. Situation 72h post-OP shows accelerated healing:

7. Situation 72h post-OP shows accelerated healing:

8. After 8 years. Significant reduction of probing depth to 2–3 mm:

1. Split case with socket preservation:

2. Sticky bone of DBBM + xHyA gel (right):

4. Tissu punches:

5. Closure of sockets with autogenous tissue:

6. Healing at 2 months:

7. Volume resorption at 2 months. Limited volume resorption in xHya+DBBM group (right):

Histology DBBM at 2 months. Low amount of new bone cells (pink). Limited resorption of DBBM (grey). Presence of soft tissue (blue).

Histology DBBM + xHyA at 2 months. Significant new bone cells. DBBM resorption. Low presence of soft tissues.

1. Patient with a distal mandibular edentulous ridge requiring implant placement:

2. Flap elevation revealed significant loss of ridge height and width:

3. Edentulous ridge with significant loss of height and width:

4. A small amount of autogenous bone was harvested leaving small cortical perforations:

5. The autogenous bone was mixed with xenograft material saturated with xHyA:

6. Placement and adaptation of the graft mixture onto the recipient site:

7. The graft mixture was covered with a resorbable collagen membrane (SMARTBRANE) and fixed with pins.

8. After 6 months. Significant gain of bone width with almost no residual graft particles visible

9. Implants of 4mm width were placed in the correct prosthetic positions:

10. After 6 months. Cone beam computed tomography (CBCT) showing a significant amount of newly formed bone:

6. 7 months histology of porcine xenograft with xHyA (H). Ongoing regenerative process:

• Osteoclasts (O) resorb porcinexenograft (S)
• New bone creation
• Minimal presence of soft tissue