Clinical cases of simultaneous implantation using autogenic tissues from the maxillary mound and retromolar region

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Introduction. Currently, implantology is increasingly using techniques that can eliminate a defect in one visit, ensuring rapid recovery and reducing injury. It is precisely such techniques as IDR "Immediate Dentoalveolar Restoration" - the author of the Brazilian periodontist, Dr. Rosa and B2S - the author's technique of B.S. Bernatsky – "Bones to Soft Tissue". Dr. Rosa's IDR technique is one of the most effective single–stage implantation protocols. This is a technique without incision and without peeling of the surgical flap, which is very important in the aesthetic area. Its main advantage is the ability to solve aesthetic issues: the elimination of defects in the alveolar ridge due to the augmentation of soft and hard tissues[1]. But there are often clinical cases when, according to all indications, it is necessary to carry out a two-stage implantation with primary targeted bone regeneration, that is, it is necessary to grow a bone. For this reason, the technique can only be applied in narrow directions[2]. The methodology that was developed by B. S. According to Bernatsky, which is called B2S, it allows us to make an incision, lift the surgical flap and transfer the graft to the same area that we need. Restoration of a bone defect can be carried out using a triple graft taken from the hillock of the upper jaw, as well as from the retromolar region, this is a horizontal platform behind the molar. In certain clinical cases, the operation ends with the immediate installation of a temporary crown[3]. Thus, the scope of immediate implantation techniques has increased significantly today. It has become possible to treat alveolar ridge defects, to use them for long-term missing teeth, to repair bone defects and at the same time to install an implant[4].
The purpose of the work. To analyze the effectiveness of IDR and B2S techniques in simultaneous implantation. To identify the advantages of the author's concept of B.S. Bernatsky based on clinical cases. Evaluate the aesthetic result of the work. To highlight the relevance of this method.
Materials and methods of research. In the process of preparing an article at the dental clinic of the Ryazan State Medical University. Pavlova, which is the base of the Department of Surgical Dentistry and Maxillofacial Surgery with an ENT course, performed three single-stage implantation operations using the IDR technique and 2 operations using the B2S concept.
Clinical case No. 1
A 50-year-old patient complained about the mobility of the crown of the tooth 2.2, the presence of a fistula, and the absence of a tooth 2.4.
Treatment plan: oral cavity scanning, production of a surgical template. Tooth extraction 2.2 with simultaneous implantation with dentoalveolar reconstruction of the hole with defect R1 by the IDR method. Production of a temporary crown using the laboratory method. Implant placement in the area of the missing tooth 2.4.

Figure 1. Fistulous tooth passage 2.2

Figure 2. Fracture of the tooth root 2.2

Figure 3. Temporary crown on the implant 2.2

Clinical case No. 2
X-ray picture of a patient 45 years old after simultaneous implantation in the 2.4 tooth area with dentoalveolar reconstruction of the well using the IDR cortical-sponge graft technique.Figure 4. Tooth destruction 2.4 to the bone level (12/15/2023)

Figure 5. Installation of implants in the area of missing teeth 2.6 and 2.7. Implant control 2.4 (09.09.2024)

Clinical case No. 3
A 35-year-old patient complained of missing a tooth in the lower jaw on the right.
Treatment plan: Placement of the implant in the missing tooth position 4.6 with simultaneous implantation with reconstruction of the vestibular defect using the B2S technique.Figure 6. Installation of the implant with a recess, fixation of the bone column with Conmet screws

Clinical case No. 4
The implant was reinstalled in area 1.4 due to peri-implantation, and the graft was fixed using B2S pins.

Figure 7. Removal of the implant

Figure 8. Graft fixation with pins

The results of the study. After analyzing the application of the techniques in practice, it can be noted that IDR is a minimally invasive and atraumatic way to eliminate a dental defect during implantation in the area of one or two teeth. The B2S technique, in turn, involves another clinical stage, in contrast to the original protocol, namely the peeling of the mucous flap, which provides a complete overview of the defect and an objective assessment of the surgical field with minimal complications. However, it is used in cases where the tooth has been missing for a long time.
Conclusion. Practice shows the successful application of IDR and B2S techniques.
IDR is still an atraumatic technique, but its indications are limited. The main advantage of the B2S technique is the expansion of the scope of indications for use, as it does not require strict patient selection. It provides greater freedom for the dental surgeon during surgery. Not many techniques can reduce the recovery period of hard and soft tissues to three to four months with extensive defects. This proves the relevance of B2S in modern implantology.

About the authors

Alisa Olegovna Povarova

Ryazan State Medical University named after academician I.P. Pavlov

Author for correspondence.
Email: povarova.2003@mail.ru
ORCID iD: 0009-0007-7716-9479
Russian Federation, 390026 Russia, Ryazan, str. Vysokovoltnaya, 9

Angelina Alekseevna Gorbunova

Ryazan State Medical University named after academician I.P. Pavlov

Email: angelinagorbunovs@yandex.ru
ORCID iD: 0009-0001-4565-0504
Russian Federation, 390026. Russia, Ryazan, st. Vysokovoltnaya, 9

Yefim Stepanovich Demin

Ryazan State Medical University named after academician I.P. Pavlov

Email: chester.62rus@mail.ru
ORCID iD: 0009-0005-7518-1023

Assistant at the Department of Surgical Dentistry and Maxillofacial Surgery with a course in ENT diseases

Russian Federation, 390026 Russia, Ryazan, st. Vysokovoltnaya, 9

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