exposed membrane after dental bone graft exposed membrane after dental bone graft

The case has been managed successfully. Oral Care Center articles are reviewed by an oral health medical professional. This is a very well documented progression showing and discussing the progression of exposure, infection, surgical intervention, and resolution. Figure 9 and The flaps were elevated to expose the atrophic ridge ( This way, the affected area will heal properly and remain healthy. Urban IA et al (2013) Horizontal ridge augmentation with a collagen membrane and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 25 patients. The formation of granulation tissue with the absence of pain is a great sign that the wound is healing properly. If you experience any of the conditions listed above, contact your The patient was instructed to take 1 g Augmentin twice daily for 1 week and to use 0.12% chlorhexidine mouth wash twice a day for 2 weeks. The ballooning effect of the membrane can be achieved by sufficient amount of grafting materials with a slow resorption and titanium pin fixation [3]. government site. At 8 weeks after the free gingival graft procedure ( The discussion is appropriate and the observations seem to be accurate. Once exposed to the oral environment, microorganisms could quickly invade the surface and pass through the membrane in 3 to 4 weeks, as reported by Simion.13. It depends, naturally, of what kind of implant did you used.this way is not practicable if you have any purulence or inflammation around the implant. The purpose of presenting this clinical case was brought out that horizontal ridge augmentation using a combination of titanium-reinforced non-resorbable PTFE membrane and FDBA resulted in the successful implants placement at the sites #46 and #45 despite the membrane exposure that occurred at 4 weeks following horizontal ridge augmentation, the infection that had occurred after a further 2 weeks. Now there is a big hole in the gum. Six-month stability following extensive alveolar bone augmentation by sausage technique, https://doi.org/10.1186/s40902-023-00384-8, Maxillofacial Plastic and Reconstructive Surgery, http://creativecommons.org/licenses/by/4.0/. On the contrary, the d-PTFE barrier is made of two layers of high-density polytetrafluoroethylene with less than 0.20.3 m porosity size. Re-evaluate the situation at that time. Oral Health, Dental Conditions & Treatments. Learn more! 5 These membranes are also As with other types of non-resorbable membranes, the most common complication is post-operative exposure Make a quick call to your dentist if you have any concerns about the healing process, especially if you experience pain. Figure 6), then the membrane coronal part was stabilized with two tacks. However, sometimes implants cannot be placed in the ideal position due to insufficient alveolar bone width or height. FOIA This work was supported by National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. The purpose was to allow your gum to grow underneath it and cover over the bone graft as the membrane protects it. Simply cut, peel, & apply to protect wounds, & more! Google Scholar, Byun SH et al (2020) Soft tissue expander for vertically atrophied alveolar ridges: prospective, multicenter, randomized controlled trial. Manage cookies/Do not sell my data we use in the preference centre. Learn more about dental bone graftsand how they can increase the viability of your dental implant. Preoperative picture before membrane removal. A retrospective study of 237 sites treated consecutively with guided tissue regeneration. and transmitted securely. If it becomes exposed, some or all of the bone graft can be lost. Alveolar ridge deformities can be caused by several factors. Gently place bone graft around the sides; Secure the bone graft and protect the site with another collagen plug or resorbable membrane; Stitch the membrane over the graft to keep it in place; After closing the perforation, a specialist will prescribe antibiotics, and based on the severity of your infection, tell you how long to take them. Bethesda, MD 20894, Web Policies One of the most frequent postoperative complications of guided regeneration therapy is the membrane exposure Vous avez des problmes de TNT ? Wounds inside the mouth might feel uncomfortable, but with the right care, they will heal quickly. In this case, guided bone regeneration (GBR) should be considered. Please feel free to, Talk Title:"Microengineered tissues for regenerative medicine and organs-on-a-chip applications", IEEE CAS Charles Desoer Life Science Systems Student Attendance Grant, Assistive, Rehabilitation, and Quality of Life Technologies, Bio-inspired and Neuromorphic Circuits and Systems, Biofeedback, Electrical Stimulation, and Closed-Loop Systems, Biomedical Imaging Technologies & Image Processing, Innovative Circuits for Medical Applications, Medical Information Systems and Bioinformatics, Wireless and Energy Harvesting/Scavenging Technology. This does not This classified the ridge deformities into three classes according to the horizontal and vertical defect components: class I, horizontal loss of tissue with normal ridge height; class II, vertical loss of tissue with normal ridge; class III, combination horizontal and vertical loss of tissue resulting in the loss of normal height and width This collagen membrane delivers predictable bone graft in dental surgery procedures, filling bony defects, ridge construction, and dental implant placement. I nostri clienti, piccole aziende, professionisti e privati ci hanno fatto crescere ed imparare. Status: Approved with Reservations. I have read this submission. One of the problems I Figure 7) Postoperative instructions (about diet, pain, bleeding and healing) and medications, including 600 mg ibuprofen three times a day for 5 days, 875 mg amoxicillin twice daily for one week and 0.12% chlorohexidine mouth wash twice a day for 2 weeks, were given to the patient. In case of large membrane exposures (>3 mm) without purulent exudate, the authors suggest immediate membrane removal so as not to jeopardize the underlying bone graft. At 2 weeks after the membrane covering surgery, pus discharge between the membrane and the surrounding tissue was noticed. A membrane is a thin collagen sponge that is used to cover the graft initially. 7. First, Do not use chlorhexidine on any open wound. HHS Vulnerability Disclosure, Help J Oral Implantol 1 June 2016; 42 (3): 289291. Jin-Woo Kim. Complications may vary from dehiscence with limited consequence to an abscess with the consequent treatment failure. Treat the area as if is were expose living bone after any oral surgery procedure. After a discussion with his referring dentist, it was decided to extract tooth #45. Figure 7. All data underlying the results are available as part of the article and no additional source data are required. 1E). Should I just resuture and attempt primary closure? Each patient experienced mesh exposure at a different rate, ranging from one to six weeks post-operation. Figure 15). GBR has been used for horizontal and vertical alveolar bone augmentation and has shown reproducible results with high implant survival rates and low complication rates [2]. Figure 8). Int J Oral Maxillofacial Implants 9(1):1329, Meloni SM et al (2019) Horizontal ridge augmentation using GBR with a native collagen membrane and 1: 1 ratio of particulate xenograft and autologous bone: a 3-year after final loading prospective clinical study. When ridge resorption occurs, adequate bone augmentation is essential to obtain satisfactory esthetic results. Be Careful about What You Eat Generally, its best to stick to a liquid diet for at least 24 hours following a bone graft. In this study, it is accomplished by using bone tacks or bone screws and membranes. Membrane exposure permits a communication between the oral environment and the newly forming tissues, increasing the potential for infection and decreasing the likelihood of regeneration The loss of jaw bone can be due to a variety of reasons, including tooth extraction, gum disease, or trauma. Gum recession is the process in which the tissue that surrounds the teeth pulls away from a tooth, exposing more of the tooth or the tooth's root. YYYY Colgate-Palmolive Company. Some existing evidence suggests that exposure is more common with non-resorbable membranes as seen in this report. I would suggest if there is any sign of infection or sepsis. Other ways to prevent gum disease include: American Academy of Periodontology: "Soft Tissue Grafts," "Periodontal Surgery: What Can I Expect? The size of the exposure was approximately 4 8 mm ( After a dental bone graft, youll probably leave the dentists office with gauze packed around the incision in your mouth. If you have experienced an oral wound, you might notice white, pink, or red tissue forming around the injury. Answer: Failed bone graft You should check with your dentist as sometimes the bone graft does fail. In addition to that, there is a disagreement about the impact of membrane exposure on bone regeneration. Treat the area as if is were expose living bone after any oral 6 weeks after the extraction of tooth #45, a free gingival graft was performed to increase the width of keratinized tissue prior to ridge augmentation. Thank you! Some screws were fixed in the defect as tenting screws (Fig. Dentist: Dr. Behere. 4. A and D Preoperative CBCT images. In recent decades, various surgical techniques for alveolar bone augmentation have been developed and widely practiced by dentists. WebExposure was monitored and patient was instructed to follow strict oral hygiene instructions around the exposed membrane. Wounds inside the mouth heal essentially the same way as wounds on any other part of the body. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Occlusal view of the implant position. Let the body repair itself and correct the problem later (re-graft and/or re implant). Decortication was performed in the buccal bone with a round bur ( The patient had hypercholesterolemia and was taking 20 mg Lipitor (atorvastatin) tablets once daily. After an additional 2 months, a definitive full ceramic restoration (IPS e.max CAD LT, Ivoclar, Schaan, Principality of Liechtenstein) was cemented on a cad/cam zirconia abutment (Atlantis, Dentsply). dont use chlorexhidine, use diluted peroxide. When you need to replace a missing or extracted tooth, a dental implant can transform your smile. The sutures came out yesterday and today the membrane covering the site fell out with bone particles attached to it. The pamphlet from the oral surgeon's office warned that day 3 was the peak of the pain / swelling period, so I guess I did expect it. I had a bone graft done to my #19 molar this past Friday. 1Department of Preventive Dental Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. The selection of an appropriate barrier is essential for the success of GBR. In addition, the native collagen membrane becomes vascularized within the first week of healing, which can reduce the burden on surgeons about patient discomfort and complications [7]. LWW. Long-term follow-up was not included in this study, but the potential risk seems to be low. The bone augmentation procedure was performed by combining a titanium-reinforced d-PTFE (Cytoplast, Osteogenics Biomedical, Lubbock, Texas) with deproteinized bovine bone graft (Bio-Oss, Geistlich, Wolhusen, Switzerland). And studies conducted by Urban et al. 1D). You may end up with a success despite exposure. This helps stabilize the graft. Here are the care instructions that you may need to practice after the surgery. A clinical and radiographic follow up was made 12 months after the placement of the definitive crown (Figures 9 through 15). Parlez-en ! Designed by: Free Joomla Themes, web hosting. This manuscript is contemporary as far as the scientific writing and the clinical procedures are concerned. An incision was made to split them membrane from the tissue then the membrane was removed ( The IEEE Biomedical Circuits and Systems Conference (BioCAS) serves as a premier international. The report mentions several times the observation of the red jelly like substance. official website and that any information you provide is encrypted Sufficient horizontal alveolar ridge width in proper position is essential to meet the functional and esthetic demands of dental implants [1]. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Bone graft material may also be used to preserve ridge width and height after tooth extraction. The membrane was left in place for additional 2 weeks to ensure bone regeneration. However, if your dentist gives you a sedative to help you relax, you will need to make arrangements to have someone else drive you home. At that time, removal of the membrane was required to avoid the spread of infection to the newly forming tissue. Ma la nostra attivit principale rimane sempre la consulenza. Immediate Implant and Customized Healing Abutment Promotes Tissues Regeneration: a 5-year Clinical Report. Is it normal for stitches and membrane to fall out like this or do I have to go in to see the dentist? All Rights Reserved. Some membranes are designed to stay exposed. Figure 11). On the other hand, rapid degradation of the native collagen membrane results in rapid epithelialization upon exposure, resulting in a relatively low risk of infection [5, 6]. Oral Care Center articles are reviewed by an oral health medical professional. Figure 10). These other procedures include: Like dental bone grafts, most other bone augmentation procedures only sound like a complex or invasive procedure. All authors read and approved the final manuscript. Correspondence to A 63-year-old female patient presented for treatment of a left maxillary premolar. After the tooth extraction and an uneventful healing of 2 months, the site was re-evaluated. However, this goal of new bone formation and intimate adaptation with the implant can be impeded by the more rapidly proliferating epithelial cells that are not involved in bone formation. WebThis collagen membrane delivers predictable bone graft in dental surgery procedures, filling bony defects, ridge construction, and dental implant placement. Local anesthesia with 2% lidocaine and 1:100,000 epinephrine was used to anesthetize the surgical area. Oral Surg Oral Med Oral Pathol Oral Radiol 116(5):540549, Hmmerle CH et al (2008) Ridge augmentation by applying bioresorbable membranes and deproteinized bovine bone mineral: a report of twelve consecutive cases. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. Clin Oral Implant Res 16(3):369378, Wang H-L, Boyapati L (2006) PASS principles for predictable bone regeneration. Your dentist can tell you which method will work best for you. Save $200 + Get 10,000 bonus points on your first online order of $1,000+ with promo code SAVE200, Online orders $500+ qualify for free standard ground shipping, USA Some research is available discussing the speed of formation (1-3 weeks post grafting, but not much is available discussing the formation and stability in the setting of membrane exposure or infection. The average stitch out period was about 2.4weeks, and postoperative dehiscence was observed about 37.5% of the total, more frequently in the mandible (50.0%) than in the maxilla (25.0%). Ridge preservation for implant therapy: a review of the literature. Google Scholar, Rothamel D et al (2005) Biodegradation of differently cross-linked collagen membranes: an experimental study in the rat. A membrane was used to cover the bone graft and the surgical defect with minimal flap reflection. A retrospective cohort study. Reconstruction of deformed, partially edentulous ridges, using full thickness onlay grafts. Inclusion in an NLM database does not imply endorsement of, or agreement with, The initial treatment option consisted in tooth removal and delayed implant insertion with a ridge augmentation procedure. At 5 months after the guided bone regeneration (GBR) procedure, a cone-beam CT scan was performed to evaluate the bone width. A dental bone graft is a procedure that replaces missing bone in your jaw with bone grafting material to encourage regeneration. This information is for educational purposes only. This clinical approach was appropriate with e-PTFE membrane since this barrier had a labyrinth-like structure with mediumhigh porosity. The postoperative CBCT image was taken three times, preoperatively, right after surgery, and 6months postoperatively to compare the amount of increase in bone height or width at the graft site. The present case describes the surgical attempt and its outcome to manage the membrane exposure that had occurred 4 weeks after horizontal ridge augmentation using non-resorbable membrane with particulate allograft bone (mineralized freeze-dried bone allograft (FDBA)). The implant site was prepared with calibrated surgical burs and a 3.4 mm diameter x 11 mm length implant (Xive S, Dentsply, Mannheim, Germany) was positioned with a recorded stability over 30Ncm. Medically Reviewed By Colgate Global Scientific Communications. National Library of Medicine The average stitch out period was about 2.4weeks. A full-thickness mid-crestal incision was made on the edentulous area using a sulcular extension to the distal aspect of tooth #47 and to the distal aspect of tooth #42. Anche noi da una piccola idea siamo partiti e stiamo crescendo. Meloni et al. The use of d-PTFE membrane has been recently claimed by several authors9,11 as a valid alternative to e-PTFE to rebuild large bony defect and atrophic maxillary and mandibular arches. GBR membranes, as well as GTR membranes, augment implant success by promoting bone and periodontal ligament growth while hindering fibrous tissue formation. For ease of use, either side of the membrane may face the defect site. These incredible restorations look and function like a regular tooth, but they also require an adequate amount of jawbone for successful implantation. Two types of dental membranes are available to function as biological and mechanical barriers to these epithelial cells and enhance the crucial structural and functional integration of living bone to the load-bearing implant. Anon. Ministry of Science and ICT,South Korea,2020R1A2C4001842,Jin-Woo Kim, Department of Oral and Maxillofacial Surgery, Mok-dong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea, Kang-min Kim,Soo-young Choi,Jung-Hyun Park&Jin-Woo Kim, Department of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Seoul Hospital, School of Medicine, Ewha Womans University, Seoul, Korea, You can also search for this author in CAD/CAM Materials for the Dental Practice, Digital Impression for the Dental Practice, Postoperative Sensitivity in Composite Restorations, Recurrent Caries Causes, Treatments, and Prevention, DS Signature Workflow Implant Dentistry, Lucitone Digital Print Denture System Curriculum, Intact tissue providing increased mechanical strength that resists being pulled out during suture removal, Resorption time of approximately 16 weeks, Maintains barrier functionality for 4-6 months, Resistant to degradation when exposed for 3-5 weeks, Excellent handling properties such as adapting and conforming to defects and adherence to tissue, Porcine derived, providing excellent biocompatibility, Excellent handling, easy to use, adapts and adheres to bone. A vertical incision was made at the disto-buccal line angle of tooth #42. 8 membrane exposure remarkably reduces bone fill, and less bone regeneration around immediate implants sites is observed when exposed membranes are compared to non-exposed membrane sites whereas in a retrospective study where 237 sites treated with guided tissue regeneration were examined, Shanaman Follow your dental professional's instructions for cleaning and protecting your oral wound if you receive an injury or undergo an operation. 1. The exposed mesh was removed between four and 10 weeks after exposure occurred. Be sure not to apply ice for more than 20 30 minutes at a time. On behalf of the Organizing Committee, I am happy to invite you to participate in the IEEE/CAS-EMB Biomedical Circuits and Systems Conference (BioCAS 2015), which will be held on October 22-24, 2015, at the historic Academy of Medicine in Atlanta, Georgia, USA. X ray after 1 year. 2023 Dentsply Sirona. A total of 8 patients underwent extensive bone grafting during the given period (mean age was 53.815.4years, 2 males and 6 females). Bone Graft Materialis used for reconstruction of bone defects in maxillofacial surgery as well as for augmentation of insufficient bone for implant retention, apicoectomy, cystectomy and other multi-sided bone defects in the alveolar process. WebBone graft healing can be compromised if the overlying gum tissue recedes or breaks down. I have a gaping hole where my tooth used to be, filled with a white substance. 2). Springer Nature. Maxillofacial Plastic and Reconstructive Surgery The distance between the bone crest and radiographical reference points in the treatment area was measured such as cephalometric landmarks, inferior alveolar nerve canals, and using PACS (picture archiving and communication system) software (INFINITT PACS 3. PubMedGoogle Scholar. See the patient every 1-2 weeks and repeat this as needed until wound is closed. Status: Approved. Various membranes, including those which are resorbable and non-resorbable, synthetic, added with growth factors and composed of modern materials, such as high-grade polymer (Polyetheretherketone), are explored in this review. Figure 13. Wound stability can be achieved by secure fixation of the membrane, which leads to successful bone regeneration [13]. Periodontology 2000 19(1):5973. Clin Oral Implant Res 31(7):585594, Kim J-W et al (2013) Alveolar distraction osteogenesis versus autogenous onlay bone graft for vertical augmentation of severely atrophied alveolar ridges after 12 years of long-term follow-up. Fontana et al12 recently proposed a clinical classification of complications with e-PTFE membrane for an easier identification of the treatment procedure. Figure 11. Talk to your dentist to learn about your payment options. New comments are currently closed for this post. The easiest and most affordable way to clinically deliver bone graft for socket preservation. The size of the exposure had increased due to flap sloughing over the membrane owing to inadequate blood supply, which could be explained by the size of the flap and narrow flap base. | However, with regular dental checkups and careful dental care at home, serious damage requiring surgery can be prevented. A gum graft may be necessary to protect your teeth from the damaging effects of gum recession, or you may choose to have one to improve the appearance of your smile. asks:I have an implant case which involved ridge splitting, implant placement, guided bone regeneration using Bio-Oss (Osteohealth) and Epiguide membrane (Riemser) in the left posterior mandible area (35-37). Before surgery, a preoperative cone-beam computed tomography (CBCT) was taken to assess the amount of residual alveolar bone. PubMed WebThe Influence of a Connective Tissue Graft Versus a Porcine-derived Membrane (Mucoderm) on the Aesthetic Outcome After Immediate Placement and Loading of a In addition, surgery in the maxillary region showed a more successful bone augmentation than in the mandible, with a higher maintenance rate. Do not floss or brush the gum line that was repaired until the area has healed. To best of our knowledge, no experimental or clinical studies have been conducted to study the proper management of post-operative membrane exposure. Measuring the amount of increase in bone height or width at the graft site via CBCT. When divided by surgical site, 4 patients are in maxilla and 4 in mandible. Then, re-schedule the bone graft until the soft tissue become totally collapsed. Bone loss, can compromise the ability to place In this case, we attempted to manage the exposure surgically by advancing the tissue coronally to cover the exposed membrane, with the aim of preventing the communication between the oral environment and the newly forming tissue. I was doing great up until this morning when I finally developed pain and extreme fatigue. Clinicians are becoming more heedful in planning teeth pulling out than ever before. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. The membrane was removed at 6 weeks after the ridge augmentation procedure. Alveolar ridge defects can be classified for diagnosis and treatment purposes. Immediate use is possible due to its distinctive pre-hydrated delivery feature. WebI had tooth extraction and bone graft done 10 days ago. X ray of the bone defect. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Here's what you can expect during and after a gum tissue graft procedure. The postoperative exposure of the membrane is the most frequent postoperative complications of ridge augmentation procedures. : The efficacy of horizontal and vertical bone augmentation procedures for dental implants - a Cochrane systematic review. The membrane had to be removed owing to the infection. A titanium-reinforced non-resorbable PTFE membrane (Cytoplast Barrier Membranes Ti-250) was stabilized to the buccal plate at the apical end using membrane tacks (Salvin, USA) then FDBA (OraGRAFT, USA) was placed beneath the membrane and packed gently ( ", Columbia University Medical Center, School of Dental & Oral Surgery: "Soft-Tissue Grafts," "Maintenance Therapy.". Then they will be removed at 21 days to 1 month. Sutures were removed 14 days after surgery (Figures 1 through 8). If you experience any of the conditions listed above, contact your dentist immediately for treatment. This helps alleviate the graft. A retrospective clinicalstudy. Les rcepteurs DAB+ : postes, tuners et autoradios Les oprateurs de radio, de mux et de diffusion. Figure 3), ridge augmentation was performed using a titanium-reinforced non-resorbable polytetrafluoroethylene PTFE membrane and FDBA. Longer follow-up studies are required in the future. Then, four pins were placed to fix the membrane over the graft. Dentsply Sirona is committed to excellence in implant dentistry and offer products for healthy hard and soft tissue regeneration that are safe, easy to use, consistent, and promote bone formation for long-term outcomes. Four weeks after the regenerative procedure, a full thickness flap was elevated to remove the d-PTFE membrane and the fixation pins. Figure 19). The second foundation for regeneration is appropriate graft selection. It doesnt hurt or feel infected. One of the keys to success in implant dentistry is osseointegration. Preoperative view of 2 failing dental implants replacing the mandibular incisors. Primary closure of the mucoperiosteal flap was then achieved (Fig. However, it is not lacking difficulties. The present case study shows the unpredictability of managing postoperative membrane exposure surgically. No bone graft remnants were observed in the surgical site. Implants placed too close: Is this restorable? Antibiotics, YES. What will give me the best chance of success? If you've recently been told by your dentist or gum doctor (periodontist) that you need a gum graft, don't panic. Please help! Call your dentist if you experience any unusual symptoms following surgery, including: Many dental insurance companies will pay a portion of the cost of gum grafts. There are many challenges when faced with an inadequate amount of healthy bone. Lee SJ (2021) The sausage technique using collagen membrane without autogenous bone graft: a case report. Expanded polytetrafluoroethylene membrane (e-PTFE) classically required perfect soft tissue closure to prevent wound dehiscence. Both the photos and the radiographs contribute to the paper as they show the issues as they were addressed. Should I try antibiotics and chlorhexidine rinse and observe? Lgende: Administrateurs, Les Brigades du Tigre, Les retraits de la Brigade, 731004 message(s) 35409 sujet(s) 30160 membre(s) Lutilisateur enregistr le plus rcent est karolkul, Quand on a un tlviseur avec TNT intgre, Quand on a un tlviseur et un adaptateur TNT, Technique et technologie de la tlvision par cble, Rglement du forum et conseils d'utilisation. The engaging three-day single-track program, all of which is included in your registration, covers a wide range of topics, including but not limited to: On behalf of the Organizing Committee, I cordially invite you to participate in the 2015 Biomedical Circuits and Systems Conference and contribute to the continued success of this rapidly growing annual event at the intersection of medicine and engineering. CBCT images were taken before and 6months after surgery to compare the amount of increase in bone height or width at the graft site. --> I believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. WebMD does not provide medical advice, diagnosis or treatment. La comunicazione off line ed on line. In fact, it is estimated that half of implant placement procedures require bone grafts.