What are the most important factors for bone regeneration?

Case Report of Guided Bone Regeneration in Dehiscence-Type Defects Using Hydrophilic Surfaced Implant (TSIII CA) and SmartBuilder

By Yong-Jin Kim, Young-Jin Park, Kyung-Tae Park


Most recently, Osstem implant introduced a TSIII CA implant, a chemically modified sand-blasted, large grit and acid-etched titanium surface implant, in order to enhance bone apposition. It might be hypothesized that the hydrophilic properties of TSIII CA implant surfaces may have a higher potential to support osseointegration in dehiscence-type defects.
So, I would like to report the GBR case in ehiscence-type defects using hydrophilic surfaced implant (TSIII CA) and SmartBuilder.

Why Hydrophilic surface in GBR? 

hydrophilic surface in GBR
A. NanoTite Collapsed Clot
B. SLActive Stabilized Clot
TSIII SA Collapsed Clot / TSIII CA Stabilized Clot
C. SLA Collapsed Clot
D. SLActive Stabilized Clot
E. Situation at 3 min.
F. Situation at 5 min.
THREE Important Factors for Bone Regeneration

Three factors of bone regeneration

Study Design (Case Report):

Age / Sex: 55Y / M
Chief complain: #34, 35, 36 Missing
Past medical history: N / S
Past dental history: #34 Extraction d / t chronic periodontitis 2 months ago Treatment plan : #34, 35, 36 implant placement #34 GBR d / t buccal bone defect

X-Ray Pre and Intra operative view
Fig. 1-3. Pre-operative radiograph & Intra-operative view

Dental Implant process
Fig. 4-6. Full thickness mucoperiosteal flap was elevated with crestal incision and one vertical incision on the buccal side of the residual alveolar ridge mesially. Buccal bone defect of #34 extraction socket was observed. TSIII CA implant 4.0x11.5mm was installed at #34 extraction socket. Insertion torque was 30NCm and ISQ value was 71.

Smart builder process
Fig. 7-9. B-Oss was soaked with normal saline and SmartBuilder (2 wall augmentation) was trimmed with Iris scissors. B-Oss was grafted on the exposed TSIII CA implant and SmartBuilder was placed. Healing abutment for SmartBuilder was connected.
The mucoperiosteal flap was closed using 4-0 Blue Nylon.

Post operative radiograph GBR
Fig. 10-12. Post-operative radiograph
It was observed that bone graft material was well maintained under SmartBuilder. In addition, the contour of bone graft was also well maintained because of the rigidity of SmartBuilder.

  2nd stage surgeryFig. 13-21. 2nd-operative radiograph & Intra-operative view 
2nd stage surgery was done 14 weeks after implant placement. During the healing period, SmartBuilder was not exposed. Mucoperiosteal flap was elevated with crestal incision and SmartBuilder was removed. Bone regeneration around the TSIII CA implant was observed. Healing abutment (5x5mm) was connected and the mucoperiosteal flap was closed using 4-0 Blue Nylon.

Condition of dental implant after 16 weeks surgery
Fig. 22-24.
Final prosthetic treatment was done 16 weeks after implant placement. Gingival condition around implants looks healthy.


Three important factors for bone regeneration are space making, presence of blood clot and cells (osteoblasts). The hydrophilic properties of TSIII CA implant surfaces may play an important role in blood clot stabilization and cell (osteoblast) affinity. SmartBuilder has excellent mechanical properties for stabilization of bone graft materials. Its rigidity prevents contour collapse, its elasticity prevents mucosa compression, and its stability prevents graft displacement. Thereby, an essential prerequisite for bone graft integration, ie, mechanical graft stability, could be guaranteed by SmartBuilder. So, it might be hypothesized that hydrophilic surfaced TSIII CA implant and SmartBuilder are the best combinations for successful bone regeneration in dehiscence-type defect


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