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12 CASE STUDY of implants, it is only in the rarest of cases that one can omit hard and soft tissue augmentation. These therefore represent key factors for every implant procedure. Particulate material provides the optimal conditions for bone regenera- tion because rapid angiogenesis and thus regeneration can take place [2,8]. The PRGF may not have any additional impact on improved regeneration of the bone. Thanks to the bond of the bone substi- tute material in the PRGF, adaptation to the defect is, however, very easy and the stability is further reinforced. The overall priority is to ensure that the augmentation material is stable. This is achieved either using resorbable membranes, which have a very high rate of complications, however, or the technique described above. The PRGF and the fibrin help with soft tissue healing. However, without doubt the critical factors for a positive outcome are the flap design and the suture technique. The flap must be able to be repositioned free of tension and the suturing is done using microsurgery so that the soft tissue is not strangulated. Consistent soft tissue management until the exposure creates the necessary conditions for long-term success of the implant. An adequately thick and keratinized gingiva around the implant ensures the implant is robust and reduces inflammations [19, 20, 22]. The full-ceramic components provide for a high degree of esthetics and biocom- patibility with longevity. The monolithic design of the crowns means that chipping can be almost disregarded. In our practice we have not seen any ceramic fractures or total loss of an e.max crown in the last four years. Fig. 39: The unsatisfactory situation in the upper jaw and the palatal bar bothered the patient. Fig. 40: In the second quadrants three CAMLOG ® SCREW-LINE implants were inserted using the CAMLOG ® Guide System wit- hout bone augmentation. Fig. 41: The ceramic superstructures were bonded to the customized PS standard abutments. [1] Becker W, Becker BE, Handelsmann M, Celletti R, Ochsen- bein C, Hardwick R et al. Bone formation at dehiscend dental implant sites treated with implant augmentation material: a pilot study in dogs.Int J Periodontics Restorative Dent 1990; 10: 92-101 [2] Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res 1983: 28-42 [3] Burkhardt R, Lang N. Role of flap tension in primary wound closure of mucoperiosteal flaps: a prospective cohort study. Clin Oral Implants Res 2010; 21: 50-54 [4] Burkhardt R, Preiss A, Joss A, Lang N. Influence of suture tension to the tearing characteristics of the soft tissues: an in vitro experiment. Clin Oral Implants Res 2008; 19: 314-319 [5] Cawood JI, Howell RA. Reconstructive preprosthetic surgery. I. Anatomical considerations. Int. J Oral Maxillofac Implants 1991; 20: 75-82 [6] Cranin AN. Implant surgery: the management of soft tissues. J Oral Implantol 2002; 28:230-7 [7] Dahlin C, Lekholm U, Linde A. Membrane-induced bone bone augmentation at titanium implants. A report on ten fixtures followed from 1 to 3 years after loading. Int J Peri- odontics Restorative Dent 1991; 11: 273-81 [8] De Carvalho P, Vasconcellos L, Pi J. Influence of bed preparation on the incorporation of autogenous bone grafts: a study in dogs. Int J Oral Maxillofac Implants 2000; 15: 565-570 [9] Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segemental skeletal defects. J Bone Joint Surg Am 1980; 62:1039-58 [10] Kleinheinz J, Büchter A, Kruse-Lösler B, Weingart D, Joss U. Incision design in implant dentistry based on vascularisa- tion of themucosa. Clin Oral Implants Res 2005; 16: 518-23 [11] Kleinheinz J, Büchter A, Ritter K, Stratmann U, Joos U. Strategie der Schnittführung in der Implantologie. ZWR 2004; 113: 367-72 [12] Kübler NR. Osteoinduction and bone reparation. Mund Kiefer Gesichtschir 1997; 1: 2-25 [13] Mellonig J, Nevins M, Sanchez R. Evaluation of an bioabsorbable physical barrier for guided bone regeneration. Part I. Material alone. Int J Periodontics Restorative Dent 1998; 18: 139-149 [14] Mellonig J, Nevins M, Sanchez R. Evaluation of an bioab- sorbable physical barrier for guided bone regeneration. Part II. Material and a bone replacement graft. Int J Periodontics Restorative Dent 1998; 18: 129-137 LITERATURE