Horizontal and vertical ridge augmentation of a knife-edge ridge
Dr. Bastian Wessing
Germany
“Why do I use the creos™ xenoprotect membrane? Because of the improved mechanical properties…for its effectiveness in many indications.”
Patient: 54, male
Clinical situation: missing teeth 46, 47. Late implant placement, bone quality D1. Poor bone quantity with 2-3 mm thickness at the crest, 8 mm and 6 mm residual bone on top of the nervus alveolaris inferior in region 46 and 47 respectively.
Surgical solution: creos™ xenoprotect membrane. Horizontal and vertical augmentation by GBR using “tenting screw technique”
Surgery date: February 25, 2015 (GBR), August 14, 2015 (implant placement), March 18, 2016 (prosthetic restoration)
Initial clinical situation
Alveolar ridge in region 46, 47 with horizontal and vertical defect (left).
Panoramic radiograph prior to the GBR procedure. The radio-opaque objects on top of the ridge in region 46 and 47 are metallic guide sleeves for determining the implant position (right).
Surgical procedure
Bone situation after flap elevation with cortical perforations (left).
To perform the “tenting screw technique”, two 10 mm long osteosynthesis screws were fixed in region 46 and 47 on top of the ridge extending 6 mm above the bone (right).
Surgical procedure
creos™ xenoprotect membrane fixed lingually using two titanium pins (left).
Composite bone graft of about 50% autologous bone chips and 50% DBBM (right).
Surgical procedure
Bone graft successfully immobilized through spanning and fixation of the creos™ xenoprotect membrane using three additional buccally fixed titanium pins (left).
Continuous sutures combined with horizontal mattress sutures for uneventful healing (right).
Surgical procedure
Panoramic radiograph after the GBR procedure.
Restorative procedure
Alveolar ridge after 6 months of healing, measuring 3 mm vertical and 8 mm horizontal bone gain (left).
Two NobelActive® implants were placed in region 46 (4.3 mm x 11.5 mm) and 47 (5 mm x 10 mm) (center).
One-stage procedure using two healing abutments 5 mm x 5 mm placed for transgingival healing (right).
Restorative procedure
Panoramic radiograph after implant placement.
Restorative procedure
Situation after four-month healing time. No fixed mucosa on the buccal site requires a free gingival graft (right).
A free gingival graft from the palate of 15 mm x 5 mm was harvested and the donor site wound was dressed with a collagen matrix (center).
A mucosal apical repositioning flap with periosteal sutures was performed and the transplant was fixed to the underground with cross sutures (left).
Outcome
Soft tissue healing after 8 weeks (left).
Nobel Biocare Complete Posterior Solution with two veneered zirconia ASC abutments (center).
Occlusal view of the full-ceramic crowns 46 and 47 (right).
Outcome
Buccal view of the final full-ceramic crowns.
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NobelActive®An implant like no other.
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creos™ xenoprotectA membrane with outstanding handling that facilitates bone gain.
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