Vertical ridge augmentation in the maxillary posterior region. Using creos™ syntoprotect Ti-Reinforced PTFE Membrane
Dr. Jesús González Medina
Spain
Patient: 67-year-old male with a complaint of difficulty with mastication and poor esthetics.
Clinical situation: Missing 24-25, and 26 exhibits grade III mobility, indicating severe bone loss vertically 11 mm at the deepest area and horizontally 2 mm, and chronic periodontitis.
Surgical solution: Extraction of 26 and vertical bone augmentation using creos syntoprotect Ti-reinforced PTFE membrane and 50% xenograft and 50% autologous bone to attain the necessary bone height for implant placement of NobelActive® TiUltra™ implants.
Restorative solution: Screw-retained implant bridge with ultra-polished zirconia crowns.
Surgery date: September 15, 2023
Total treatment time: 2 years
Tooth position: 24, 25, and 26
Alveolar ridge in maxillary left region with missing tooth 24 and 25, and associated bone loss. Recession at tooth positions 23 and 26 (left).
CBCT image shows the resorbed alveolar bone, vertically 11 mm in the deepest area and horizontally 2 mm (right).
OPG reveals the bone defect in the maxillary left region, missing teeth 24 and 25, and bone loss around tooth 26 and 27.
Extraction of periodontally compromised tooth 26 (left).
Flap elevation reveals knife-edge ridge and bone defect (right).
creos syntoprotect membrane placed with composite bone graft (Xenograft 50%, Autologous 50%) (left).
Membrane stabilization using creos screw fixation (right).
Alveolar ridge after 5 months of guided bone regeneration.
During the process of implant placement, the elevation of the flap reveals an intact creos syntoprotect membrane. Notably, this membrane has maintained its integrity even after 14 months.
14 months post GBR, successful vertical bone gain is evident following membrane removal. Horizontal bone gain of 12 mm on average. 100% vertical bone gain (within bone frame).
Osteotomy and NobelActive® TiUltra™ implant placement in tooth position 24: RP 4.3x11.5 at 35 Ncm and in tooth position 26: RP 4.3x10 at 35 Ncm.
The analyzed sections show vital spongy bone tissue, with trabecular formations of different morphology and size. The interposed connective tissue is fibro-cellular, generally loose and well vascularized. At one end, a wide band of acellular fibrous connective tissue is observed. In several areas and adhering to the vital bone, several irregular conglomerates of a basophilic, granular, acellular foreign material with smaller eosinophilic fragments are visible.
Screw-retained ultra polished zirconia crowns implant bridge replacing 24,25 and 26 (left).
Buccal view of final prosthesis. Patient wanted function and esthetics (right).
2-year follow-up - Postoperative radiograph.
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creos™ syntoprotect meshNon-resorbable reinforced PTFE mesh for the stabilization and support of bone grafts in horizontal and vertical ridge augmentations.
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NobelActive®An implant like no other.
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