success is... - DENTSPLY Friadent

2a_Bone situation after
bone removal
2b_Membrane fixed with miniscrew
and still folded back for later support
The patient wore a bridge to replace tooth 36 and 37 for a
long time. It was to be replaced as a consequence of caries
in tooth 38 and an associated root-canal treatment. Because
the remaining retention area on tooth 38 was minimal and
there was danger of a new bridge becoming detached, the
patient decided to have a restoration with endosseous
implants in our practice. The initial situation shown in figure
1a and palpation of the region indicated an alveolar ridge
strongly atrophied transversally, while the vertical plane was
virtually completely retained as shown in Fig. 1b.
2_GRAFTING
Dec. 1, 2005 The primary incision was selected in a strongly
buccal direction. Preparation in the lingual direction was in
form of a mucoperiosteal flap; the buccal preparation was a
split flap, and a mucosal flap and a periosteal flap were
prepared separately. Grafting was required before implant
placement due to an inadequate alveolar ridge width shown
in Figure 1c. It was decided to select the donor and receiver
regions in close proximity to each other to reduce postoperative
3a_Grafted material under membrane
IDENTITY | 23
3b_Status after suturing
inconvenience to a minimum for the patient. If possible there
should only be one surgical site. In this case cortical bone
was removed apically to the graft site above the oblique line
(Fig. 2a). The donor region was suitable as its position below
the subsequently inserted membrane favored the growth of
blood vessels from the uncovered bone marrow into the
grafted material. Approximately 20 % of a granulated bone
replacement material was added to increase the volume of
the grafted material.
A miniscrew (Medartis, Basle, Switzerland) was inserted
from lingual direction to fix the titanium-reinforced membrane
(GoreTex TR6Y, W. L. Gore & Associates Gmbh, Putzbrunn/
Germany). As shown in Figure 2b, the screw also supported
the membrane on the buccal side. Once the graft had been
placed (Fig. 3a), the seating of the membrane was checked.
Make sure that the membrane is positioned on the bone
without gaps after adapation and that there is an adequate
distance from the periodontium of the neighboring teeth.
The membrane is fixed buccally by reshaping the previously
prepared periosteal flap on the buccal side. It was finally