Major Bone Augmentation
Dr. Ilkka Pallonen, DDS
Horizontal bone and soft tissue augmentation in the posterior mandible.
The Situation
A healthy 75-years-old woman lost her dental bridge on area 44–47, due to fracture of tooth 44. Patient’s dental hygiene was excellent and she was very motivated to return to chew normally. The patient had previous implant treatment at the
left mandible posterior site and wanted to have a fixed solution also at the right side. The patient was informed about the lack of horizontal bone volume and accepted to undergo through a GBR procedure before implant placement.
The Risk Profile
Dr. Ilkka Pallonen, DDS
Maxillofacial Surgeon DDS in Tampere University Finland.
Maxillofacial specialty training in central Finland (Jyväskylä & Tampere) 2011–2018.
Consultant Maxillofacial surgeon, in charge of implant therapy, bone and soft tissue regeneration in Tampere University Hospital.
President of Implantology division of Finnish dental association Apollonia.
Tampere Oral Hammaslääkärit Sumeliuksenkatu, private practice.
Helsinki Terveystalo Kamppi, private practice.
“Patient had high expectations for treatment outcome. There was a need to reconstruct bone volume horizontally. Deficiency of keratinized tissue needed to be taken care of during treatment.”
The Approach
In order to be able to provide an implant supported bridge, we needed to reconstruct the bone with the horizontal sausage technique approach described by Dr. Istvan Urban. After bone grafting and implant placement, a free gingival graft was used to increase the thickness of the keratinized tissue. A wide keratinized tissue zone key to ensure long-term success of the implant treatment.
The Outcome
Prior to implant placement, a Geistlich Bio-Gide® membrane was used to stabilize the graft, which consisted of a 50/ 50% mix of autologous bone and Geistlich Bio-Oss®. Implantation was pleasant due to good volume of regenerated bone. Keratinized gingiva was widened with a palatal free gingival graft two months after implant placement.
The patient was satisfied with the outcome.
1 Patient loses dental bridge on region 44–46, due to fracture of tooth nr. 44. | 2 Operative situation 3 months after tooth 44 extraction. Safety-flap, from tooth 42 to ramus. Clinically 2 mm horizontal width at the top of ridge. Oblique-form ridge and implants would have to be lowered 6–7mm, to have a good bone coverage. | 3 Horizontal bone regeneration using a mix of 50 % autologous bone from ramus and 50 % of small granules of Geistlich Bio-Oss® | 4 A 30×40 mm Geistlich Bio-Gide® fitted to the site and fixed with titanium pins to stabilize the graft underneath. | 5 Double layer closure with PTFE 3-0 and Novafil 6-0 sutures. | 6 After six months of healing there was 8–9mm of horizontal bone width at the whole area. We noticed the need to reduce bone height of 2 mm, to have enough room for future prosthetic restorations | 7 4,2 mm diameter wide implants placed on sites 44 and 46. | 8 After healing, only 2mm of keratinized gingiva was left. Soft tissue augmentation with a free gingival graft was performed. | 9 Second stage surgery to reveal implants, 4 months after implant placement. Lingually moved keratinized tissue around implants. Closure with Caprosyn 5-0 sutures. | 10 Radiological status 1-year after loading. There was excellent bone coverage on every aspect of both implants. | 11 Occlusal view of the clinical status 1-year after loading. | 12 Lateral view of the clinical status 1-year after loading.
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