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Jorge M. Galante: A combined procedure for post extraction implants with simultaneous bone and gingival regeneration and immediate temporary restoration

  The purpose of this case report is to describe a multidisciplinary approach to tooth replacement in the aesthetic area. The challenge of this procedure is to perform, in a single session, the extraction of the tooth, the preparation of the osteotomy for implant insertion, and meticulous planning of the incision approach for the proper relocation and repositioning of the gingival tissues. The course of the incision should facilitate the correction of gingival recessions and also proper bone regeneration and prevention of alveolar collapse. A temporary prosthetic restoration is placed immediately after surgery. PRODUCT INFORMATION BY THE MANUFACTURER Products used in this case report: the Straumann® Bone Level Implant line was designed for a natural look and feel, providing flexibility and a balanced prosthetic portfolio for every indication. Straumann® Emdogain® is a unique protein mix which influences a number of different cells and processes – the gold standard when it comes to inducing the regeneration of lost periodontal tissues in a safe, easy and predictable way. The Straumann® Variobase abutment family offers extended restorative options with maximum design freedom. botiss cerabone® is a natural bovine bone grafting material which provides dependable stability and strength, predictably integrating into newly formed bone and ensuring volume maintenance and a strong, long-lasting matrix to support the successful placement of dental implants. The botiss Jason® membrane is a native collagen membrane obtained from porcine pericardium, whose advantageous biomechanical and biologic properties are preserved during the production process, resulting in beneficial properties like distinct tear resistance (despite its low thickness of only 0.1 to 0.25 mm) and easy adaptation to the bone surface. PICTURE DOCUMENTATION Fig. 1 galante01 Fig. 2 galante02 Fig. 3 galante03 Fig. 4 galante04 Fig. 5 galante05 Fig. 6 galante06 Fig. 7 galante07 Fig. 8 galante08 Fig. 9 galante09 Fig. 10 galante10 Fig. 11 galante11 Fig. 12 galante12 Fig. 13 galante13 Fig. 14 galante14 Fig. 15 galante15 Fig. 16 galante16 Fig. 17 galante17 Fig. 18 galante18 Fig. 19 galante19 Fig. 20 galante20 Fig. 21 galante21 Fig. 22 galante22 Fig. 23 galante23 Fig. 24 galante24 Fig. 25 galante25 Fig. 26 galante26 Fig. 27 galante27 INITIAL SITUATION The patient was a 40-year-old woman who presented at our clinic with type 3 mobility in tooth 21. We started with the admission diagnostic sequence (ADS), which consisted of clinical evaluation, radiological examination, photographic analysis and study models mounted on a semi-adjustable articulator. In the clinical analysis a fracture was noted at the cervical level of tooth 21, while marked gingival recession was also observed in the six upper anterior teeth (Fig. 1). Oral hygiene was poor, with the presence of plaque and moderate gingival inflammation. The patient stated that she had suffered dental trauma long ago, and that the consequence of that trauma had been the need for endodontic treatment for tooth 11. Numerous teeth had been treated with plastic restorations, including some with recurrent caries, while teeth 36, 37 and 46 had been replaced with osseointegrated implants/crowns. We requested a cone beam three-dimensional CT scan with interactive software (Fig. 2). TREATMENT PLANNING Impressions were made for study models to prepare a diagnostic wax-up for a temporary crown, which in turn serves as a surgical guide for implant insertion (Fig. 3). The lab technician was asked to make a temporary crown that was exactly the same size as the ideal clinical crown. The laboratory was also requested to make a resin key for positioning of the crown (Fig. 4). Basic periodontal therapy, prophylactic manual and ultrasonic scaling, and plaque control were performed. The surgery was planned, the patient was given antibiotic therapy consisting of 2 g of amoxicillin with clavulanate one hour before surgery, followed by 1 g every 12 hours for a week. SURGICAL PROCEDURE The course of the incisions provides access for simultaneous extraction, treatment of bone regeneration and treatment of gingival recessions of teeth 12, 11, 21, 22. The recession heights were measured from the cemento enamel junction (CEJ) to the gingival margin, and this measure was transferred from the tip of the papilla to mark the boundary of the incision. These incisions were directed obliquely medially in line with the “frontal approach” of Zucchelli (Fig. 5). Vertical discharge incisions were made distal to teeth12 and 22. The surgical papillae were elevated as a partial thickness flap up to the height of the gingival margins of the neighboring teeth, from where the flap became full thickness to a level 3 mm apical to the bone margin. From this limit it again became a partial thickness flap in two planes. A deep plane involved cutting the muscle attachments of the periosteum to bone, while a second superficial plane was designed to release the muscle attachments from the mucosa. This superficial incision allows complete freedom in repositioning the flap into the coronal level. The papilla between the two central incisors was not incised, since it detaches and communicates by tunneling. The flap at the level of tooth 21 was raised in its full thickness throughout. After the total mobilization of the flap was verified, the fractured tooth was gently extracted, and the remains of the periodontal attachment were completely removed, followed by preparation of the osteotomy for implant placement. A Straumann Bone Level implant 4.1×12 was used in this case, taking into account the three-dimensional positioning for adequate prosthetic restoration. A healing cap on the implant was placed to allow proper suturing of the tissue (Figs. 6-8). Straumann® Emdogain was placed at the recessions according to the manufacturer’s protocol to promote periodontal regeneration and improve healing (Fig. 12). The de-epithelialization of the anatomical papillae was completed. Dense connective tissue was harvested from the palatal area (Figs. 9, 10), a strip approximately 12 mm long by 5mm wide including connective and epithelial tissue. The incision depth was approximately 1.2 to 1.5 millimeters thick. On a tongue separator the epithelium was removed in full, while attempting to keep the thickness as uniform as possible. The thickness of the dense connective tissue after removal of the epithelium was approximately 1 mm. The graft was sutured with 6-0 nylon to the inside of the flap at the height of tooth 21, while trying to keep the graft 1 mm apical to the gingival margin (Fig. 11). The flap was made full thickness in order to expose bone and facilitate the regeneration of cortical bone by guided bone regeneration with bone substitutes (botiss® cerabone) and with resorbable pericardium membrane (botiss Jason membrane, Fig.11). The pericardium membrane was trimmed to match the shape of the cortical plate and no tacks were needed for its fixation. The membrane extended mesio-distally to the neighboring teeth, and apico-coronally from the base of the flap just to the bony crest. The bone substitute cerabone was placed inside the gap between the implant and the alveolus, and over the buccal cortical plate below the membrane, to prevent collapse. Next, the surgical papillae on the most distal anatomical sites were sutured with a suspensory suture, and the surgical papillae between 11-12 and 21-22 were then sutured. Finally, the vertical incisions were sutured. A transparent template was placed at the palatal donor site as a surgical dressing. Once the surgical phase was completed, the prosthetic procedures were initiated. A prosthetic component made of PEEK (Straumann) was used to support the temporary crown. This was trimmed and attached to the temporary acrylic crown for mechanical retention. With the help of the keys to reposition the crown it was placed at the preset ideal position and fixed with self-cured acrylic (Figs. 13-14). Afterwards the cylinder was unscrewed, the anatomy of the transmucosal portion was completed in the laboratory taking care to leave a well-defined CEJ, and, from this boundary to the implant abutment interface, a concave surface was left to allow for the housing of the soft tissues (Fig. 15). All occlusal contacts in centric and excentric movements were eliminated. The patient was instructed to avoid making excessive use of this area, avoid brushing during the first three days and keep the area clean with chlorhexidine mouthwash and gel. The patient was monitored weekly and the sutures were removed at three weeks (Fig. 16). PROSTHETIC PROCEDURE The patient was followed up at regular intervals, and the crown was removed at four months for a clinical and radiographic. evaluation (Figs. 17-18). The osseointegration was checked. An impression of the implant was taken and transferred to the laboratory for the manufacture of the definitive restoration (Figs. 19-20). In the lab the model was scanned with a 3D scanner (Amman Girrbach) and the mirror image of the corresponding tooth was reproduced with the help of CAD/CAM software and then machined in resin. This procedure was for diagnostic purposes, in order to evaluate the anatomy and adaptation to the tissues. The restoration was placed in the mouth and left for 4 weeks to allow the soft tissue to adapt to the anatomy of the crown, while the laboratory completed the final restoration, replicating the temporary crown on a Straumann® VarioBase abutment with porcelain-injected Empress (Ivoclar, Lab ZirLab) (Figs. 21–27). FINAL RESULT We consider that the procedure presented in this report requires extensive training of a multidisciplinary team comprised of a surgeon, prosthodontist and prosthetic lab technician for a combined approach with simultaneous working. However, this produces excellent results. At the surgical level, when bone regeneration is required, communication of the wound with the oral environment should be avoided at all costs. This is why the healing of soft tissue is usually expected (6/8 weeks) to result in proper surgical closure after tooth extraction in the delayed approach. This requires a first surgical session for implant installation and simultaneous bone regeneration, followed by a waiting period of 4/6 months for the completion of osseointegration and a second surgical session for implant connection. Once the soft tissues have healed, after approximately 4/6 weeks, the prosthetic gingival modeling stage is started, which takes about 6/8 weeks or more. Later, this gingival modeling is transferred to the laboratory through a customization of the transfer coping to produce the final restoration. Also, the restoration approach involves the exact opposite approach. We aim to produce an immediate temporary restoration based on the anatomical features of the final restoration. Thus, on completion of the surgical procedures, the hard and soft tissues heal around the final crown anatomy. The challenge is to achieve, in a single combined procedure, implant placement immediately after extraction, bone and gingival regeneration, and sealing of the tissues around the restoration in a very tight and precise manner so as to maintain and protect the underlying blood clot, isolated from the oral environment, which is the main factor responsible for the regeneration. CONCLUSION This protocol is the result of a learning curve that we have been developing over time, based on scientific evidence for the individual procedures (see supporting evidence) together with the evidence from our own research center. What we have developed is a combination of a series of isolated and individualized procedures in a single complex procedure. While it is necessary to continue to deepen and analyze this procedure in the long term, the results obtained to date are equivalent to, or more favorable than, those achieved when procedures are performed in stages. These results have been very motivating to continue to deepen this therapeutic line. The procedure offers the main advantages of exposing the patient to fewer surgical procedures, a reduction in maneuvers and prosthetic sessions, with the consequent decrease in clinical time and total treatment time. SUPPORTING EVIDENCE Systematic reviews Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement. Int J Oral Maxillofac Implants 2007;22:49–70. Esposito M, Grusovin MG, Coulthard P, Worthington HV. The efficacy of various bone augmentation procedures for dental implants: A Cochrane systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants 2006;21:696 –710. Esposito M, Grusovin M, Worthington H, Coulthard P. Interventions for replacing missing teeth: Bone augmentation techniques for dental implant treatment. Cochrane Database Syst Rev 2006:CD003607. Animal Studies Marco Caneva, Daniele Botticelli, Fabrizio Morelli, Gianfranco Cesaretti, Marco Beolchini, Niklaus P. Lang. Alveolar process preservation at implants installed immediately into extraction sockets using deproteinized bovine bone mineral – an experimental study in dogs. Clin. Oral Impl. Res. 23, 2012; 789–796. doi: 10.1111/j.1600-0501.2011.02332. Caneva M, Botticelli D, Rossi F, Cardoso LC, Pantani F, Lang. Influence of implants with different sizes and configurations installed immediately into extraction sockets on peri-implant hard and soft tissues: an experimental study in dogs. Clin. Oral Impl. Res. 23, 2012, 396–401 doi: 10.1111/j.1600-0501.2011.02310. de Sanctis M, Vignoletti F, Discepoli N, Zucchelli G, Sanz M. Immediate implants at fresh extraction sockets: bone healing in four different implant systems. J Clin Periodontol 2009; 36: 705–711. doi: 10.1111/j.1600-051X.2009.01427. Tomasi C, Sanz M, Cecchinato D, Pjetursson B, Ferrus J, Lang NP, Lindhe J. Bone dimensional variations at implants placed in fresh extraction sockets: a multilevel multivariate analysis. Clin. Oral Impl. Res. 21, 2010; 30–36. doi: 10.1111/j.1600-0501.2009.01848. Fickl S, Zuhr O, Wachtel H, Stappert CFJ, Stein JM, Hürzeler MB. Dimensional changes of the alveolar ridge contour after different socket preservation techniques. J Clin Periodontol 2008; 35: 906–913. doi: 10.1111/j.1600-051X.2008.01305.x. (Correction added on 27 August 2008, after first online publication. Author’s name Stein JM was corrected.) Hürzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. The socket-shield technique: a proof-of-principle report. J Clin Periodontol 2010; 37: 855–862. doi: 10.1111/j.1600-051X.2010.01595. Fickl S, Kebschull M, Schupbach P, Zuhr O, Schlagenhauf U, Hürzeler MB. Bone loss after full-thickness and partial-thickness flap elevation. J Clin Periodontol 2011; 38: 157–162. doi: 10.1111/j.1600-051X.2010.01658. Clinical studies Istvan A. Urban, DMD, MD1/Heiner Nagursky, PhD2/Jaime L. Lozada, DDS3 Ridge Augmentation with a Resorbable Membrane and Particulated Autogenous Bone With or Without Anorganic Bovine Bone–Derived Mineral: A Prospective Case Series in 22 Patients Int J of Oral & Maxillofac Implants. Volume 26, Number 2, 2011. Buser D, Ingimarsson S, Dula K, Lussi A, Hirt HP, Belser UC. Long-term stability of osseointegrated implants in augment- ed bone: A 5-year prospective study in partially edentulous patients. Int J Periodontics Restorative Dent 2002; 22:109–117. Sanz M, Cecchinato D, Ferrus J, Pjetursson EB, Lang NP, Jan L. A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Clin. Oral Impl. Res. 21, 2010; 13–21. doi: 10.1111/j.1600-0501.2009.01824. Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S, Pini-Prato G. Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. J Clin Periodontol 2012; 39: 760–768. doi: 10.1111/j.1600-051 Stephen T. Chen, BDS, MDSc, PhD, FRACDS1/Daniel Buser, DMD, Prof Dr Med Dent2 Esthetic Outcomes Following Immediate and Early Implant Placement in the Anterior Maxilla—A Systematic Review. Int J Oral Maxillofac Implants 2014;29(suppl):186–215. doi: 10.11607/jomi.2014suppl. Case reports Dr. Jorge M. Galante. Predictable GBR procedures in sites with high esthetic compromise. Starget|July 3rd, 2015 Clinical Cases, Dental Biomaterials, Dental Implants, Dental Prosthetic. Dr. Jorge M. Galante Prof. Dr. Jorge M. Galante Specialized in bucco-dento-maxillary prosthetics and implant surgery. Director at the Galante Institute, Mar del Plata, Argentina. Professor at the Dental School of the University of Buenos Aires, Argentina (F.O.U.B.A). Director of the Advanced Course on Complex Surgery in Implantology by the Argentinian Association of Odontology, A.O.A. at the University of Salvador (U.S.A.L.), Buenos Aires, Argentina. The post Jorge M. Galante: A combined procedure for post extraction implants with simultaneous bone and gingival regeneration and immediate temporary restoration appeared first on STARGET COM.

ITI World Symposium 2017: Meet the next generation of implant dentistry

  The International Team for Implantology (ITI) is holding the next edition of its flagship event – the ITI World Symposium – in 2017 from May 4 to 6 in Basel, Switzerland. The scientific program along with the faculty list have been published on the ITI World Symposium 2017 website at The main theme of the meeting is “Key factors for long-term success”. Find inspiration for your future at the ITI World Symposium 2017. Meet not only the field’s leading international speakers, but also a select group of talented young specialists from around the world, representing the next generation of implant dentistry. Yeliz Cavusoglu and Luiz Gonzaga tell you why the ITI WS 2017 is also the right event for young professionals at the start of their career. Find out why Prof. Irena Sailer and Prof. Urs Belser think you need to be in Basel, Switzerland for the ITI WS 2017. Scientific program chair Prof. Daniel Wismeijer on how new ideas help us to look at things in different ways: Why we from Straumann think you have to be in Basel at the ITI WS 2017! REGISTER NOW For more information and to register for the most important implant dentistry meeting in 2017, go to the official ITI World Symposium website: WEBSITE Keys to the entire treatment cycle from diagnosis through treatment to aftercare More than 80 speakers from all over the world will be sharing their expertise in a series of plenary and parallel breakout sessions over three days. They will be providing keys to the entire treatment cycle from diagnosis through treatment to aftercare, offering sustainable long-term solutions. In addition to the field’s leading international speakers, the faculty also includes a broad cross-section of young and talented specialists from around the world, representing a diversity of evidence-based approaches and the next generation of implant dentistry. The Scientific Program Committee led by Prof. Dr. Daniel Wismeijer has designed a practically oriented program of information and approaches that participants can immediately implement in daily practice. To ensure that the take home messages are directly accessible to as broad an audience as possible, all plenary sessions will be simultaneously translated from English into nine languages. What will be important tomorrow?  “With the theme ‘key factors for long-term success’, the aim is not only to highlight what is state of the art today but also what will be important tomorrow – looking at the technology and approaches that are set to direct practice in the near future,” explained Daniel Wismeijer, Chair of the Scientific Program Committee. “Our speakers are providing keys to various areas within implant dentistry and are also showing how they can be used to open doors to best practice.” The role of technology in our lives is the theme of keynote speaker Dr. Kevin Warwick, a leading cybernetics researcher at the University of Coventry whose area of study is artificial intelligence, robots and cyborgs. Kevin Warwick will be taking a look at how healthcare is developing in the light of technological advances. By contrast, the groundbreaking work of the ITI in the field of implant dentistry during its 37-year history forms the subject of a presentation by Dr. h.c. Thomas Straumann and Prof. Dr. Daniel Buser. Pre-Symposium Corporate Forum The World Symposium scientific program is complemented by a half-day Pre-Symposium Corporate Forum presented by Straumann, Morita and botiss, where opinion leaders talk about their experience with the latest products and technologies. The extensive industry exhibition provides participants with a perfect opportunity to visit key companies, see what’s new and find out how they can apply it in daily practice. THE LOCATION The ITI World Symposium is being held at the Messe Basel within the halls designed by renowned Basel architects Herzog & de Meuron. The unique facade of twisted aluminum bands encloses the ITI World Symposium 2017 setting that is inspired by the dynamic world of modern airports. Bustling departure gates, quiet lounges and a lively exhibition zone provide ample opportunity for the event’s more than 4,200 anticipated visitors to meet and network while taking part in an exciting scientific journey. This is further facilitated by an innovative technology service that allows participants to exchange and gather information using a small interactive device. Any information gathered continues to be accessible and up to date in the “cloud”, which eliminates the need to produce and carry around large amounts of paper during the event. By choosing Basel as the event location, the ITI is returning to its roots and home base. The city itself provides a beautiful backdrop to the event, with a charming old town that is easily accessible from all the hotels and the congress venue. ABOUT THE ITI The International Team for Implantology (ITI) is an academic association that unites professionals around the world from every field of implant dentistry and related disciplines. It actively promotes networking and exchange among its membership of currently more than 15,000. ITI Fellows and Members regularly share their knowledge and expertise from research and clinical practice at meetings, courses and congresses with the objective of continuously improving treatment methods and outcomes to the benefit of their patients. In 36 years, the ITI has built a reputation for scientific rigor combined with concern for the welfare of patients. The organization focuses on the development of well-documented treatment guidelines backed by extensive clinical testing and the compilation of long-term results. The ITI funds research as well as Scholarships for young clinicians, organizes congresses and continuing education events, and runs more than 600 Study Clubs around the globe. The organization also publishes reference books such as the ITI Treatment Guide series and operates the ITI Online Academy, a peer-reviewed, evidence-based e-learning platform with a unique user-centric approach. The post ITI World Symposium 2017: Meet the next generation of implant dentistry appeared first on STARGET COM.

Straumann and maxon motor announce partnership to produce dental implant components by ceramic injection moulding (CIM)

  Two leaders combine strengths to make ceramic implant treatments easier for dentists and more affordable for patients. Straumann to obtain 49% stake in joint venture company, subject to approval by German Federal Cartel Office (Bundeskartellamt). First CIM components expected in the near term – pending favourable laboratory and clinical results and regulatory applications Basel, 23 November 2016: Straumann has entered a partnership with maxon motor to develop ceramic components for dental implant systems that are produced by injection moulding instead of conventional cutting techniques. The partnership includes a joint venture company, maxon dental GmbH based near Freiburg, in Germany, which will develop and produce CIM components for Straumann. Under the terms of the agreement, Straumann will obtain a 49% stake in maxon dental GmbH – subject to approval by the German Federal Cartel Office – and has an option to increase its equity stake to full ownership in 2026. Financial terms were not disclosed. maxon motor has 20 years’ experience in CIM for mechanical precision parts. During the past 10 years, maxon motor has broadened the application of its CIM technology to include dental implants and owns various patent applications and patents. The partnership provides Straumann with access to this exciting technology and corresponding expertise. Marco Gadola, CEO of Straumann: “There are few – if any – technology providers in the world that can equal maxon motor with regard to innovation, expertise and reliability in CIM. Combining our strengths in dentistry with their technology leadership, the initial goal of our joint venture is to make ceramic implant treatments easier for dentists and more affordable for patients who want highly esthetic, metal-free solutions. We expect to launch our first CIM components in the near term – providing that the outcome of laboratory and clinical programs and regulatory applications are favourable”. About maxon motor Headquartered in Sachseln, Switzerland, maxon motor develops and manufactures compact electric drive systems for applications requiring high precision and reliability. maxon motor is a worldwide leader for small DC drive systems, which are used in insulin and cardiac pumps, surgical power tools as well as humanoid robots, passenger aircraft and spacecraft. Continually striving for innovation, maxon motor pioneered the use of high strength, low wear injection molded zirconia components in miniature gear and shaft assemblies some 20 years ago. The post Straumann and maxon motor announce partnership to produce dental implant components by ceramic injection moulding (CIM) appeared first on STARGET COM.

Roberto Sleiter/Nathalie Oppliger: Individually milled bone augmentation to restore masticatory function (botiss maxgraft® bonebuilder)

  The 72-year-old healthy male patient presented at our practice in mid-2014 with the aim of improving his dental situation (Fig. 1). His quality of life was substantially impaired by his very mobile upper and lower dentures. He wanted to improve his appearance and, in particular, achieve a stable fit of his dentures, ideally by fixed implants in the upper and lower jaws. The upper jaw showed residual dentition with a very poor and unsightly periodontal situation (Fig. 2). In the lower jaw there was a complete denture on a severely atrophied bone ridge (Fig. 3). PRODUCT INFORMATION BY THE MANUFACTURER The botiss maxgraft® bonebuilder is a new innovative, customized allogenic bone block which is individually designed and adjusted to the desired 3-dimensional bone contour. Based on planning data and clinician-approved, the bonebuilder is produced by a milling machine and is provided in a sterile condition ready for implantation. It is the ideal bone substitute to rebuild 3-dimensional defects and to reconstruct the ridge, allowing a patient friendly treatment PICTURE DOCUMENTATION Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 TREATMENT PLANNING Since the volume and quality of bone in the upper jaw were satisfactory (type II according to Lekholm and Zarb criteria), following extraction of the residual teeth with a poor prognosis, we opted for a fixed prosthesis on four implants. The initial situation in the lower jaw was more difficult. The severely atrophied edentulous lower jaw and the close proximity of the bone to the inferior alveolar nerve meant that implants were possible only in the interforaminal area (Fig. 4). The bone resorption was even clearer on a CBCT scan. We therefore decided to proceed with a substantial interforaminal bone augmentation prior to implant insertion. First of all, the upper jaw was provided with an ideal solution in terms of both function and esthetic appearance. During this time the lower jaw was adapted accordingly in preparation for the definitive implant provision in a second step. Since the implant provision for the lower jaw represented the greater challenge in this patient in terms of anatomy, surgery and implantation, this case report will focus only on the procedure for the lower jaw. PLANNING In order to obtain sufficient bone for the augmentation in the lower jaw and avoid any morbidity associated with iliac crest bone harvesting in this patient, we opted for the allogeneic bone augmentation technique proposed by the company botiss. The detailed planning included a CBCT scan and the virtual transmission of the ideal prosthetic arrangement of the lower jaw teeth (Fig. 5). The position of the implants was defined and the required bone material calculated. The data was then transmitted to botiss, who prepared our custom-made blocks from bone tissue (Fig. 6). SURGICAL PROCEDURE The first step was the bone augmentation with the individually milled bone blocks (maxgraft® bonebuilder). To this end, the bone surface of the application points was lightly freshened, and the maxgraft® was then fixed in place with Straumann osteosynthesis screws (Fig. 7). Collagen-modified xenogeneic bone replacement material was then applied and covered with the porcine collagen membrane (Fig. 8). Periosteal fenestration was followed by tight primary closure of the wound. An OPT was recorded postoperatively for control purposes (Fig. 9). Four months after the bone augmentation two interforaminal implants (Straumann® RN ø 4.1mm, length 8mm, position 33, 43) were inserted (Figs. 10 and 11), and the osteosynthesis screws were removed at the same time. PROSTHETIC PROCEDURE Three months after the implantation definitive impressions were taken for the lower jaw implants, as well as conventional bite registration and preparation of a wax checkbite. The patient was provided with a hybrid denture anchored on a CADCAM titanium bar with extensions distally and male retainers (Fig. 12). One minor special feature is the connection between the implant and bar, which involves the use of special abutments. The patient was told how to clean the bar and the implants in the upper jaw. Furthermore, a 4-month recall guarantees a stable prosthetic outcome (Fig. 13). CONCLUSION CADCAM systems for the preparation of individually produced bone blocks like those supplied by Botiss facilitate minimally invasive bone augmentation procedures. At the same time, these long-lasting implant solutions offer maximum comfort for the patient. Roberto Sleiter Dr. med. dent. Studied dental medicine at the Università Cattolica in Rome, Italy. Specialist in oral surgery (since 2002). Private practice in Egerkingen, Switzerland. External Senior Physician at the Department of Oral Surgery at the University of Bern, Switzerland with Prof. Daniel Buser. Member of the Swiss Dental Association (SSO), the Swiss Society of Oral Surgery and Stomatology (SSOS) and the Swiss Society of Oral Implantology (SGI). Nathalie Oppliger Dr. med. dent. Studied dental medicine at the University of Basel, Switzerland. Trained at the Clinic for Reconstructive Dentistry and Myoarthropathy, University of Basel. Dentist in the practice of Dr. Roberto Sleiter, Egerkingen The post Roberto Sleiter/Nathalie Oppliger: Individually milled bone augmentation to restore masticatory function (botiss maxgraft® bonebuilder) appeared first on STARGET COM.


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