Background information
Prof. Massimo Simion and Dr. Isabella Rocchietta:
«Vertical augmentation of severe localized edentulous atrophic alveolar ridges is
still challenging. The membrane technique (guided bone regeneration) has been
shown to be a valuable and predictable treatment method1,2,3. While resorbable
membranes, especially native collagen membranes (Geistlich Bio-Gide®), have
been used widely and successfully for bone regeneration in small to medium sized
defects, in vertical ridge augmentation greater membrane stability is currently
required. Therefore, we prefer to use the titanium-reinforced ePTFE-membrane.
However, the surgical technique with this membrane is technically complex and
involves a high risk of premature membrane exposure resulting in bacterial
contamination.
We use autogenous bone chips underneath the membrane. Thereby we
increase the potential for bone regeneration outside of the bony housing. The
admixture of Geistlich Bio-Oss® granules to the autogenous bone helps to
maintain the stability of the regenerated bone, due to the slow degradation
process of Geistlich Bio-Oss®4,5.»
2. Aims of the therapy
> Vertical bone regeneration in a (partially) edentulous jaw in order to provide
sufficient long-term stability for implant-supported tooth restorations
3. Surgical procedure
Fig. 1 Clinical view of the patient's edentulous
right mandible. The severe atrophy can be
appreciated and minimal keratinized gingiva is
present.
Fig. 2 Orthopantomography of the patient. A
bilateral mandibular atrophy is present. The
treatment of the right hand side will be
presented.
2
Fig. 3 The surgery is carried out after
administering local anaesthesia combined with
sedative premedication. A full thickness incision is
made within the keratinized mucosa starting
from the distal aspect of the cuspid. An
intrasulcular incision is performed buccally
around the cuspid and lingually extending to the
lateral incisor. A vertical releasing incision is
made at the mesiobucccal angle and at the distal
aspect of the crestal incision. Buccal and lingual
flaps are reflected with a periosteal elevator.
Once exposed, the cortical bone is curetted with
a back-action chisel to remove all residual
connective tissue. Intraoperative view after flap
elevation.