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Dr. Bastian Wessing

Horizontal and vertical ridge augmentation of a knife-edge ridge

Dr. Bastian Wessing

Germany

“Why do I use the creos™ xenoprotect membrane? Because of the improved mechanical properties…for its effectiveness in many indications.”

Case courtesy of Dr. Wessing

Patient: 54, male

Clinical situation: missing teeth 46, 47. Late implant placement, bone quality D1. Poor bone quantity with 2-3 mm thickness at the crest, 8 mm and 6 mm residual bone on top of the nervus alveolaris inferior in region 46 and 47 respectively.

Surgical solution: creos™ xenoprotect membrane. Horizontal and vertical augmentation by GBR using “tenting screw technique”

Surgery date: February 25, 2015 (GBR), August 14, 2015 (implant placement), March 18, 2016 (prosthetic restoration)

 

 

 

Case courtesy of Dr. Bastian Wessing.

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Case courtesy of Dr. Wessing

Initial clinical situation

Alveolar ridge in region 46, 47 with horizontal and vertical defect (left). 

Panoramic radiograph prior to the GBR procedure. The radio-opaque objects on top of the ridge in region 46 and 47  are metallic guide sleeves for determining the implant position (right).

Case courtesy of Dr. Wessing

Surgical procedure

Bone situation after flap elevation with cortical perforations (left).

To perform the “tenting screw technique”, two 10 mm long osteosynthesis  screws were fixed in region 46 and 47 on top of the ridge extending 6 mm above the bone (right).

Case courtesy of Dr. Wessing

Surgical procedure

creos™ xenoprotect membrane fixed lingually using two titanium pins (left). 

Composite bone graft of about 50% autologous bone chips and 50% DBBM (right).

Case courtesy of Dr. Wessing

Surgical procedure

Bone graft successfully immobilized through spanning and fixation of the creos™ xenoprotect membrane using three additional buccally fixed titanium pins (left).

Continuous sutures combined with horizontal mattress sutures for uneventful healing (right).

Case courtesy of Dr. Wessing

Surgical procedure

Panoramic radiograph after the GBR procedure.

Case courtesy of Dr. Wessing

Restorative procedure

Alveolar ridge after 6 months of healing, measuring 3 mm vertical and 8 mm horizontal bone gain (left).

Two NobelActive® implants were placed in region 46 (4.3 mm x 11.5 mm) and 47 (5 mm x 10 mm) (center).

One-stage procedure using two healing abutments 5 mm x 5 mm placed for transgingival healing (right).

Case courtesy of Dr. Wessing

Restorative procedure

Panoramic radiograph after implant placement.

Case courtesy of Dr. Wessing

Restorative procedure

Situation after four-month healing time. No fixed mucosa on the buccal site requires a free gingival graft (right).

A free gingival graft from the palate of 15 mm x 5 mm was harvested and the donor site wound was dressed with a collagen matrix (center).

A mucosal apical repositioning flap with periosteal sutures was performed and the transplant was fixed to the underground with cross sutures (left).

Case courtesy of Dr. Wessing

Outcome

Soft tissue healing after 8 weeks (left).

Nobel Biocare Complete Posterior Solution with two veneered zirconia ASC abutments (center). 

Occlusal view of the full-ceramic crowns 46 and 47 (right).

Case courtesy of Dr. Wessing

Outcome

Buccal view of the final full-ceramic crowns.

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