Dr Fabrizio Colombo

GBR using a Ti-reinforced non resorbable membrane and simultaneous sinus lift

Dr. Fabrizio Colombo, DDS

Italy

Case courtesy of Dr. Colombo

Patient: 62, F, No systemic diseases, no oral pathologies or dental problems other than the existing one.

Clinical situation: absence of the dental elements from 1.3 to 1.7, horizontal atrophy of the I quadrant and vertical atrophy in the region of 1.4, 1.5, 1.6 and 1.7.

Surgical solution: GBR using creos™ syntoprotect Ti-reinforced PTFE membrane and a mixture of creos™ xenogain and autologous bone to improve the width of the alveolar ridge. Sinus lift through lateral approach to reach the amount of bone useful to place implant in the posterior area. Placement of 4 NobelReplace CC implants after 8 months of healing. Free gingival graft to get keratinized tissues around the implants.

Restorative solution - Provisional: Acrylic (PMMA) screw retained temporary crowns. Final: Metal-ceramic crowns.

Surgery date: October 23, 2018 (GBR/Sinus Lift). July 1, 2019 (Implants placement). October 17, 2019 (Soft tissues management). November 18, 2020 (Final prosthesis)

Total treatment time: 25 months

Tooth position: 13-14-15-16

 

 

 

Case courtesy of Dr. Fabrizio Colombo, DDS.

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Case courtesy of Dr. Colombo

Initial clinical situation - GBR and Sinus Lift surgery

Extra-oral view: no gummy smile; slight asymmetry during spontaneous smile (left).

Intra-oral lateral view (top right).

Detail of the atrophy (bottom right).

Case courtesy of Dr. Colombo

Treatment planning - GBR and Sinus Lift surgery

Pre-surgical OPG (left).

CBCT showing horizontal atrophy of the alveolar ridge and pneumatization of the right maxillary sinus (right).

Case courtesy of Dr. Colombo

Surgical procedure - GBR and Sinus Lift surgery

Opening of a full-tickness trapezoidal flap (left).

Occlusal view of the horizontal atrophy (right).

Case courtesy of Dr. Colombo

Surgical procedure - GBR and Sinus Lift surgery

Antrostomy (left).

Ti-reinforced non resorbable PTFE membrane (creos™ syntoprotect) already fixed on the palatal wall and grafting material in situ (mix of 50% autologous bone and 50% creos™ xenogain). At the top left of the picture the collagen membrane (creos™ xenoprotect) is placed to protect the Schneiderian membrane (right).
 

Case courtesy of Dr. Colombo

Surgical procedure - GBR and Sinus Lift surgery

Resorbable and non-resorbable membranes in place. The Ti-reinforced non-resorbable PTFE membrane was fixed using self tapping screws (left).

Occlusal detail of the membrane before closure of the wound (right).

Case courtesy of Dr. Colombo

Surgical procedure - GBR and Sinus Lift surgery

Detail of the wound closed by primary intention.

Case courtesy of Dr. Colombo

Surgical procedure - GBR and Sinus Lift surgery

OPG immediately after the surgery (left).

CBCT after 8 months healing (right).

Case courtesy of Dr. Colombo

Surgical procedure - Implant placement

Clinical picture after 8 months of healing (lateral view) (left).

Clinical picture after 8 months of healing (frontal view) (right).

Case courtesy of Dr. Colombo

Surgical procedure - Implant placement

Surgical guide in place (left).

Reopening (right).

Case courtesy of Dr. Colombo

Surgical procedure - Implant placement

Detail of the regenerated bone (occlusal view).

Case courtesy of Dr. Colombo

Surgical procedure - Implant placement

Four NobelReplace CC implants in place. The ones in position 13-14-15 are sizing 3.5x13 mm, the distal one is a 4.3x11.5 mm (left).

Closure of the wound by primary intention (right).

Case courtesy of Dr. Colombo

Surgical procedure - Soft tissues management (FGG)

Clinical picture after further 4 months of healing (12 months since start of GBR) (left).

Opening a partial-thickness flap (right).

Case courtesy of Dr. Colombo

Surgical procedure - Soft tissues management (FGG)

Placement of 4 healing abutments (left).

Placement of an epithelial-connectival tissue graft (right).

Case courtesy of Dr. Colombo

Surgical procedure - Soft tissues management (FGG)

End of the soft tissue surgery (left).

10 days of healing after soft tissue surgery (right).

Case courtesy of Dr. Colombo

Restorative procedure - First quadrant rehabilitation

Clinical picture just after provisional insertion.

Case courtesy of Dr. Colombo

Restorative procedure - First quadrant rehabilitation

Radiograph 10 months after provisionalization (left).

Final soft tissue picture (right).

Case courtesy of Dr. Colombo

Restorative procedure - Atrophic first quadrant rehabilitation

Clinical picture (frontal view) 2 weeks after final prosthesis insertion (left).

Clinical picture (lateral view) 2 weeks after final prosthesis insertion (right).

Case courtesy of Dr. Colombo

Outcome - Atrophic first quadrant rehabilitation

OPG and CBCT 1 year after prosthetic loading.

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