GBR using a Ti-reinforced non resorbable membrane and simultaneous sinus lift
Dr. Fabrizio Colombo, DDS
Italy
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
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).
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).
Surgical procedure - GBR and Sinus Lift surgery
Opening of a full-tickness trapezoidal flap (left).
Occlusal view of the horizontal atrophy (right).
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).
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).
Surgical procedure - GBR and Sinus Lift surgery
Detail of the wound closed by primary intention.
Surgical procedure - GBR and Sinus Lift surgery
OPG immediately after the surgery (left).
CBCT after 8 months healing (right).
Surgical procedure - Implant placement
Clinical picture after 8 months of healing (lateral view) (left).
Clinical picture after 8 months of healing (frontal view) (right).
Surgical procedure - Implant placement
Surgical guide in place (left).
Reopening (right).
Surgical procedure - Implant placement
Detail of the regenerated bone (occlusal view).
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).
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).
Surgical procedure - Soft tissues management (FGG)
Placement of 4 healing abutments (left).
Placement of an epithelial-connectival tissue graft (right).
Surgical procedure - Soft tissues management (FGG)
End of the soft tissue surgery (left).
10 days of healing after soft tissue surgery (right).
Restorative procedure - First quadrant rehabilitation
Clinical picture just after provisional insertion.
Restorative procedure - First quadrant rehabilitation
Radiograph 10 months after provisionalization (left).
Final soft tissue picture (right).
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).
Outcome - Atrophic first quadrant rehabilitation
OPG and CBCT 1 year after prosthetic loading.
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creos™ syntoprotectYour easy choice of dense PTFE membranes to expand grafting options.
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creos™ xenogain3 methods of application to meet all your bone grafting needs.
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NobelReplace® Conical ConnectionProven performance, enhanced esthetics.
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