CAD/CAM international magazine of digital dentistry

I user report _ alveolar ridge reconstruction Fig. 1_Presurgical aspect revealing massive Periodontitis and bone resorption in region 32, 42, 44. Fig. 2_The CB-Scan exposing region 32—with partial loss of the buccal and lingual wall region 32–44. _Introduction A high clinical evidence of grafting procedures from extraoral autologeous donor sites like i.e. from the iliac crest in difficult bone loss sites is still the practice in oral or oral-maxillofacial surgery. However, the invasive surgery combined with a prevalence of patients morbidity and suffer is an issue to discuss the persisting legitimation of this procedure. Since the appearance of re- liable bone substitute materials with or without any autologeous bone added, the positive results concerninglongtermstabilityofregeneratedbone even in difficult cases have become very pre- dictable. This article will point out in a case report the re- liability of alternative and less invasive techniques for 3-D bone reconstruction in the mandible and question the necessarity of iliac hip grafts for intraoral bone augmentation. _Materials and methods Afemalepatientaged48yearsoldwithasevere and advanced periodontitis in the maxilla and the mandible came into our clinic with the desire of a complex treatment plan with an implant retained denture in both jaws. This case report will pinpoint the treatment of the mandible. A CBVT was reveal- ing massive bone loss in height and width in the mandible arch from canine to canine and apical cyst at tooth 23, 26 and 28 (Figs.1 & 2). According to our protocol we started with an initial scaling and HELBO®-Laser decontamination prior to the surgery to decrease the number of pathologic germs and post op infections. Tooth 18 and 19 in the left mandible were intended to maintain until the finalization of the prosthetics to give some comfort during temporization with an immediate denture that was placed post op. Preoperative the patient received 1,200 mg of Clindamycin. The patient desired the surgery of tooth removal and ridge augmentation persued under general seda- tion. After nasal intubation and local anesthesia the bridge in the lower was removed and the remain- ing teeth despite from 18 and 19 as mentioned before (Figs. 3 & 4). After full flap preparation with crestal incision, releasing incisions and exposure of the mental nerve exit, the volume of the severe bonelosswasrevealedaswellastheminorsofttis- sue conditions due to inflammatory tissue prolif- eration (Figs. 5 & 6). The success of 3-D bone aug- mentation is bonded to primary wound closure and tensionless flap adaptation. Thus, the perios- teum is dissected with a scissor from the epi- periostal connective tissue before augmentation procedures to reduce bleeding and guarantee a 3-D alveolar ridge reconstruction in a case with severe bone loss Author_Prof Marcel Arthur Wainwright, Germany 24 I CAD/CAM 3_2012 Fig. 1 Fig. 2