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CAD/CAM international magazine of digital dentistry

user report _ alveolar ridge reconstruction I flap flexibility without compromising soft tissue and nutritive blood vessels. For bone augmentation a bone block was har- vested via ultrasonic surgery from the retromo- lar region distal from 32 of the right mandible (Piezotome II, Acteon France). This bone block was devided into two halfs. One was used for two “bone shields” to create a mold for the grafting material, one was particu- lated with a bone mill and mixed with defect blood and a -TCP (Nanobone®, Artoss GmbH, Rostock, Germany). The bone blocks were fixed with two osteosynthesis screws (Fig. 7) and the mixture of autologenous bone plus -TCP in mixing ratio 50:50 was used to fill the gaps and increase the rigde width and height. To increase the bone augmentation material volume an allograft block (Puros®, Zimmer Dental) was particulated and added to the mixture. Before placing the material a non resorbable titanium-reinforced membrane (Cytoplast Ti-250, Sybron Implant Solutions) was adapted lingually and folded to shape the aug- mentation complex according to the new and desired crest volume (Fig. 8). Upon the non resorbable membranes three xenogenous resorbable membranes (Tutodent®, Zimmer Dental) were placed according to the sandwich membrane layer technique to create a better adaptivity to the flaps (Fig. 9) and enhance wound healing. Primary wound closure (Fig. 10) wasachievedwitha4-0metricsuture(Gore-Tex®, Gore). The patient carried a clamb retained pro- visional denture that was rebased with a soft Fig. 3_ Site before bridge removal and extraction. Fig. 4_Surgical Site after bridge removal and extraction of teeth 33, 32, 42, 43, 44. Fig. 5_After Cystektomy the dramatic severe horizontal and vertical bone loss is visible. Fig. 6_Frontal aspect of the compromised bone situation. Fig. 7_Fixation of the autologous bone blocks which have been harvested ultrasonically from the retromolar region of the right mandible. Fig. 8_3-D crest reconstruction with the “mold-technique” with clearly visible horizontal and vertical augmentation. Fixation of a titanium reinforced ePTFE- membrane with pins. Fig. 9_Resorbable collagenous membranes are placed upon the non resorbable membranes. Fig. 10_Wound closure with 4-0 metric GoreTex sutures after flap mobilasation. I 25CAD/CAM 3_2012 Fig. 6Fig. 5 Fig. 4Fig. 3 Fig. 10Fig. 9 Fig. 8Fig. 7