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ePaper created 2014-08-26, 21:44:32 | version 1.30.01
I 35 case report _ restoration of atrophied maxillae I CAD/CAM 3_2014 _Initial situation The 60-year-old patient was referred to the practice with a telescopic restoration on natural abutment teeth 11, 21, 22 and 23. Crown and bridge restorations were used in the mandible; however, teeth 21 and 22 could not be preserved and were extracted. Abutment teeth 11 and 23 could not be preserved, but served as abutments for the temporary restoration until fabrication of the final prosthetic restoration. In the premolar region specifically, pro- nouncedhorizontalandverticalbonedefectsthat required comprehensive augmentative measures were identified in the preoperative 3-D CBCT images (Figs. 1–4). _Surgical treatment The surgical treatment consisted of three pro- cedures, each performed at three-month inter- vals. In the first procedure, performed under gen- eral anaesthesia, a FRIOS MicroSaw (DENTSPLY Implants) was used to harvest a bone block from the retromolar region of the right mandible (Figs.5&6).Theharvestedboneplatewasthinned and then placed at a distance using osteosynthe- sis screws (micro-screw, Prof. Khoury and stoma) for horizontal expansion of the right maxilla and the resulting space was filled with particulate autogenous bone chips (Fig. 7). Particulate bone causes an increase in the surface and therefore better vascularisation of the augmented bone. In the second quadrant, an external sinus floor lift was performed based on the layering technique (Fig. 8). A slow resor- bable phycogenic bone grafting material (FRIOS Algipore, DENTSPLY Implants) was placed in the cranial region, while the caudal region was filled withautogenousbonechips.Thisarrangementof bone grafting material and autogenous bone chips meant that the implants were placed in approximately10mmofautogenousbone,accel- erating the healing phase. With this technique, the bone grafting material introduced in the cranial region prevented rapid resorption due to the pressure of the maxillary sinus. The sinus window was covered by a non- resorbable membrane made of medical-grade Fig. 5_Bone block harvesting with the FRIOS MicroSaw. Fig. 6_Thinning of the harvested bone block. Fig. 7_The thinned bone block placed at a distance. The area is prepared for filling with particulate autogenous bone chips. Fig. 8_Sinus floor lift. The surgical site is filled with FRIOS Algipore. Fig. 8Fig. 7 Fig. 6Fig. 5 CAD0314_34-39_Zastrow 22.08.14 14:29 Seite 2