Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-09-14, 10:12:26 | version 1.38.0
| industry 26 implants 3 2016 Augmentation and implant treatment Two-stage surgery in the severely resorbed edentulous mandible Author: Dr Marko Nikolic, Croatia Introduction An adequate bone volume at the future implant site is a prerequisite for ideal implant placement andimplantsuccess.Aresidualbonewithavertical dimension less than 5.0 mm indicates a cut-off point and implies the need of additional augmen- tation procedures in connection with implant in- sertion,whereashighervaluesofthealveolarcrest ≥ 5.0 mm are considered to be sufficient for treat- ment with standard-diameter implants without the urgent need of any horizontal bone augmen tation.1 Distant donor sites like the anterior and posterior iliaccrestandintraoralareasliketheretromandibular andtheinterforaminalregionofthechinarecommon sources for harvesting autogenous bone-grafts. De- pending from the donor site, patient and surgeon should be aware of the possible confrontation with various advantages but also disadvantages when harvesting the bone. Harvesting bone from the iliac crestrequirespatienthospitalisation,andsurgeryun- der general anaesthesia, whereas intraoral bone har- vestingcanbeperformedambulatoryandunderlocal anaesthesia.2, 3 The main problem with autogenous bonegraftingisrepresentedbythehighriskofpatient morbidity, causing pain, swelling, and healing prob- lems at the donor site.3 Theaimofthiscasepresentationistodemonstrate a predictable, two-stage operating protocol for the horizontal augmentation of the severely resorbed, edentulous anterior mandible with an autogenous bone graft, harvested from the crestal alveolar ridge atimplantsite,inordertocreateasufficientbonevol- ume for the later implant therapy, without donor morbidity for the patient. Patient data The 47-year-old male patient visited our dental of- ficeinordertorenewhisoldandpoorfittingprostheses in the lower and in the upper jaw. The remaining five teeth 32–43 in the front of the lower jaw had been re- moved three months previously due to a chronic peri- odontitis in our dental practice. Nearly all remaining teethintheupperandthelowerjawshowedsignificant signs of progredient chronical periodontitis, insuffi- cient root treatments and prosthetic suprastructures as well (Fig. 1). The medical history of the patient was withoutanysignificantpathologicalfindings. Fig. 1: Pre-operative panoramic X-ray: poor periodontal and prosthetic conditions. Figs. 2a and b: Pre-operative CBCT: aspect of the extremely horizontally resorbed alveolar ridges of the anterior part of the mandible. Fig. 1 Fig. 2a Fig. 2b 32016