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| industry 28 implants 3 2016 growthfactors(PRGF)membrane(BTIBiotechnology Institute, Blue Bell, USA) and additionally with a bar- rier membrane for guided bone regeneration (GBR, Bio-Gide,GeistlichBiomaterialsVertriebsgesellschaft mbH, Baden-Baden, Germany; Fig 9). The healing of the graft was uneventful and without any complica- tions, like membrane exposure, being classified as a frequent post-operative complication.5 The patient wasprovidedwitharemovableprovisionalprosthesis. Re-entry and implant surgery There-entryforthedelayedimplantplacementpro- tocol was planned after a healing period of four months. With regard to the soft aspect of the aug- mentedareaoftheanteriormandible,thedimensions of the alveolar ridge appeared sufficient enough for implantplacement(Fig.10).TheCBCTdataconfirmed the assumption, demonstrating a significant gain of bonevolumeintheinterforaminalregionoftheman- dible after augmentation. The horizontal thickness of thecrestalalveolarbonewas5.53mminregion44and 4.43 in region 32. The augmentation procedure re- sultedinahorizontalbonegainofabout3.9mminre- gion 44 and 3.3mm in region 32 respectively, repre- senting a mean bone gain of 3.6mm (Fig. 11). After elevating the flap, an apparently good osseointegra- tionandstabilisationoftheautograftwiththeunder- lying pristine bone could be noticed (Fig. 12). Prior to implantplacement,thefixationscrewswereremoved. The four implants with a diameter of 3.75mm and a length of 11.5mm (BEGO Semados® RSX, BEGO Im- plantSystems)wereinsertedepicrestallyinregions33, 31, 41 and 43 using the freehand-method without a surgicalguide(Fig.13).Theinsertiontorqueoftheim- plants was 35Ncm with good primary stability. Pre-prosthetic surgery and prosthetic rehabilitation After three months of uneventful submerged heal- ing,thepanoramicX-rayshowedasuccessfulimplant osseointegrationwithoutanysignsofboneresorption (Fig.14).Duetoalackofkeratinisedgingiva,wedecided for an enlargement of the ratio between attached and freegingivabyperformingmuco-gingivalsurgerywith theEdlan-Mejcharmethod(Figs.15,16&17).Afteran additional healing period of one month, the final bar retained,aremovableacrylicoverdenturewasincorpo- rated.Thebarwasconstructedwithbarabutments(PS TiBA,BEGOImplantSystems)andanon-preciousalloy (Wirobond®, BEGO Dental, Bremen) and was screw- retainedonthefourimplants(Figs.18,19&20). Discussion Inourcasepresentation,thepatientsufferedfrom an extremely horizontal bone resorption, resulting in Fig. 7 Fig. 8 Fig. 12 Fig. 13 Fig. 9 Fig. 10 Fig. 11 Fig. 7: Aspect of the bone harvest. Fig. 8: The graft was fixed with four miniscrews. Fig. 9: The osseous graft was covered with a PRGF membrane and a barrier membrane for GBR. Fig. 10: Sufficient horizontal ridge dimensions after a healing period of four months. Fig. 11: The CBCT shortly before re-entry demonstrated a significant gain of bone volume after augmentation. Fig. 12: After flap elevation, a good osseointegration and stabilisation of the autograft was noticed. Fig. 13: After the fixation screws were removed, the four implants with a diameter of 3.75mm and a length of 11.5mm were inserted epicrestally without a surgical guide. 32016