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CAD/CAM international magazine of digital dentistry No. 4, 2016

| cone beam supplement treatment planning based on CBCT 40 CAD/CAM 4 2016 3.6mm in our patient, it was slightly smaller com- pared to the average bone gain of 4.3mm, as re- portedinasystematicreviewbyJensenandTerheyden in 2009,5 but was comparable to the findings of a recent review by Sanz-Sanchez et al., showing a meanbonegaininhorizontaldefectsof3.9mmina staged approach.9 Nonetheless, we gained enough bonevolumeforinsertionoffourstandarddiameter implants. Considering the fact that the fixation screws had to be removed, and with regard to a number of benefits of a delayed implant placement inaugmenteddeficientalveolarridges,weoptedfor atwo-stageprotocol.Eventhoughdelayedimplant placement with flap elevation required a second surgical intervention and therefore an additional burden for the patient, it comprised the additional advantage of a visual and tactile assessment with respect to the osseointegration of the autograft in our patient case. Another crucial advantage of the stagedapproachcomprisedinteraliathepossibility foranimplantplacementinanidealpositionforthe later prosthetic restoration under visual control.5 Another reason for open access for implant place- ment was the use of non-resorbable microscrews for the stabilisation of the bone graft. The decision to utilise non-resorbable titanium screws in favour to resorbable screws out of poly (D,L-lactide) acid, was supported by the findings of a systematic re- view of the Cochrane Collaboration.6 Thus, resorb- able screws seem to have a high susceptibility for fractureduringfixationofonlaygrafts.Asthecom- bination of autogenous grafts with guided bone regeneration (GBR) is apparently associated with superior outcomes, we decided to use a barrier membrane.9 With the additional application of a PRGF membrane, we aimed to utilise the beneficial effects of platelet-derived rich plasma for an ad- vanced wound therapy, and the reduced risk of post-operativeinfection.10 Thevestibuloplastywith the Edlan-Mejchar method was performed for two purposes. Firstly it was done in order to create a sufficientamountofkeratinisedmucosa.According to findings of a systematic review, published by Lin et al., a lack of keratinised mucosa around implants fosters plaque accumulation, inflammation, and soft-tissuerecession.11 Secondlyweaimedtocreate enough space for the final overdenture. Conclusion The staged approach with the use of an autoge- nous bone graft, harvested from the surgical site in the anterior mandible, resulted in a significant horizontalbonegain,andtooktoagoodosseointe- gration of both, autograft and implants. Obviously, the described grafting procedure has not been pre- viously reported in literature. Despite the lack of anyexperiencereports,ourmethodrevealednone- theless a successful rehabilitation with an implant- supported,screw-retainedprostheticrehabilitation, andisstillinfunctionwithoutanybiologicalortech- nical problems after a three-year follow up._ Special thanks to Dr Pantelis Petrakakis. Editorial note: A list of references is available from thepublisher. contact Dr Marko Nikolic Artdental Clinic Tometici 1d Kastav, Croatia Tel.: +385 51 582888 info@artdental.hr Fig. 18: Facial view of the bar construction and PS TiBA abutments. Fig. 19: Oral view of the bar. Fig. 20: After an additional healing period of one month after muco-gingival surgery, the bar was inserted. Fig. 21: Final prosthetic restauration of the upper and lower jaw. Fig. 18 Fig. 19 Fig. 20 Fig. 21 42016 Tel.: +38551582888

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