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Implant Tribune Middle East & Africa Edition No. 3, 2017

D2 ◊Page D1 IMPLANT TRIBUNE Dental Tribune Middle East & Africa Edition | 3/2017 Fig 17 Fig 18 Fig 19 Fig 20 Fig 21 Fig 22 Fig 23 Fig 24 Fig 25 Fig 26 Fig 27 Fig 28 Fig 29 Fig 30 Fig 31 Fig 32 resulting in a very narrow atrophic ridge, with inadequate bone width to properly house implants (Figure 8). The treatment plan included regen- eration of the ridge using NeoGen™ Ti-Reinforced Membrane and simul- taneously placed Neoss ProActive Straight Implants. A full thickness flap was opened, osteotomies were prepared on the palatal aspect of the ridge, and two Neoss ProActive Straight implants were placed. Both implant sites had fenestrations on the buccal side (Fig- ure 9) and palatal dehiscences (Fig- ure 10). A Neogen™ Ti-Reinforced Membrane Medium was trimmed, shaped, and fitted at the implant site. Autogenous bone chips collected during drilling of the implant oste- otomies were used to fill the palatal dehiscence (Figure 11). No material was used to fill the buccal fenestra- tion, the strength of the mesh cre- ated the space for bone regeneration. The membrane was secured with two tacks buccally (Figure 12). Flap closure was achieved, and the soft tissue healing was uneventful (Fig- ure 13). After 7 months, second stage sur- gery was performed. A mid-crestal incision with releasing incisions was used to lift a flap and expose the membrane (Figure 14). The titanium mesh kept the membrane shape stable for the entire healing period. Removal of the membrane revealed that the whole volume enclosed by the membrane had been regener- ated with new bone and a new wide ridge had been created (Figure 15). Ex- cess bone on top of the cover screws was removed (Figure 16). PEEK heal- ing abutments were connected to the implants and the flap was closed (Figure 17). Radiographic assess- ment confirmed bone regeneration around the implants (Figure 18). Af- ter 3 months of soft tissue healing (10 months after membrane place- ment) the implants were temporary restored (Figure 19). Case 3 Vertical ridge augmentation in the esthetic zone A 40 year old patient presented with a missing central incisor and a resorbed ridge (Figure 20). It was planned to perform a vertical ridge augmentation with NeoGen™ Ti- Reinforced Membrane – Medium Interproximal and simultaneous implant placement of Neoss ProAc- tive Straight implant. A full thickness flap with releasing incisions was opened, revealing a large vertical defect (Figure 21). A Ne- oss ProActive Straight implant was placed an 8 mm vertical defect (Fig- ure 22). Autogenous bone cylinders (3.4 x 4-5 mm) were harvested from the oblique line of the mandible in the molar region and placed around the implant to accelerate regenera- tion and to act as space fillers (Figure 23). A Neogen™ Ti-Reinforced Mem- brane Medium Interproximal was trimmed, shaped, and fitted at the surgical site and secured buccally with two tacks (Figure 24). Stress free flap closure was achieved by releas- ing the periosteum on the buccal side (Figure 25). The soft tissue heal- ing was uneventful (Figure 26-27). After 6 months, second stage sur- gery was performed. A mid-crestal incision with releasing incisions was used (Figure 28). The flap was lifted to expose the membrane (Figure 29). The soft tissue can easily be separat- ed from the membrane after healing. The membrane was removed. Newly formed bone fills the entire space created by the membrane (Figure 30). Excess bone on top of the cover screw was removed to get access to the implant (Figure 31). A PEEK heal- ing abutment was connected to the implants and the flap was closed (Figure 32). Radiograph taken direct- ly after abutment connection shows that bone has been successfully re- generated up to the level of the im- plant platform (Figure 33). Conclusion The cases show that vertical ridge augmentation and horizontal ridge widening with optimal bone fill can be achieved in a predictable manner when performing GBR using the Ne- oGen Ti-Reinforced Membrane. Dr Norbert Hassfurther MD, DDS, Dr. med. (PhD), Oral and Maxil- lofacial Surgeon, Germany. Norbert Hassfurther qualified and was licensed to practice medicine in 1982 at the Justus-Liebig University in Giessen, Germany. In 1985 he completed his train- ing and qualified to practice dentistry. He completed his Specialist degree in Oral and Maxillofacial Surgery in 1991 and was appointed as Senior Physician at the Department of Oral and Maxillofa- cial Surgery at the University of Giessen, Germany. In 1994 he established his own private practice in Wetttenberg, Germany where his main focus is in the area of den- tal implantology and bone grafting. He has lectured throughout Europe on his bone grafting techniques. Fig 33 pose the membrane. The membrane was removed, excess bone removed and PEEK healing abutments were connected to the implants. As seen in figure 7, the implants were totally enclosed in newly formed bone, and the ridge had been regenerated to the desired height. Case 2 Regeneration of an extremely narrow ridge A 19 year old female presented with two congenitally missing teeth in the premolar area of the upper jaw,

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