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ePaper created 2017-05-12, 09:42:21 | version 1.38.0
| industry Fig. 8: Autologous shell using the Gellrich technique: a) removal of the chip; b) status after three months regio 24; c) implant insertion (Strau- mann BLT SLActive). Fig. 8a Fig. 8b Fig. 8c The anterior region After the loss of anterior teeth, there is a rapid loss of alveolar bone, particularly in the vertical and sagittal directions.19,20 Initially, the anterior bone is resorbed as a result of the thin vestibular bone lamellae and this later changes to vertical losses. In most cases, bone augmentation is neces- sary if a sensible immediate implantation has been missed.26 A sensibly planned immediate implanta- tion is to be preferred. Anatoform implant designs can optimise this approach.27 An immediate load- ing concept is also possible and can preserve and even restore the buckle bone without a complex bone augmentation, applying autologous bone chip augmentation only (Figs. 3a–g).28–32 Results that contradict these data must also be discussed in terms of the implant design and the biomaterial surfaces.33–35 In the anterior mandible and the pos- terior mandibular incisor regions low-profile im- plants with a diameter of 3 mm or less are indicated and are one possible option for a single crown restoration (Figs. 4a–c). Indirect and direct sinus floor elevation When posterior teeth are lost from the upper jaw, there is initially an expansion of the maxillary sinus with bone resorption proceeding from the cranial to the caudal direction with no change in the alve- olar ridge height and this must be treated by elevat- ing the maxillary sinus floor with corresponding augmentation (sinus floor elevation).36 Two tech- niques are differentiated here: – Direct sinus floor elevation is carried out tran- sorally with the sinus membrane being preserved (Figs. 5a–c).37, 38 Fig. 9: a) Panoramic radiograph; b) 2-D cutting of the membrane; c) 3-D thermally shaped shell; d) tunnel approach regio 16; e) inserted shell with particulate augmentation and screw fixation; f) implant insertion during the woven bone phase (Strau- mann BLT SLActive). Fig. 9a Fig. 9b Fig. 9c Fig. 9d Fig. 9e Fig. 9f 36 implants 2 2017