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clinical case

Vertical and horizontal guided bone regeneration of a severely resorbed mandible

Dr. Isabella Rocchietta

DDS. MSc. Specialist in
Periodontics, Italy

Case facts

Patient:

A 29-year-old female in good health.

Clinical problem:

The patient had received an attempt of implant placement together with a split-crest augmentation technique that failed soon after the initial surgery.  The failed implants were removed, resulting in a severe bone defect.

Clinical solution: 

Opening the flap and augmenting the site with a bone graft and PTFE membrane. Additionally, the site is covered with a collagen membrane, and the flap is sutured. Furthermore, re-entry after nine months to install two implants.

Treatment plan:
  • Perform vertical and horizontal guided bone regeneration.
  • Utilize a non-resorbable titanium-reinforced NeoGen PTFE Membrane.
  • Allow for nine months of healing.
  • Place two implants to support a three-unit bridge.
  • After an additional six months, proceed with the final restoration placement.
Products:

1 NeoGen Ti-Reinforced PTFE Membrane

Conclusion: 

Successfully achieved highly vascularized bone regeneration to the required level and width within nine months, allowing for the placement of implants. After an additional six months, the final restoration was placed.

Step by step

Step by step

  • Fig 1 Isabella
    Figure 1.

    Initial clinical situation. Severely resorbed posterior mandible following a previous failed attempt to insert dental implants with a split-crest technique. 

  • Fig 2 Isabella
    Figure 2.

    CBCT evaluation showing a major bone defect in the posterior area of the mandible, with a length of 25 mm and a height of about 10 mm.

  • Fig 3 Isabella
    Figure 3.

    Bone defect visible after full thickness flap elevation. A mid-crestal incision was performed with intrasulcular incisions. Vertical incisions were performed one tooth away from the defect.

  • Fig 4 Isabella
    Figure 4.

    The site was prepared with bone perforation. A NeoGen Ti-Reinforced PTFE Membrane was inserted and fixed lingually with two screws. The titanium-reinforced membrane provides structural support for space maintenance and undisturbed bone regeneration.

  • Fig 5 Isabella
    Figure 5.

    Bone augmentation. Positioning of bone graft (50% autologous bone and 50% deproteinized xenograft) to support site augmentation.

  • Fig 6 Isabella
    Figure 6.

    The membrane is fixed buccally with two screws under tension to ensure good stability of the augmentation site.

  • Fig 7 Isabella
    Figure 7.

    Full coverage of bone graft particulates. A collagen membrane was used to cover the bone particulate close to the adjacent teeth that were not covered by the PTFE membrane.

  • Fig 8 Isabella
    Figure 8.

    Tension-free primary closure. Periosteal flap releasing incisions in order to achieve a tension-free and complete primary closure of the site.

  • Fig 9 Isabella
    Figure 9.

    CBCT after nine months of healing. Note the level of regenerated bone up to the NeoGen Ti-Reinforced PTFE Membrane.

  • Fig 10 Isabella
    Figure 10.

    CBCT evaluation after nine months of healing, note the vertical and horizontal bone regeneration, filling the whole volume under the NeoGen Ti-Reinforced PTFE Membrane.

  • Fig 11 Isabella
    Figure 11.

    Re-entry nine months after augmentation, after removal of the membrane. Note the level and width of regenerated bone. The newly formed bone is highly vascularized as indicated by abundant bleeding during site preparation for implant placement.

  • Fig 12 Isabella
    Figure 12.

    Final restoration delivered six months after implant placement. The tissue levels are stable around the restoration with a satisfactory esthetic result.

  • Fig 13 Isabella
    Figure 13.

    Radiograph six months after implant placement with final restoration. The bone level is stable at implant level.

“The dual PTFE layer of the NeoGen membranes allows for optimal soft and hard tissue integration. The clinical handling is excellent, and its use allows for regenerating large three-dimensional bone volumes”
Isabella Rocchietta, DDS, MSc, Specialist in Periodontics, Italy

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