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GBR and simultaneous implant placement in the narrow alveolar ridge

Situation A 53-year-old female patient had a fixed bridge on site 23-26 and presented with secondary caries on #26.

Pre-operative Panorama


The treatment plan provided for a 8-week period to allow the extraction socket to heal.

Buccal view of the edentulous narrow ridge 8 months after the extraction.

Extremely narrow ridge was found. The implant-beds were prepared after reduction of the alveolar ridge.

The sinus floor on site 26 was augmented by the crestal approach using SCA kit.

3.5X13mm and 4.5X10mm implants were placed on site 24 and 25 respectively. CMI fixation with 35Ncm of initial stability was achieved on #26 through inferior cortical fixation. A severe buccal dehiscence was present on site 24.

1mm CTi-spacers were placed on site 24 and 25.

A combination of autogenous bone and allograft was applied to the defect. E2 type of CTi-mem was placed and 3 point fixation was made using two cover screws and one fixing screw over the graft.

A sheet of Collatape was placed over the CTi-mem.

The flap was secured with horizontal mattress and interrupted technique.

Postoperative radiographic view.

Incision line has healed 2 weeks after the surgery.

No CTi-mem exposure was observed at 16 weeks after the surgery. It would be due to the ideal fixation of the CTi-mem.

4 months later, CTi-mem was uncovered and it was verified that new bone formation has been made on the buccal and the lingual side.

Complete bone regeneration was observed following the spacer removal.

Healing abutments are in place. The flap was apically positioned to achieve keratinized gingiva.

Panoramic radiograph taken after stage Ⅱ surgery.

Impression was made a month after stage Ⅱ surgery.

Cemented abutments in place.

A 3 unit cement retained PFM FPD was delivered.

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