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The staged approach on atrohpic ridge using NeoBiotech IS II active fixture and nonresorbable membra

Situation


Patient Information

Female 60 yrs old Non-contributory NKDA Drink occasionally, never smoked

PDH Extraction #36,37,46 Scaling Root canal treatment and gold crown on #17

Diagnosis & Treatment Plan Generalized severe chronic periodontitis Scaling & subgingival curettage Open flap debridement Extraction #26,27,28,38,47,48 Ridge augmentation #36,37,46,47 Implant placement #26,27,36,37,46,47


Pre-operative radiograph

 

Occlusal view of the surgical site under local infiltration injection with 2% lidocaine before incision


Lingualized crestal incision and full thickness flap elevation

Horizontal bone resorption has progressed since extraction of #36,37. The remaining horizontal bone width is almost 4 mm. The staged approach has been decided. Decortication has been done.

0.5 cc of Oragraft and 0,5 cc of A-oss has been grafted.

OpenTex nonresorbable membrane has been placed on top of the grafted bone. Periosteal penestration has been done to release the buccal flap.

Horizontal mattress suture has been done to stabilize the membrane. With one key suture, buccal and lingual flaps are approximated.

Single interrupted suture has been done to adapt the buccal and lingual flaps.

1 wk follow up photo

4 months after ridge augmentation procedure

Slightly lingualized incision and full thickness flap elevation before membrane removal

Nonresorbable membrane has been removed.

Guide pins have been inserted after initial drilling.

Two 5.0*10.0 mm NeoBiotech IS Ⅱ active fixtures have been placed on #36,37 at 30Ncm. Fixture direction pins have been placed to check occlusal relationship.


Through ridge augmentation with mixture of Xenograft and allograft, up to 5mm of mature bone has been achieved. Enough initial stability also has been achieved with NeoBiotech IS Ⅱ active fixtures on the grafted bone site.

Two 5.5*5.0 healing abutments have been placed.

Two splint SCRP PFM crowns have been fabricated and cemented with Fujicem.

Panorama taken on the day of prosthetic completion

 

Conclusion

A60 year old female patient came to the clinic with horizontal bone resorption which had been progressed due to the extractions of #36 and #37. The atrophic ridge was grafted with a combination of Xenobone and allobone, then a nonresorbable membrane was placed over it. After 4 months of the stage I surgery, it was revealed that 5mm of mature bone has been achieved, and Neobiotech IS ll active fixtures were placed on the grafted site achieving enough initial stability.

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