IM0410

user report _ alveolar ridge reconstruction I tissue conditions due to inflammatory tissue prolifer- ation(Figs.5&6).Thesuccessof3-Dboneaugmenta- tion is bonded to primary wound closure and tension- less flap adaptation. Thus, the periosteum is dissected with a scissor from the epiperiostal connective tissue before augmentation procedures to reduce bleeding andguaranteeaflapflexibilitywithoutcompromising softtissueandnutritivebloodvessels. Forboneaugmentationaboneblockwasharvested via ultrasonic surgery from the retromolar region dis- talfrom32oftherightmandible(PiezotomeII,Acteon France). Thisboneblockwasdevidedintotwohalfs.Onewas used for two “bone shields” to create a mold for the graftingmaterial,onewasparticulatedwithabonemill andmixedwithdefectbloodanda -TCP(Nanobone®, ArtossGmbH,Rostock,Germany).Theboneblockswere fixed with two osteosynthesis screws (Fig. 7) and the mixtureofautologenousboneplus -TCPinmixingra- tio 50:50 was used to fill the gaps and increase the rigdewidthandheight.Toincreasetheboneaugmen- tationmaterialvolumeanallograftblock(Puros®,Zim- merDental)wasparticulatedandaddedtothemixture. Beforeplacingthematerialanonresorbabletitanium- reinforced membrane (Cytoplast Ti-250, Sybron Im- plant Solutions) was adapted lingually and folded to shapetheaugmentationcomplexaccordingtothenew and desired crest volume (Fig. 8). Upon the non re- sorbable membranes three xenogenous resorbable membranes (Tutodent®, Zimmer Dental) were placed accordingtothesandwichmembranelayertechnique tocreateabetteradaptivitytotheflaps(Fig.9)anden- hancewoundhealing.Primarywoundclosure(Fig.10) was achieved with a 4-0 metric suture (Gore-Tex®, Gore).Thepatientcarriedaclambretainedprovisional denturethatwasrebasedwithasoftmaterialandwas instructedtohavenosolidfoodfor10days.Postoper- ative the patient continued with 1,800 mg Clinda- mycin, Ibuprofen 600 mg and a decongestant enzyme based medicine (Bromelain-Pos®, Ursapharm, Ger- many).Thenextdaythepatienthadanexpectedcheek swellingbutwasnotsufferingfrompain,after10days the sutures were removed. However, 6 weeks later a membrane exposure of the non resorbable membrane was evident, but due to the fact that this is tollerable whenthepatientisinstructedtomaintainoralhygiene andre-calledonceaweek,thesuccessoftheoutcome wasnotthreatened(Fig.11a).Thetitaniumpinsandthe titanium reinforced membranes were removed after 4 months. Fig. 3_ Site before bridge removal and extraction. Fig. 4_Surgical Site after bridge removal and extraction of teeth 33, 32, 42, 43, 44. Fig. 5_After Cystektomy the dra- matic severe horizontal and vertical bone loss is visible. Fig. 6_Frontal aspect of the compromised bone situation. Fig. 7_Fixation of the autologous bone blocks which have been har- vested ultrasonically from the retro- molar region of the right mandible. Fig. 8_3-D crest reconstruction with the “mold-technique” with clearly visible horizontal and vertical aug- mentation. Fixation of a titanium reinforced ePTFE- membrane with pins. I 29implants4_2010 Fig. 3 Fig. 4 Fig. 7 Fig. 8 Fig. 5 Fig. 6