Horizontal bone and soft tissue augmentation in the posterior mandible

The Situation

A healthy 75-years-old woman lost her dental bridge on area 44–47, due to fracture of tooth 44. Patient’s dental hygiene was excellent and she was very motivated to return to chew normally. The patient had previous implant treatment at the left mandible posterior site and wanted to have a fixed solution also at the right side. The patient was informed about the lack of horizontal bone volume and accepted to undergo through a GBR procedure before implant placement.

The Approach

In order to be able to provide an implant supported bridge, we needed to reconstruct the bone with the horizontal sausage technique approach described by Dr. Istvan Urban. After bone grafting and implant placement, a free gingival graft was used to increase the thickness of the keratinized tissue. A wide keratinized tissue zone key to ensure long-term success of the implant treatment.

The Outcome

Prior to implant placement, a Geistlich Bio-Gide® membrane was used to stabilize the graft, which consisted of a 50/50 mix of autologous bone and Geistlich Bio-Oss®. Implantation was pleasant due to good volume of regenerated bone. Keratinized gingiva was widened with a palatal free gingival graft two months after implant placement. The patient was satisfied with the outcome.

Keys to Success

• Patient motivation and oral hygiene improvement
• Soft tissue handling
• Hard tissue augmentation prior to implant placement
• The use of a native collagen membrane
• Prosthetic driven implant planning