Dental Asia Nov/Dec 2018

User Report NOVEMBER / DECEMBER 2018 DENTAL ASIA 35 Predictable Horizontal Ridge Augmentation and Soft Tissue Thickening Using an Allogenic Bone Strut and a Porcine Collagen Membrane By Dr. Sebastian Stavar V a r i o u s r e p o r t s h a v e demonstrated the superiority of implant supported dental restorations over removable prosthetics in terms of patient acceptance, aesthetic appearance and quality of life. 1 The prerequisite for successful and stable implantation of a fixed restoration is a sufficient amount of residual bone in which the implant can be submerged. Edentulism, however, may significantly promote bone resorption and, thus, compromise the feasibility of placing a fixed implant. While a smaller implant diameter and the introduction of short implants represent excellent implant-based approaches to overcome limitations in the lack of both horizontal and vertical bone height, extensive bone atrophy may not allow these systems to be implanted. Despite the advantages of implant supported restorations, prosthodontists tend to advise a shift in treatment to removable prosthetics in these situations, whereby the patient’s desire for permanent rehabilitation remains unmet. To address this issue, several methods for alveolar bone augmentation, predominantly based on the harvesting of autologous bone tissue, have been developed. 2 While these procedures represent valuable Fig. 2: Intraoral view Fig. 3: Pronounce bone loss on the buccal wall solution for predictable and efficient bone augmentation, bone substitute materials, especially allogenic bone grafts, have the potential to dispense with the need for bone harvesting. 3-4 Initial situation A 66-year-old female, non-smoker in good general health, presented with missing teeth in sites 36, 45 and 46, which were extracted due to caries and fracturing. While the missing teeth in sites 36, 45 and 46were initially restoredwith bridges, the patient wished for a fixed implant- supported prosthetic restoration in sites 45 and 46, due to a failure of the bridge. However, a pronounced loss of bone tissue in the posterior mandible (Cawood and Howell Class III), especially concerning the buccal wall, was observable at the initial assessment and further confirmed by radiographic imaging, so that direct implant placement was impossible (Figs. 1-3). 5 The thin soft tissue in the region concerned posed an additional problem for proper treatment and aesthetic rehabilitation (Fig. 2). Treatment planning Several treatment options for restoring the lost bone and soft tissue were discussed with the patient in order to Fig. 1: Panoramic radiograph