Bone and Soft Tissue Augmentation in Implantology

Fig 2-27aPronounced atrophy in the mandibular bilateral free-end situation after long-term restoration with removable dentures.

Fig 2-27bThree-dimensional illustration of the necessary autologous graft for implant insertion into the mandible. It was planned to harvest bone grafts from the iliac crest due to the poor bone volume of the mandibular external oblique line.

Fig 2-27cA surgical guide based on CBCT data for optimum utilization of the grafted bone 3 months after vertical augmentation using transplants from the iliac crest.

Fig 2-27dInsertion of three implants in the left mandible in a fully regenerated iliac crest graft. Another four implants were inserted in the grafted right mandible.

Fig 2-27eDefinitive prosthetic restoration.

Fig 2-27fControl radiograph 2 years postoperatively.

Fig 2-28aPersistent primary teeth in the absence of the right and left mandibular central incisors. Despite many years of orthodontic treatment, it was not possible to obtain sufficient space for two implants.

Fig 2-28bClinical situation 4 weeks after extraction of the primary teeth.

Fig 2-28cSevere atrophy of the alveolar ridge.

Fig 2-28dA bone block is harvested from the apical region of the chin with a micro saw.

Fig 2-28eRemoval of the bone block with a thin chisel.

Fig 2-28fLongitudinal split of the bone block into two thin blocks.

Fig 2-28gInsertion of one implant after bone spreading and grafting of one of the blocks on the vestibular side to support the mobile and thin vestibular bone wall.

Fig 2-28hReplantation of the second bone block back in its original donor site.

Fig 2-28iControl radiograph 4 months postoperatively.

Fig 2-28jClinical situation 6 months postoperatively after conditioning the soft tissue with the temporary restoration.

Fig 2-28kClinical situation after definitive prosthetic restoration with a pontic for the left central incisor supported by the implant of the right central incisor.

The use of 3D imaging, especially with prepared radiopaque, prosthetically oriented structures or the superimposition of digitally generated prosthetic proposals, allows for the detailed planning from the anatomical and prosthetic points of view. 66

Finally, a greater planning effort is rewarded by fewer prosthetic and laboratory/technical complications or problems for a precise implant placement in order to achieve an optimal prosthetic restoration after an extensive grafting procedure. Despite the intensive preoperative diagnostics, it is necessary to pay close attention to the recommended protocols in order to avoid complications and failures. 96

Fig 2-29aMultiple hypodontia in the maxilla and mandible of a 19-year-old female patient.

Fig 2-29bClinical situation with a relatively high smile line and a slightly reduced vertical dimension.

Fig 2-29cIntraoral situation documenting a looseness of the vertical dimension.

Fig 2-29dSevere alveolar ridge atrophy in the anterior mandible.

Fig 2-29eClinical situation 3 weeks after extraction of the primary teeth in the maxilla.