Horizontal bone and soft tissue augmentation in the posterior mandible

BioBrief - 2-Stage Implant Placement

The Situation

A healthy 75-year-old woman lost her dental bridge spanning areas 44–47 due to a fracture of tooth 44. With excellent dental hygiene and a strong motivation to resume normal chewing, she sought a fixed solution for the right side, similar to her previous implant treatment on the left posterior mandible. Informed about the insufficient horizontal bone volume, she agreed to undergo a guided bone regeneration (GBR) procedure before implant placement.

The Approach

To provide an implant-supported bridge, we employed the horizontal Sausage Technique^TM as described by Dr. István Urban. This involved bone grafting followed by implant placement. Subsequently, a free gingival graft was utilized to enhance the thickness of the keratinized tissue, a crucial factor for the long-term success of the implant treatment.

Bone Augmentation with the Sausage Technique^TM

Prior to implant placement, a bone grafting procedure was performed using the Sausage Technique^TM to restore the horizontal bone dimension.

Soft Tissue Management for Long-Term Stability

A free gingival graft was applied to ensure sufficient keratinized tissue, improving peri-implant tissue stability.

The Outcome

Prior to implant placement, a Geistlich Bio-Gide® membrane was used to stabilize the graft, composed of a 50:50 mix of autologous bone and Geistlich Bio-Oss®. The implantation process was smooth, attributed to the substantial volume of regenerated bone. Two months post-implant placement, the zone of keratinized gingiva was expanded using a palatal free gingival graft. The patient expressed satisfaction with the outcome.

Keys to Success

• Patient motivation and impeccable oral hygiene
• Meticulous soft tissue management
• Adequate hard tissue augmentation prior to implant placement
• Utilization of a native collagen membrane
• Prosthetic-driven implant planning

This case underscores the importance of comprehensive treatment planning and the use of reliable biomaterials in achieving successful dental rehabilitation.