Case of ridge splitting and two implants placement with GBR and soft tissue modification to create ideal emergence profile

170 Rating(s).


Posted on By Samvel Bleyan In Bone Grafting

Case of severely atrophic lower right mandible treated with ridge splitting and two regular platform implants.Autologous bone chips harvested and used to fill the gaps ,xeno-bone in sticky format were used as a second layer , gradted zone covored with collagen membrane and sutured in three layers:deep horizontal mattress, marginal horizontal mattress and continues interlocking. Four months later second stage surgery was performed to place healing abutments and increase the volume of the soft tissues around implants with SCTG from the palate utilizing Zucchelly's technique. Later using dynamic compression technique emergence profiles was modified to get ideal shape.Customized open-tray transfers used to take impression for final crowns, properly reflecting created emergence profiles. Final hybrid screw retained crowns were delivered two months later after last emergence profile modification.

initial vew of severely atrophic ridge
splitting the ridhe with piezosurgery tip

osteotomy using Densah drills
placement of two implants 4,5-10 mm each


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22 Comments

collagen membrane used to cover grafted site
3 layers suturing


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4 months later second stage surgery
measuring ISQ


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isq value
harvestig graft from the palate


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deepithelizing the graft using 15c blade
CTG ready tu be used


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donor site covered by collagen sponge
CTG positioned under vestbular flap


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healing abutments and sutured flaps
x ray with HA


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donor site 5 days post-op - uneventful healing
emergence profiles with standard healing abutments


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emergence profiles after temporary crowns modification using dynamic compression technique
emergwnce profiles after second modification of temporaries


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final emergence profiles- ready to deliver definitive crowns
final crowns delivered


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Dear Samvel your work ever surprise me... when I see this approach i have one question in my mind... it´s going to be enough to create an ideal volume? I have mathematic in my mind... if Im going to place an implant in an atrophic bone and is a 1st molar, for example... I need 10-12 mm buccal- lingual volumen, soft tissue included. maybe in this case, I prefer a Khoury technique, and you do very well too... I saw your cases!... when you decide to do one technique and others? best regards my friend.
Alberto Miselli

ridge split


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there are some limitations for ridge splitting. if bone volume and width is less then 3 -3,5 mm than khory technique or sausage ot gbr with corticallamina,or ti-reinforced membrane or titanium mesh have to be implemented. its all about cancellos bone...if you have 1.5- 2 mm of cancellous bone - you may try to split the ridge-otherwise will broke vestibular plate and than turn to Khoury technique- screwing broken plate to host bone.
thanks for interesting question Alberto!hugs and kisses!


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My friend,

Congrats on this beautiful case. i just love your attention to every detail in all of your cases that I see, Bravo !!
I do agree with Alberto, this ridge to me seems too thin for ridge splitting. I think the key factor for success here was the beautiful GBR that you did. Beautiful from start to finish Samvel.

Warm regards,
Ehab


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Thanks a lot for comment dear Ehab! Trying to post my cases with the details which may be interesting for audience...

virtualimplant placement


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Completely agree with Ehab and Juan Alberto....GREAT RESULT really came from the beautiful GBR approach and tissue management and not the split IMHO. thanks for sharing, Dr. S


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thanks Maurice for comment!i suppose that both gbr and ridge splitting played their roles to gget the final result.being surrounded with auto bone plate and adding auto and xeno bone chips allows to come to predictable outcome.


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Samvel. Magnificent case! It is the comprehensive understanding of the details that make the difference in the long run and you cover them all.
Particularly the tension free Flap upon CTG placement. I find a laser pasty plastic afterward can sometimes further enhance the site. Chuck


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interesting point!thanks for idea Chuck!impatient to see you in Madrid!

splitting ridge
4 months later


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See U in Madrid!


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Love that “Everted Suturing”


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Three layers suturing, Paul!


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Very well done Samvel!
I agree with the ridge split importance for this type of cases. Those colleagues, who think that doing just GBR is enough, could appreciate slight buccal dehisence on the distal implant where ridge split had been partially completed.
Another option is subcrestal placement - this helps to bypass the atrophy zone.


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Thanks for comment Anton! Multiple factores influencing the final result!


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