Vertical bone augmentation
Successful placement of implants requires sufficient alveolar ridge height. Conventional approaches to increase the ridge height include autogenous bone block grafting, interpositional bone grafting, and form-stable membranes.
Augmentation with bone blocks
Autogenous bone blocks are the material of choice to compensate insufficient bone height. Resorption, however, can result in functional and aesthetic complications.
Contouring the bone block with slow resorbing Geistlich Bio-Oss® bone substitute and covering the augmented area with a Geistlich Bio-Gide® collagen barrier reduces graft shrinkage. The volume of the augmented ridge remains stable1.
Vertical resorption of the alveolar ridge is visible.
A mixture of autogenous particulated bone and Geistlich Bio-Oss® is used to cover the bone blocks and to cover steps between the margins of the grafts and the recipient bed. This procedure will simplify the contouring of the graft.
The grafts (blocks and particulated bone + Geistlich Bio-Oss®) are covered with a resorbable collagen membrane (Geistlich Bio-Gide®) in order to stabilise the particulated graft and to reduce the risk of bone resorption.
Yxoss CBR® - Individually made 3D Titanium Mesh
Larger and complex augmentations, especially with a combined horizontal-vertical defect morphology, still present a major surgical challenge. In these cases, the augmentation material requires a high level of regenerative ability, which can be achieved by mixing Geistlich Bio-Oss® and autologous bone. In addition, long-term stabilization of the augmentation material is necessary, which the ReOss® Customized Bone Regeneration (Yxoss CBR®) mesh structure can provide. The aim of this technique is to use the tried and tested material titanium in combination with modern CAD/CAM technology to achieve defect-specific, customized bone regeneration.
Initial situation: severely atrophied free-end situation on both sides of lower jaw
Transverse reconstruction on the DVT - depiction of complex bone defects
3D reconstruction: imaging before surgery shows combined bone defect
Filling the titanium mesh with a mix of autogenous bone and Geistlich Bio-Oss®
Situation after inserting Yxoss CBR® and fixing with two screws
Re-entry showing alveolar ridge after removing Yxoss CBR®
Positioning of implants - accurate placement of all implants
Opening of the right side via a crestal incision
Simple removal of titanium mesh by separating the pre-determined break point using a raspatory
Well vascularized augmentation material 5 months after augmentation
Advantages of Yxoss CBR® compared to conventional titanium mesh or titanium-reinforced membranes:
- Customizing can lead to a shortened operation time and fewer complications, as there are no sharp edges or restoring forces.
- Easier fixation - with one or two screws as needed - which is also possible in the coronal area.
- Incorporating a pre-determined break point also makes removal of the titanium mesh easier.
- The augmentation material can be determined individually in relation to autogenous bone and bone replacement.
References:
- Chiapasco M, et al.: Clin Oral Implants Res 2013; 23(9): 1012-21.
- Zitzmann N, et al.: Int J Oral Maxillofac Implants 1997; 12(6): 844-52.
- Schneider D, et al.: Clin Oral Implants Res 2013; Feb 25. [Epub ahead of print].
- Tal H, et al.: Clin Oral Implants Res 2008; 19(3): 295-302.
- Simion M, et al.: Clin Oral Implants Res 2007; 18(5): 620-29.
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