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- 2-Stage Implant Placement(36)
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Found 166 Results

Eswar Kandaswamy, BDS, MS
Amber Kreko, DDS

Horizontal Ridge Augmentation with a Layered Allograft-Xenograft Approach

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Image 1a depicts the pre-operative situation, while the inset shows a cross-sectional view of the deficient ridge in area #12.

Pre-operative view, post-flap reflection.

An inner layer of vallos® demineralized cortical particles (allograft) was applied to the defect.

An outer layer of Geistlich Bio-Oss® (xenograft) was applied on top of vallos® (allograft).

Bone grafts covered with Geistlich Bio-Gide® and secured via tacks

Final sutured closure over the bone grafts covered with Geistlich Bio-Gide® and secured via tacks

Four-week post-operative image demonstrating good soft tissue healing.

Sequential CBCT imaging comparisons, from pre-operative to 6 and 9 months post-operative, confirm the re-establishment of horizontal ridge width achieved through bone augmentation.

Comparative CBCT cross-sectional analysis of pre-operative (left) and 6-month post-operative (right) images reveals an increase in horizontal ridge width.

1 - Initial clinical situation showing an extended horizontal and vertical bone gap at former positions of teeth 3 and 4 which were extracted 8 weeks earlier.

2 - CBCT showing a deficient vestibular contour and the corresponding bone defect. 3-D design of Yxoss CBR® derived from the patient’s anatomy.

3 - Surgical situation with horizontal and vertical bone defect.

4 - After testing the adaptation of Yxoss CBR® to the defect, it is filled with a graft consisting of 30% autologous particulate bone and 70% granules of Geistlich Bio-Oss®.

5 - Yxoss CBR® fixed with titanium screws.

6 - Adaptation of Geistlich Bio-Gide® over the structure. Complete, tension-free wound closure will follow.

7 - Sites at the day of the procedure after sutures placed. Tunnel between #23,24 and partial thickness flap raised between #23,22.

8 - Radiographic situation after 6 months of healing, before reopening.

9 - Insertion of two implants (Straumann® BLT). The resonance frequency measurement shows ISQ values of 70-75.

10 - Insertion of the healing abutments and adaptation of the flap.

11 - Soft tissue maturation 12 weeks after implant insertion.

12 - Clinical situation after prosthetic finalization, 18 months after surgery. X-ray shows stability of marginal bone levels.

1 - Patient with missing teeth 3, 4 and 5 in combination with horizontal and vertical atrophy. Situation incompatible with ideal and prosthetically guided implant insertion.

2 - Initial CBCT showing vertical and horizontal bone deficit.

3 - 3-D model obtained from CBCT with the corresponding Yxoss CBR® design.

4 - Final titanium scaffold ready for use.

5 - Exposure of the bone defect with full thickness flap.

6 - Fixation of Yxoss CBR® filled with a mix of autologous bone chips and Geistlich Bio-Oss® using two titanium screws.

7 - Coverage with a Geistlich Bio-Gide® membrane.

8 - Tension-free hermetic suture of the flap.

9 - After 8 months, the adequate rooting of the bone graft is assessed by CBCT and the insertion of the implants is planned in a prosthetically guided manner.

10 - 8 months after the GBR the scaffold is removed and two endosseous implants are inserted.

11 - Radiography with three elements supported by implants.

12 - Final prosthetic reconstruction 3 months after implant placement, without the need of a temporary interim solution.

Pre-operative image showing a fractured, endodontically treated tooth #9.

Left: Pre-operative sagittal CBCT image demonstrating a Kan Class 1 sagittal root position with initial digital implant planning conducted during the consultation appointment. Right: Definitive digital implant planning.

Left: Tooth #9 was extracted with minimal flap elevation, preserving the papillae. Right: A 3.6 x 15 mm implant was placed in a fully guided manner with a palatal bias to maximize the facial gap dimension, achieving a +2mm gap.

Left: The underside of the periosteum was incised just apical to the mucogingival junction, and a supra-periosteal pocket was created using sharp dissection with a #15 blade. Right: The facial gap was packed with 50 mg of Geistlich Bio-Oss Collagen®. A cover screw was temporarily placed to prevent bone graft granules from entering the implant chamber.

Left: A 15mm x 20mm x 3mm Geistlich Fibro-Gide® collagen matrix was inserted into the supra-periosteal pocket, with the coronal portion positioned to cover the facial bone crest. Right: The provisional crown was placed, and the facial mucosal flap was coronally advanced to cover the Geistlich Fibro-Gide® collagen matrix.

2-week post-operative follow-up

Final restoration at 16 months post-operative.

Final restoration with a screw-retained crown at 16 months post-operative.

Periapical radiograph at 16 months post-operative demonstrating stable crestal bone levels.

Implant placement planned for site #3 and #5 with soft-tissue treatment utilizing a CTG and for sites #10, #12 and #13 with soft-tissue augmentation using Geistlich Fibro-Gide®

2 - Uncovering of site #10 shows a narrow ridge width and an insufficient amount of soft-tissue thickness.

3 - Tooth #10 was extracted and immediately replaced by an implant.

4 - Fill the gap procedure with Geistlich Bio-Oss Collagen® to achieve contour augmentation and preserve horizontal ridge dimensions.

5 - Geistlich Fibro-Gide® was trimmed to half of the thickness to fit the defect and placed into sites #10, 11, 12 and 13.

6 - The entire site was closed tension-free to facilitate uneventful wound healing.

7 - The 3 month follow-up shows uneventful soft-tissue healing and an increase of soft-tissue thickness at the desired sites.

8 - The 6 month follow-up with the final reconstruction shows that the soft-tissue thickness at the desired site is maintained over time. This contributes to an esthetic and pleasing outcome. (Restorative work by Dr. Chao-Chieh Yang, IUSD)

9 - The 2 month follow-up showing a comparison of the treated sites, one with CTG (left) and one with Geistlich Fibro-Gide® (right) in the same patient. Comparable results have been achieved with both treatments, but without the need for a donor site.

Initial Situation: a failing mandibular molar with a vertical sub-osseous fracture.

A pre-operative radiograph and CBCT showing the cross-section of the involved tooth.

An implant site was developed by placing a pilot drill down the mesial root space, then uprighting it. This was continued up through the drill sequence. The mesial radicular septum is moved in the process.

A Camlog® 5.0 x 11 mm implant was placed with the platform set just down below the bone height of the socket walls.

After placing a 4.0 mm height cylindrical gingiva former in the implant, 250 mg of Geistlich Bio-Oss Collagen® was packed down in the socket around the implant.

Geistlich Mucograft® was adapted to the region then tucked down under the gingival margin.

The gingival margins were adapted and closed together with 4.0 teflon sutures (Cytoplast™, Osteogenics). The region was then covered with Glustich - PeriAcryl®90 Oral Tissue Adhesive.

4 months later following Emergence Profile Development.

An occlusal view of the final one-piece, screw-retained zirconia crown restoration based on a Camlog® Titanium Base Abutment.

Initial Situation: a failing mandibular molar with a vertical sub-osseous fracture.

A pre-operative radiograph and CBCT showing the cross-section of the involved tooth.

An implant site was developed by placing a pilot drill down the mesial root space, then uprighting it. This was continued up through the drill sequence. The mesial radicular septum is moved in the process.

A Camlog® 5.0 x 11 mm implant was placed with the platform set just down below the bone height of the socket walls.

After placing a 4.0 mm height cylindrical gingiva former in the implant, 250 mg of Geistlich Bio-Oss Collagen® was packed down in the socket around the implant.

Geistlich Mucograft® was adapted to the region then tucked down under the gingival margin.

The gingival margins were adapted and closed together with 4.0 teflon sutures (Cytoplast™, Osteogenics). The region was then covered with Glustich - PeriAcryl®90 Oral Tissue Adhesive.

After 3 months of healing, the top of the gingiva former is exposed and the situation is ready for Emergence Profile Development. This is quite standard.

4 months later following Emergence Profile Development.

An occlusal view of the final one-piece, screw-retained zirconia crown restoration based on a Camlog® Titanium Base Abutment.

1 - Initial Clinical Situation, Occlusal/Buccal Shots of Missing teeth #12 and 13.

2 - Intra-Operative, Implant Placement of #12 and 13.

3 - Intra-Operative, Placement of Geistlich Fibro-Gide® in the Buccal Concavity of #12 and 13.

4 - Immediate Post-Operative Buccal Soft Tissue Thickness.

5 - Two Months Post-Operative Healing with Provisional Restorations.

Initial clinical presentation.

Implants are placed at Tooth 7* and Tooth 8* with simultaneous GBR using vallos® mineralized cortical‑cancellous granules.

Geistlich Bio-Gide® Forte is positioned over the augmented sites without pins or tacks.

Primary wound closure with horizontal mattress sutures and single interrupted sutures.

Seven days postoperatively, soft tissue healing is progressing well.

At the 3-month review, healing is favorable with no complications.

Page 6 of 14

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