Clinical case description:
Mandible horizontal bone graft.
There are some clinical cases where it is impossible to screw an implant due to inadequate volume vestibular/lingual.
One of the technics to improve volume quantity is the apposition of a mixture of autogenous bone with xenograft protected by a bioresorbable membrane stabilized with tacks.
The condition for this technique is that we should have at least 8mm of bone height. This clinical case i a good exemple of how a panoramic radiography can be "misleading" as a pre operative exam for implant placement.
Following visual and tactile examination it appears to have enough bone, however in the CT scan we can see a lack of bone on the vestibular side of premolar zone. That is why actually a CT scan seems to be a indispensable tool to avoid unpleasant surprises!
This surgery is relatively simple but soft tissue manipulation, membrane stabilization with tacks are very important steps to avoid tension and maintain good blood circulation.
The increase of the soft tissue mobility, by releasing some fibers on the periosteum, is necessary to cover the amount of bone graft.
Polytetrafluoroethylene sutures are essential because they are more elastic and compensate edema after surgery. This material can stay for a longer period of time without tearing, impact food rests or bacterias due to smooth surface and biological integration.
Autogenous bone is obtained with a scraper on cortical surface in the retro molar area.
Closing soft tissues takes so much time as the surgery itself cause mattress and single sutures are really necessary to be well done to not have disappointments!
This technique has support in published articles by and col, and other authors.
Prof Istvan Urban is an excellent teacher and a very special and friendly human being.