Augmentation enables an optimized bone and tissue volume for implantation procedures improving clinical long-term prognosis and achieving contemporary patient esthetic expectations. In this horizontal augmentation with Professor Dr. Hannes Wachtel, Munich/Germany, guided bone regeneration (GBR) and guided tissue regeneration (GTR) is combined in a double-layer technique.
The second stage surgery aims to increase the thickness of hard and soft tissue on the atrophic facial side of a previously placed implant in the region of an upper left first premolar. An alveolar ridge incision takes place in the keratinized gingiva extended with an atraumatic marginal incision of the adjacent teeth with a microsurgical blade for better healing outcome. A mucosa flap is performed and is splitted beyond the mucogingival junction presenting the implant emergence. In order to get enough mobility for augmentation and reliable primary wound closure the flap is extended inducing the visualization of the operation side. In a second procedure a connective tissue graft is harvested out of the palate with a single incision technique. The autologous connective tissue graft is sculptured out and is accurately positioned to the buccal flap with microsurgical sutures avoiding slipping out of position. A fresh surface of the cortical recipient bone is guaranteed with perforations opening the marrow cavity and provoking an optimal blood perfusion to the artificial deproteinized bovine donor bone. The Double-layer technique takes place with an external Bio-Gide porcine-derived collagen membrane facing the smooth side to the inner membrane and the rough surface to the soft tissue. Below an internal Ossix-membrane with a long life-time is used on the allograft BioOss to maintain a longer barrier functionality allowing sufficient time for selective bone tissue growth in the osseous defect. Both membranes are trimmed and placed simultaneously in the operation side. The donor bone is inserted and contured below the double-layer. The bone chips are soaked in blood to enable the application and contouring of the augmentation. Wound closure is accomplished with multilayer sutures performing a double sling technique with Gore-Tex material. The sutures are nodded and simultaneously tightened guaranteeing reliable wound closure avoiding membrane exposure. For perfect approximation in the marginal areas flap coadaptation is adjusted with microsurgical sutures.