Before the planned implantation in the lower right jaw, horizontal bone augmentation is performed to compensate for the bone loss following tooth extraction and establish a bone situation that is needed to accommodate an implant. Following a primary ridge incision, a mucoperiosteal flap is prepared up to the ramus of the mandible and the operative field is exposed. In a next step, Dr. Bolz uses a piezoelectric device to collect autogenous bone from the ramus.
With water acting as a continuous coolant, this allows for the gentle, controlled removal of bone during which the loosened bone fragments can be collected with the help of a filter. In the bone area to be augmented, multiple perforations are drilled into the corticalis in order to facilitate optimal perfusion of the graft and hence good conditions for its engraftment. A pericardial membrane is fixed on the buccal side of the augmentation area as a stabilizing barrier for the augmentation material already helping during its placement.
The autogenous bone is mixed with alloplastic bone substitute and the patient's blood, and placed horizontally to the local bone, modeled and condensed. Once the placement of bone mixture is completed the entire area is covered with the membrane, which is then secured in the lingual area by resorbable pins. Macrosurgical sutures are applied to reliably adapt and secure the edges of the wound and protect against membrane exposure which must absolutely be avoided. Primary wound healing is another factor required for an optimal result of this surgery.