In order to insert an implant later, Dr. Marc Hinze, Munich/Germany, extracts tooth 11 in this young patient due to a longitudinal fracture. He fills the extraction alveole with bone substitute, and closes it using a connective tissue punch. Following healing over an eight-week period, an anterior implant is inserted and further bone augmentation carried out using the bone-lamina technique.

Due to a longitudinal fracture, tooth 11 was extracted by means of an atraumatic technique, an augmentation was carried out in the area of the socket and the wound was closed using a soft-tissue punch from the maxillary tuberosity. After a healing phase lasting eight weeks, an anterior implant is inserted within this operation and another bony augmentation carried out using a bone lamina technique. The incision is made along the alveolar ridge shifted slightly in a palatinal direction and in the sulcus in the area of the neighbouring teeth: a fully layered lap is formed.

Here it is important to entirely reveal the bony defect and effectively mobilise the flap so as to create space for augmentation using the bone lamina technique. Implantation is undertaken using a prepared drill template which precisely specifies the position and axial direction of the implant. Once the insertion has been made there is a bony recess of a few millimetres in the implant shoulder area which is built up by the bone lamina technique.

This is a GBR technique using two membranes, with the upper membrane ensuring improved tissue integration and the lower membrane performing a barrier function. With the bone lamina technique, the augmentation material is inserted between the bone and the barrier membrane, which is previously secured using titanium pins. Once the membranes have been secured under the palatinal section of the flap, a multi-layered wound closure without tension is applied.