This surgery is conducted four months after the augmentation of the mandible with autologous bone. Appl. Professor Dr. Christian Mehl, Munich/Germany, demonstrates the insertion of four implants in the posterior region of the mandible. In the anterior region a connective tissue graft is placed to thicken the gingiva. This surgery is conducted four months after the augmentation of the mandible with autologous bone.
First, full thickness flaps are elevated gently with the papillae elevator and raspatory. During the implant drilling as well as the implant insertion the bone needs to be treated gently in order to avoid overheating and pressure in the augmented bone area. The implant drilling should be conducted with a maximum of 800 to 1000 cycles a minute under water cooling. The implant bed needs to be further prepared with a tap in order to create screw threads for the implant which will minimize tension within the bone during the implant insertion.
Especially in the augmented area, it is necessary to work without tension or pressure to not affect the stability of the new bone structure. Dr. Mehl repeatedly emphasizes that any overheating, pressure or tension need to be avoided since these factors damage the bone and may cause the failure of the treatment. Once the implant beds are prepared in the posterior region of the mandible, Dr. Mehl demonstrates the cautious insertion of the implants. Some additional bone substitute material is applied.
In the anterior region a connective tissue graft is placed to thicken the gingiva. In this way, the rest area for the prosthesis is enlarged. As a consequence, the denture base will be more extended and supported, and can be better cleaned by the patient. At the end, the graft and flaps are secured with microsurgical sutures.