In the premolar region of the right maxilla, Dr. Marc Hinze, Gräfelfing/Germany, conducts bone augmentation and implant insertion in one session. Applying the GBR technique, two membranes - a bone-lamina membrane and an Evolution membrane (collagen membrane) - are placed to create and maintain space for bone in-growth. A bone substitute material is used for the augmentation.
The treatment is performed in the region of the first premolar in the right maxilla, where bone volume is reduced. First, after sulcular and crestal incision, a full thickness flap is carefully prepared and elevated in the buccal as well as the palatal region.
Next, the pilot drilling is exerted to determine the prothetic axis of the implant. The implant bed is gradually extended, always paying attention to and checking the implant position and direction. In the buccal region, the bone volume is especially reduced. As a consequence, bone fenestration is created during drilling. Nonetheless, the implant is inserted.
Applying the GBR technique, two membranes - a bone-lamina membrane and an Evolution membrane (collagen membrane) - are cut into shape and placed to create and maintain space for bone in-growth. Pins are applied to stably fixate both membranes in the buccal region. The inner bone-lamina membrane functions as a barrier; the external Evolution membrane facilitates tissue integration.
In a next step, bone substitute material is filled into the pocket between membranes and bone to cover the buccal fenestration and remodel the area three-dimensionally. Then, the augmented area and the implant are covered with the membranes. Their palatal endings are placed below the palatal flap.
Before wound closure, periosteal incision needs to be made to gain enough mobility of the flaps, so that a tension-free approximation of the flaps is possible. The buccal and palatal flap are sutured in a deeper and a marginal layer. After the wound edges in the augmented area are well apposed to promote primary wound healing, the operator closes the relief incisions with microsurgical sutures.