Open communication with the patient and expectations management

Prosthetically Guided Regeneration (PGR) in the posterior maxilla.

Dr. Paolo Casentini, DDS · Italy
 · June 29, 2022

The Situation

The 60 years-old female patient’s chief complaint was represented by unsatisfactory esthetics and function, related to loss of multiple maxillary teeth. Her request focused on improving esthetics and function by means of a fixed reconstruction. The patient presented 5 residual anterior maxillary teeth (from 13 to 22) that could be maintained. After preliminary periodontal diagnosis and treatment, specific diagnostic steps for implant treatment demonstrated inadequate bone volume for implant placement.


The Approach

Bi-lateral sinus lift with Geistlich Bio-Oss Pen® and horizontal bone augmentation with a 1:1 mix of autogenous bone and Geistlich Bio-Oss® were performed 6 months prior to implant placement, following a Prosthetically Guided Regenerative (PGR) approach. The augmented sites were protected with Geistlich Bio-Gide® stabilized with titanium pins. The template utilized for radiographic diagnosis and GBR was then used to guide the implants placement.


The Outcome

After a healing period of 6 months, adequate bone volume was achieved for the placement of 5 implants. Geistlich Fibro-Gide® was also used to optimize soft tissue volume at the buccal aspect of implants. Implants were early loaded with a temporary screw-retained fixed prostheses 6 weeks after placement. The final prosthetic reconstruction included ceramic veneers of the frontal residual teeth and zirconium-ceramic screw retained fixed prostheses on implants.


Keys to Success

  • Open communication with the patient and expectations management
  • Prosthetically Guided Regeneration (PGR): use of the same template from the preliminary prosthetic project to the actual bone augmentation
  • Prosthetically guided implant placement for a correct implant positioning and restoration
  • Geistlich Biomaterials for a predictable regeneration











About the author

Dr. Paolo Casentini, DDS | Italy

Graduated in Dentistry at the University of Milan, Fellow and Past Chairman of the Italian section of ITI, Active member Italian Academy of Osseointegration. Co-author of 10 text-books including ITI Treatment Guide volume 4 translated in 8 languages and “Pink Esthetic and Soft Tissues in Implant Dentistry” translated in 5 languages. His field of interest is advanced implantology in complex and esthetically demanding cases. He has extensively lectured in more than 40 Countries.