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Case study

Minimally invasive approaches for major indications

A significant ridge deficiency with horizontal and vertical dimensions. How should this three-tooth gap be treated?

A 66-year-old female patient was referred to receive implant therapy for a three-tooth gap in the left mandible. The clinical and radiographic evaluations demonstrated a significant ridge deficiency with horizontal and vertical dimensions. The horizontal ridge width was between 1 to 2 mm. Using dental digital volume tomography, an augmentation with a Yxoss CBR® was planned. (Figs. A, B) In the first step, a Yxoss CBR® titanium scaffold was inserted.
A ridge incision was performed, and a flap was prepared. (Fig. C) The Yxoss CBR® titanium mesh was fitted and filled with autologous bone, obtained using a SafeScraper Twist®, and Geistlich Bio-Oss® in a 50:50 mix (Figs. D, E). The Yxoss CBR® was fixed using two screws (1.7 mm) and covered with Geistlich Bio-Gide®. (Fig. F) The flap was adapted to ensure complete soft-tissue closure. During the following weeks wound healing was uneventful. After 14-weeks, the Yxoss CBR® was removed. (Figs. G-I) Horizontal ridge width was approximately 5-6 mm, and two endosseous implants could be inserted simultaneously (3.8 and 4.3 diameter). (Fig. J) The two implants were surrounded with autologous bone chips obtained during drilling.
Correct positioning was checked radiographically. (Fig. H) Wound healing progressed uneventfully, and orthodontic treatment was performed. After six months the implant abutment was placed for soft-tissue modeling. (Fig. L)

Why this treatment?

Dental implant success depends on adequate bone support. In the case presented, it was necessary to build up vertical as well as horizontal ridge dimensions. Major ridge deficiencies, especially vertical and combined horizontal/ vertical defects, require bone augmentations with form-stable support to realize successful and uneventful Guided Bone Regeneration (GBR). Current major ridge augmentation procedures employ membranes, conventional titanium meshes, bone shields, bone blocks and/ or native bony walls with interpositional grafting or distraction osteogenesis.
Conventional titanium meshes are recommended for combined bony defects of more than 3 mm. As they are adapted to the ridge defect, titanium meshes require advanced surgical skills, and the procedure is often time-consuming.
Furthermore, a high risk (up to 50%) for soft-tissue dehiscences has been recorded.1,2 The new Yxoss CBR® titanium scaffold is a three-dimensional (3D)-printed scaffold that combines the advantages of titanium, 3D-imaging, planning tools and 3D-printing. Customized, the mesh has an optimized fit and preserves volume for osteogenesis. Also, surgery time and the risk of soft-tissue dehiscences may be reduced. Compared with other techniques, the Yxoss CBR® technology allows combined autologous and xenogeneic bone graft augmentation.
Geistlich Bio-Oss® offers protection from ridge volume loss due to resorption, and given its osteoconductivity, rapid and integrated bone growth.3-5
Autologous bone combines osteogenesis, osteoconductivity and osteoinductivity.6 The combination of autologous and xenogeneic products placed under the Yxoss CBRR scaffold gives us the possibility to rebuild major 3D defects in our daily ambulant office.

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