PMC6594337_01
Orthopantomography previous to dental extractions.
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A 45-year-old man presented mobility of a metal-ceramic fixed bridge in the second quadrant after ten years of function (Figure 1).
Previous CBCT.
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After the exploration, the bridge and the pillar teeth were considered nonrestorable, and in the Cone Beam Computed Tomography (CBCT), a severe loss of the alveolar bone of the second quadrant is evidenced (Figure 2).
Intraoral view before guided bone regeneration surgery.
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After the teeth extraction, we decided to wait a month to make sure the healing and stabilization of the soft tissues (Figure 3).
Appearance of the bone after the mucoperiosteal flap. There is a great defect with horizontal and vertical component, not suitable for the placement of dental implants.
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Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
(a) Measurement of the most severe defect. (b) Measurement of the most severe defect.
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Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
Bone scraper to decorticate and to collect autologous bone.
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fig6
Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
Cortical lamina fixed with microscrews in its palatal portion.
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fig7
Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
Autologous bone and xenograft.
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fig8
Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
Bone graft placing taking as buccal limit the canine eminence conserved from the patient.
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fig9
Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
Buccal fixation of the cortical bone membrane with microscrews and covering of the mesial defect with a resorbable collagen membrane.
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fig10
Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
Suture without stress using monofilament suture.
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fig11
Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
Orthopantomography after the surgery.
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Immediately after the surgery, a control orthopantomography was taken (Figure 12).
CBCT after healing during 6 months.
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Six months after the surgery, a new CBCT was performed (Figure 13) for implant planning and three internal conical connection implants (Galimplant  Sarria, Lugo, Spain) were placed in positions 22, 24, and 25 (3.5 x 12 mm, 4 x 12 mm, and 4.5 x 8 mm, respectively), with an insertion torque of 30 N/cm (Figures 14 and 15).
Clinical view after 6 months during dental implant placement.
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Six months after the surgery, a new CBCT was performed (Figure 13) for implant planning and three internal conical connection implants (Galimplant  Sarria, Lugo, Spain) were placed in positions 22, 24, and 25 (3.5 x 12 mm, 4 x 12 mm, and 4.5 x 8 mm, respectively), with an insertion torque of 30 N/cm (Figures 14 and 15).
Orthopantomography after dental implant surgery.
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Six months after the surgery, a new CBCT was performed (Figure 13) for implant planning and three internal conical connection implants (Galimplant  Sarria, Lugo, Spain) were placed in positions 22, 24, and 25 (3.5 x 12 mm, 4 x 12 mm, and 4.5 x 8 mm, respectively), with an insertion torque of 30 N/cm (Figures 14 and 15).