PMC6085604_01
CBCT showing insufficient bone width at tooth #46.
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A cone beam CT scan was taken to evaluate the ridge width and height and the location of vital structures ( Figure 1 and Figure 2).
CBCT showing insufficient bone width #46.
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A cone beam CT scan was taken to evaluate the ridge width and height and the location of vital structures ( Figure 1 and Figure 2).
Pre- ridge augmentation.
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At 8 weeks after the free gingival graft procedure ( Figure 3), ridge augmentation was performed using a titanium-reinforced non-resorbable polytetrafluoroethylene PTFE membrane and FDBA.
Full thickness flap reflection.. The mental nerve can be seen.
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Figure 4). Flap advancement adjacent to the mental foramen area was conducted after a full-thickness mucoperiosteal flap was elevated beyond the mucogingival junction by pushing back the flap using wet gauze until the mental nerve was located ( Figure 4).
Measuring the bone width (3 mm). Decortication was performed to increase blood supply in the area.
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Decortication was performed in the buccal bone with a round bur ( Figure 5).
Non-resorbable membrane covering FDBA.
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FDBA (OraGRAFT , USA) was placed beneath the membrane and packed gently ( Figure 6), then the membrane coronal part was stabilized with two tacks. Flaps were sutured with 4-0 non-resorbable PTFE sutures (Cytoplast  Sutures, Osteogenics Biomedical) ( Figure 7) Postoperative instructions (about diet, pain, bleeding and healing) and medications, including 600 mg ibuprofen three times a day for 5 days, 875 mg amoxicillin twice daily for one week and 0.12% chlorohexidine mouth wash twice a day for 2 weeks, were given to the patient.
Suturing, primary closure was achieved.
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FDBA (OraGRAFT , USA) was placed beneath the membrane and packed gently ( Figure 6), then the membrane coronal part was stabilized with two tacks. Flaps were sutured with 4-0 non-resorbable PTFE sutures (Cytoplast  Sutures, Osteogenics Biomedical) ( Figure 7) Postoperative instructions (about diet, pain, bleeding and healing) and medications, including 600 mg ibuprofen three times a day for 5 days, 875 mg amoxicillin twice daily for one week and 0.12% chlorohexidine mouth wash twice a day for 2 weeks, were given to the patient.
The patient at 2 weeks follow-up.
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The patient at 4 weeks follow-up.
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The size of the exposure was approximately 4 x 8 mm ( Figure 9 and Figure 10).
4 weeks follow-up, membrane exposure can be observed.
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The size of the exposure was approximately 4 x 8 mm ( Figure 9 and Figure 10).
Membrane covering surgery.
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PTFE) were used ( Figure 11). Patient was instructed to use chlorhexidine mouthwash and weekly recall to monitor the surgical site.
The patient at 1 week after membrane covering surgery.
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At the 5-week follow up point, 1 week after our surgical attempt to cover the membrane exposure, the size of exposure had increased ( Figure 12).
The patient at 2 weeks after membrane covering surgery.
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At the 6-week follow-up point, 2 weeks after the membrane covering procedure, intraoral examination revealed pus discharge between the membrane and the tissue ( Figure 13).
The underlying tissue after membrane removal.. No bone graft remnants were observed in the surgical site.
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An incision was made to split them membrane from the tissue then the membrane was removed ( Figure 14).
Suturing after membrane removal.
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The flap was sutured using resorbable sutures ( Figure 15).