Author
Dr. Pil Lim, DDS, MDS
Private practice
Seoul, Korea
A 38-year-old female patient had cantilevered bridges at site 14-16 and 44-46. The plan was to eliminate cantilevers and place 4 implants at site 16, 17, 46, and 47. In addition, the GBR procedure using CTi-mem was planned due to buccal bone defects at site 46 and 47.
The ridge was exposed with a crestal incision.
Autogenous bone chips were harvested in the retromolar site using the ACM drill.
2 implants were placed after the host bone decortication process.
Panoramic radiograph taken after implants placement.
The buccal bone defect was filled with autogenous bone chips harvested with ACM.
A type of CTi-mem was placed over the graft and fixed with sutures in the periosteum.
The wound closure was achieved with sutures.
Stage Ⅱ surgery 4 months after the initial surgery.
It was verified that the volumetric stability of the bone graft was achieved after CTi-mem removal.
CTi-spacers were removed.
The suture was placed over the healing abutment.
4 months after stage Ⅱ surgery.
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<br/>Author<br/> Dr. Pil Lim, DDS, MDS<br/>Private practice<br/>Seoul, Korea<br/><br/><br/><br/>
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A 38-year-old female patient had cantilevered bridges at site 14-16 and 44-46. The plan was to eliminate cantilevers and place 4 implants at site 16, 17, 46, and 47. In addition, the GBR procedure using CTi-mem was planned due to buccal bone defects at site 46 and 47.
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_03.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_03.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_03" /></a>
The ridge was exposed with a crestal incision.
<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_04.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_04.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_04" /></a>
Autogenous bone chips were harvested in the retromolar site using the ACM drill.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_05.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_05.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_05" /></a>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_06.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_06.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_06" /></a>
2 implants were placed after the host bone decortication process.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_07.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_07.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_07" /></a>
Panoramic radiograph taken after implants placement.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_08.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_08.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_08" /></a>
The buccal bone defect was filled with autogenous bone chips harvested with ACM.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_09.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_09.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_09" /></a>
A type of CTi-mem was placed over the graft and fixed with sutures in the periosteum.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_10.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_10.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_10" /></a>
The wound closure was achieved with sutures.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_11.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_11.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_11" /></a>
Stage Ⅱ surgery 4 months after the initial surgery.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_12.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_12.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_12" /></a>
It was verified that the volumetric stability of the bone graft was achieved after CTi-mem removal.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_13.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_13.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_13" /></a>
CTi-spacers were removed.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_14.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_14.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_14" /></a>
The suture was placed over the healing abutment.<br/><br/>
<a href="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_15.jpg"><img width="960" height="720" src="http://gaoforum.com/wp-content/uploads/2014/12/C11_GBR_15.jpg" class=" vc_box_border_grey attachment-full" alt="C11_GBR_15" /></a>
4 months after stage Ⅱ surgery.<br/><br/>
This case presents the GBR procedure using a customized titanium mesh (A type of CTi-mem) at site 46 and 47. Prior to the CTi-mem placement, the buccal bone defect was filled with autogenous bone chips harvested with ACM http://gaoforum.com/implantation-with-gbr-using-cti-membrane/){kind=link}
I agree with your decision in intentionally exposing the buccal side and remaining the lingual side intact, rather than doing the ridge split technique. The GBR on the buccal side with the autogenous bone from the buccal shelf area, and covering with the titanium mesh will become one of the predictable treatment modality. This is better than block bone graft. Fantastic result, Dr. Phil!
Just one question, how did you manage the soft tissue covering without the membrane exposure? Most of us are suffering from this problem.