Vertical augmentation with equine block in the frontal mandible

  • cover image
  • 1. Seriously resorbed alveolar ridge at the time of first surgical intervention. Both sublingual glands with ducts are seen to be above it when the tongue  is move up.
  • 2. Semicircular osteotomy was performed with diamante circular saw in general anesthesia
  • 3. Osteotomy of lingual compact bone was completed with chisel in order to avoid damaging of lingual periostium. The mobile segment of residual ridge was covered with soft tissue to give appropriate blood supply.
  • 4. Sp-Block was reshaped and inserted between mobile and stable segment of mandible.
  • 5. Mobile segment was fixed with two mini plates. Gaps were also filed with Sp-Block particles, obtained by mincing.
  • 6. Uneventfully healed wound after 10 days of surgical intervention.
  • 7. Reconstructed alveolar ridge covered with uninflamed mucosa. Narrow zone of keratinized mucosa was presented and mini plates under mobile mucosa could be seen.
  • 8. Re-entry due to implantation after 6 months of augmentation with Sp-Block under local anesthesia. Vital bone with incorporated xenograft was found. Mini-plates with all screws were on the same place.
  • 9. Insertion of two implants-regions 42, 32. Minimal dehiscence was detected at region 42.
  • 10. Dehiscence at 42 was first covered with Gen-Os.
  • 11. Particles of xenograft at 42 site was covered with resorbable membrane (Evolution Standard).
  • 12. Sutured surgical wound after implantation and GBR.
  • 13. Suprastructures for supporting denture with stable mucosa after 7 months of implantation and 3 months of healing abatement installation.
  • 14. Rehabilitation with removable denture of both jaws.
  • 15. CBCT scan of lower jaw before augmentation. Both mental foramina were seen on the top of resorbed alveolar ridge (3D reconstruction project-down left).
  • 16. Ortopanthomogram one week after sandwich technique with Sp-Block. Two mini-plates and screws were positioned on both segments to stabilized graft and raised segment.
  • 17. Lateral cephalometric radiograph one week after augmentation. The gap between both segment  is seen. Osteotomy was performed below mental spine.
  • 18. Orthopanthomogram before implantation. Radio opaque between both segment could be seen.
  • 19. CBCT region 42 one week after implantation. On buccal side dehiscence of two phase implant (diameter 3,5mm, length 8mm)  was cowered with particles of Gen-Os.
  • 20. CBCT medial line one week after implantation and 6 months after implantation. Residual radio opaque material could be seen. Damaged mini screw during fixation at first surgical intervention. Block graft is well incorporated between both segments.
  • 21. CBCT region 32 at the same time. Blurred shape of graft could be seen at buccal aspect. Implant (diameter 3,5 mm, length 8 mm)  with conical connection was inserted sub-crestal.
  • 22. Orthopanthomogram 13 months after augmentation and 7 months after implantation with GBR.  Both implants with prostethical suprastructure were seen with stable peri-implant bone.
  • 23. Orthopanthomogram 8 months after  prosthetic was delivered. Stable crestal bone could be seen.
  • Clinical indication: vertical augmentation
  • Products : Evolution, Gen-Os, Sp-Block
  • Authors : Dr. Kočar Miha
  • Information about patient: Female 56
  • Credits : Documentation provided by Dr. Kočar Miha, Liubljana (Slovenia)
    UMC LJUBLJANA Department of Maxillofacial and Oral Surgery
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