Treatment of a complex defect in the upper jaw: the F.I.R.S.T. protocol

Radiographic evaluation at consultation visit.

Cone-beam computerized tomography exam after 4 months of healing.

Clinical view of the defect.

Flap design

Flap design

The fit of the tooth-supported surgical template is carefully tested

Implant site preparation.

Implant placement.

Occlusal view of the horizontal bone defect around the dental implants

Lamina® is adapted to the defect.

Mix of Gen-Os®, Apatos®, and fibrin sealant.

Mix of Gen-Os®, Apatos®, and fibrin sealant in place.

Mix of Gen-Os®, Apatos®, and fibrin sealant in place.

Fibrin sealant is applied over the bone particles to allow Lamina® adhesion

Lamina® is placed with slight pressure.

Lamina® is placed with slight pressure.

Flap suture after the GBR.

Postoperative cone-beam computerized tomography exam.

Soft tissue healing after 5 months. Healing at the augmented site

Soft tissue healing after 5 months. Soft tissue evaluation of the adjacent tooth.

Second stage surgery. Flap design.

Lamina® removal.

Bone regeneration after Lamina® removal

Bone biopsy.

Bone biopsy.

Soft tissue augmentation at adjacent tooth.

Soft tissue augmentation at adjacent tooth.

Flap sutures.

Flap sutures.

Cone-beam computerized tomography examination after second stage surgery.

Three-dimensional superimposition of the CBCT after the first (gray) and second (red) stage surgery using Romexis.

Definitive prosthesis delivery on buccal view.

Definitive prosthesis delivery on palatal view.

Peri-apical x-ray at definitive crown delivery after 4 months.

This image is showing particlesof the Gen-Os® totally surrounded by newly formed bone. Biomaterial is acellular but has the same physiological properties as bone; hence, new bone is forming around the particles.