Vertical Guided Bone and Tissue Regeneration with F.I.R.S.T.

The pre-operative clinical image shows a lack of teeth in positions 34 and 35.

The CBCT scan revealed a vertical defect in position 34

Two implants are placed. The cortical bone is drilled to promote bleeding and recruit Mesenchymal Stem Cells

A fibrin sealant, after dilution 1:10 of the thrombin, is mixed with Gen-Os®

Lamina® Soft is hydrated for five minutes with sterile saline and glued onto Gen-Os® bone granules by using a fibrin sealant

Suture without tension on the edges. Post-operative x-ray.

New anatomy and volume of the site after six months.

Since, compared to other techniques, there is no need to remove barriers, pins, or screws, a minimally invasive, partial-thickness incision is made to expose the implants.

Two healing abutments are placed six months after the surgery

5/0 monofilament sutures sling around the healing abutments.

The clinical view shows the complete and uneventful soft

Prosthetic rehabilitation using a screwed monolithic zirconium bridge. Papillae are absent, but there is adequate keratinised mucosa

The follow-up radiograph shows newly formed bone between the canine and implant in position 34

2-year check-up: creeping of the keratinized mucosa is noted.

The comparison of the pre-operative and the two-year follow-up. CBCT reveals new bone formation in positions 34 and 35.

The two-year follow-up CBCT shows a vertical bone gain of 6.90 mm

CBCT cross sections at 2 years show the presence of a convex-shaped porcine cortical lamina (arrows). Long-term resorption of the cortical lamina promotes this type of result.

The seven-year follow-up shows creeping of the keratinized mucosa and new papillae formation. The bone peak is stable between the canine and the implant in position 34

The seven-year follow-up shows creeping of the keratinized mucosa and new papillae formation. The bone peak is stable between the canine and the implant in position 34