Combination with guided bone regeneration
Clinical Challenge
A difficult case of oral rehabilitation with a particular challenge at regions 15 and 16. The patient had a car accident some years before and was hit in this area. It resulted in an anatomical change to the sinus with partial loss of buccal sinus wall and scar tissue inside part of the sinus.
Pre-operative occlusal view.
Cut to size Geistlich Bio-Gide® covers fibrotic tissue present in the superior part of the sinus.
Geistlich Bio-Gide® trimmed for ridge reconstruction and stabilized with bone tacks placed apically to the sinus window.
Final position of Geistlich Bio-Gide® used to isolate fibrotic tissue caused by previous trauma.
Geistlich Bio-Oss® placed inside the sinus and also correcting the bone deficiency in the first third of the ridge.
Final position of Geistlich Bio-Gide®. It was positioned buccally with bone tacks and packed under the palatal flap. Note: remaining pieces were used to additionally isolate the buccal area.
Immediate postoperative, a combination of horizontal mattresses and single interrupted sutures.
Occlusal view of the regenerated tissue at implant surgery, 10 months after the bone grafting.
Implant position. Note that narrow implants (3.25 x 10 mm and 3.25 x 8 mm) were used due to the limited space in the edentulous region.
Sutures after implant placement.
Panoramic radiographic 3 years after the bone grafting. Note the stability of the regenerated tissue and that both sides were restored.
Clinical outcome at a glance
Objectives
- Challenging due to anatomic variations caused by previous car accident.
- Sinus floor elevation with lateral window approach in combination with a guided bone regeneration.
- Implant placement at 10 months after bone augmentation.
Conclusions
- Two-stage sinus floor elevation treatment.
- A sinus floor elevation in combination with a guided bone regeneration using Geistlich Bio-Oss® and Geistlich Bio-Gide® leads to stable bone volume for implant placement.
Aim / Approach
During flap reflection, the scar tissue was dissected and part of it removed. After this step, a Geistlich Bio-Gide® membrane was placed to isolate the fibrotic tissue present in the superior part of the sinus. Then the sinus membrane was elevated in the medial region of the sinus. The sinus cavity was filled with Geistlich Bio-Oss® which was also used to regenerate the ridge deficiency. Geistlich Bio-Gide® was stabilized buccally with bone tacks and packed in the palate.
Conclusion
This approach was able to regenerate both the sinus and ridge bone deficiency in one surgery.
