Horizontal and vertical ridge augmentation of a knife-edge ridge

A 54-year-old man presented with missing right lower teeth and ridge deficiency. 

Clinical examination revealed that the mandible was edentulous from the right lower first molar to the second molar region. Radiographically, atrophy of the mandibular alveolar ridge in the same teeth site was observed.  Bone quantity of 2-3 mm thickness at the crest, 8 mm and 6 mm residual bone on top of the nervus alveolaris inferior in region #46 FDI / #30 US and #47 FDI / #31 US.

Horizontal and vertical augmentation by GBR (guided bone regeneration) was carried out using the “tenting screw technique”. This technique involves expanding the soft tissue volume and using screws as “screw tent poles” for the surrounding particulate graft. This helps prevent the soft tissues from contracting around the particulate graft and subsequently displacing it or causing physiologic resorption. To immobilize the bone graft a creos™ xenoprotect was used, which is a resorbable, non-chemically cross-linked membrane. After 6 months bone augmentation on the alveolar ridge was noticeable and two NobelActive® implants were placed.

After 4 months of healing, a free gingival graft from the palate was used as there was no fixed mucosa on the buccal site. Once the soft tissues were appropriate, two full-ceramic crowns were fitted.