Augmentation Techniques – the Basis of Aesthetic

Management of Class V defects The primary goal in the presence of extensive three- dimensional defects is to reconstruct the missing bone structure, preferably by block osteotomy and autologous block grafting. Soft-tissue management is particularly important in this situation, as the aug- mented bone must be reliably covered with soft tis- sue during the healing phase to ensure a successful outcome. We routinely use fixated blocks of spon- gious cortical bone, combined with resorbable mem- branes to protect the augmentation material against resorption. This approach involves a low rate of com- plications in the presence of appropriate soft-tissue management, the use of microinstruments, and thanks to the good biocompatibility of the resorbable collagen membrane. Augmentation is performed by onlay grafting of a bone block. A special osteosynthesis screw (Corti- cofix-System, CAMLOG) is used for fixation. This trac- tion screw will ensure that the bone block is com- pletely immobilized by exerting pressure on the bony bed (Figure B4). Then a mixture of autologous spongy bone and Bio-Oss (Geistlich) is placed on the bone block for defect contouring. Finally, the material is covered with a resorbable membrane (BioGide, Geistlich) to protect the augmented site from uncontrolled resorption (Figure B5). After a healing period of five months, the site is once again surgically exposed, showing virtually no signs of resorption. This is followed by implant place- ment in conjunction with soft-tissue augmentation. After another healing period of four months, the implant is uncovered and fitted with a temporary restoration for soft-tissue conditioning (Figures B6–B9). Finally, a CAMLOG zirconium abutment and an all- ceramic restoration are inserted to optimize the aes- thetic outcome of treatment (Figure B10–B11). EDI Case Studies 10 Fig. B1 Juvenile traumatic tooth loss. Fig. B2 Horizontal bone loss extending facially over the entire root length. Fig. B3 Combined three-dimen- sional defect with a vertical com- ponent (class V). Fig. B4 The bone block is effective- ly immobilized in the defect area by the Corticofix screw. Surface contact with the native bone is required for the transferred bone block to be reliably pervaded. Micromovements need to be ruled out. Fig. B5 Membrane coverage using a mucosa-friendly semipermeable collagen membrane (BioGide, Geistlich). The membrane is fixat- ed to protect the augmented bone against resorption. Fig. B6 There are virtually no signs of resorption after 5 months of healing. The Corticofix screw has is removed prior to implantation.