Augmentation Techniques – the Basis of Aesthetic

Class III defects Class III indicates that a buccal bone deficit of > 3 mm is present. With appropriate surgical techniques, these situations can still be treated in a single-step procedure. In other words, bone augmentation and implant placement are performed in the same ses- sion. Care must be exercised in patient selection, as this approach has been reported to involve increased complication rates. In the following example, an undiagnosed root fracture preceded by anterior trau- ma gave rise to a class III defect after two years of subchronic inflammation. There were more than 3 mm of buccal lamella missing (Figures D1–D3). In the presence of major bone defects, the mandibular angle is an appropriate harvesting site, which, if anatomical conditions are favourable, will yield sufficient amounts of bone to the action of using cutters, oscillating saws, diamond discs or trephine burs (Figure D4). A trephine cutter is used to harvest bone from the ascending ramus. The spongy bone in that region can be carefully extracted with a sharp scoop (Figure KW2). Aesthetic components used in the restorative phase included temporary resin abutments (PE resin) to shape the gingiva and definitive zirconium abut- ments to support the all-ceramic restoration (Figures D5–D7). EDI Case Studies 5 Fig. D1 Bone deficit following implant placement. Fig. D2 Defect filling with autolo- gous bone. Facial overcontouring is only required if an adequate buccal thickness of the bone cover (at least 3 mm) has to be estab- lished. Abb. D3: Defektkonturierung mit Gemisch aus autologer Spongiosa und Bio-Oss (Geistlich), Defektab- deckung mit resorbierbarer Mem- bran (BioGide, Geistlich) Fig. D4 A trephine cutter is used to harvest bone from the ascend- ing ramus. The spongy bone in that region can be carefully extracted with a sharp scoop. Fig. KW2 Autologous bone mate- rial after harvesting, stored in autologous blood. Fig. D5 Temporary resin abutment for gingival shaping. Fig. D6 Zirconium abutment. Fig. D7 All-ceramic restoration.