Implant Dentistry Today No 14

Implant Dentistry Today 22 Background: A 60-year-old patient, female. Non-contributory medical history, non-smoker. Atrophy of the posterior maxilla. The subperiosteal tunneling technique can be used for the treatment of the atrophic mandible and maxilla, with the insertion of a grafting material under a raised subperiosteal tunnel that permits accessing the lateral ridge. This surgical EthOss Tunnel Graft clinical Case performed by Dr Minas Leventis, UK. Fig 1: Initial clinical view. Note the thin residual bridge and the atrophy of the soft tissues. Fig 4: One cc of β -TCP/Calcium Sulfate (EthOss) was injected into the subperiosteal pouch using a graft gun. Fig 7: Additional veneer grafting of the area with EthOss. Fig 10: Four months post-op. Note the augmented ridge and the presence of thick keratinized soft tissues. Fig 2: Initial axial and coronal CBCT views. Fig 5: Clinical view: Immediately post-op, after suturing the laparoscopic access incision.The graft material is placed under intact mucoperiosteal tissue, thereby minimizing the risk of exposure of the graft due to wound dehiscence. Fig 8: Tension-free closure. Fig 11: Penguin ISQ measurements revealing excellent stability for all implants (ISQ: 70-71). Fig 3: Under local anaesthesia, a vertical incision was made distally to the lateral incisor for access to the deficient bone site. Using a thin periosteal elevator, a sub-periosteal tunnel was created buccally to accommodate an adequate volume of the grafting material. It is important to preserve the integrity of the periosteum throughout the procedure. Decortication of the bone was not performed. Fig 6: Twelve weeks post-op. A full- thickness flap was raised. Adequate soft bone was regenerated at this time point, enabling the placement of 3 implants. Note the expansion of the newly-formed bone. Fig 9: Periapical x-ray immediately after. Fig 12: Prosthetic implant abutments in place, torqued to 35 Ncm. Fig 15: CBCT 1 year after loading of the implants. Fig 13: Final cement-retained restoration. Fig 14: Periapical-xray immediately after fitting the restoration. technique is associated with minimal postoperative patient morbidity, and minimal risk of loss of augmentation volume due to loss of graft arising from local wound dehiscence. In this case, a self-hardening fully resorbable synthetic material, composed of β -TCP and Calcium Sulfate (EthOss), was used utilizing this interesting minimally invasive pre-implant bone augmentation method. n