Prof Ziv Mazor Atrophic Maxillary Reconstruction Combined with Immediate Loading

Prof  Ziv Mazor  Atrophic Maxillary Reconstruction Combined with Immediate Loading

The case of today is a very extreme and unique case in which we are going to do major bone regeneration and reconstruction It’s a 54 year old lady, who had been wearing a denture for many years, and lost a lot of the vertical and horizontal dimensions of the face.
By looking at the ridge here you might think that probably we have a lot of bone. But as you’ve seen on the CT scans there is minimal amount of bone present. So we are now reflecting the flap to expose the deficient ridge. As you can see in this picture, there is almost no bone available at the horizontal dimension – maybe 2mm in some places and maybe less in some others. So the treatment plan was to do bi-lateral sinus augmentation as you can see here by manually elevating the Schneiderian membrane and another sinus elevation on the upper left side which is done right here And, in the front – I was planning to place six implants with ridge expansion by using osseodensification so those are the densifying drills which are working counter-clockwise and while working with those burs, we are able to expand the ridge without having any perforations or dehiscences. Mixing now xenograft and allograft together and reconstituting it with the liquid of the PRF is being carried out and afterwards we are adding the serum which will create what everybody is calling today “sticky bone” but we call it a PRF block and that will be very helpful later on with augmenting the sinuses and also the ridge deficiencies. So here in the front we did nasal floor elevation together with implant placement now so you are looking at the implants, which are inserted in the front. We are packing the nasal floor and inserting all six implants in the anterior region. Now the left sinus is being packed and here we are placing two wider implants after doing osseodensification. So prosthetic-wise we have multi-unit abutments. We are fixating now the transfers for taking an impression for doing an immediate loading temporary reconstruction. So sinus is being packed together you can see the xenograft, allograft and PRF. Now OSSIX VOLUMAX will be utilized here in order to reconstruct the buccal deficiency. So first we need to prepare the VOLUMAX by adding (sterile) saline to the material and the material will soak the saline and we will have a volume which is much bigger than any conventional membrane. So here you can see the dimensions of the material. Prior to placement we have to wet the material with sterile saline and then the material will be ready for use. So I’m adding first the graft material And you see that it’s quite easy to handle and the OSSIX VOLUMAX will be as a superficial layer. We can of course cut it into pieces and adjust it where needed. PRF membranes are placed on top and then primary closure is carried out So now we are preparing the other OSSIX VOLUMAX scaffold membranes to be placed on the left side as well, In the same manner as we did the right side. So you can see that we have different shapes and lengths for the VOLUMAX material Now closing up the flaps, and we are ready now to carry on with the prosthetic plan and you can see here the panoramic x-ray of the case after a temporary restoration.

Author: Kevin Mason

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