Augmentation

What augmentative methods are available?

Socket grafting

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After every tooth extraction, the resulting defect in the bone (empty socket) should be filled with bone augmentation material and covered with a resorbable membrane. If this is not done, it automatically leads to breakdown of the bone (bone atrophy) and hence the bone in this area has to be rebuilt at a later stage.

Distraction osteogenesis

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If there is a defect in the maxilla or mandible, the available bone can be split and part of it can be moved using a special device known as a distractor. A wide variety of distractors are available.

Pedicled sandwich plasty (PSP)

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This method also involves splitting the bone, but the bone segment is moved straight away and fixed with small titanium plates. The resulting defect is filled with the bone augmentation material Algipore (Dentsply Implants).

Horizontal two-step pedicled sandwich plasty (two-step PSP)

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If the bone in both jaws is high enough but too narrow, it is sectioned in a minor preliminary operation and finally split and expanded after a minimum of 28 days so that implants can be inserted.

Augmentation – guided bone regeneration (GBR)

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Smaller bone defects are repaired by this method. The filling material comprises the bone augmentation material Algipore - KLS martrix, mixed with blood and possibly bone chips generated during bone cutting. These chips are collected in a special container (bone trap) or added to osteogenesis-promoting substances such as platelet-rich plasma (PRP).

Tenting

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This is a special form of augmentation. For vertical repair of a bone defect, a resorbable osteosynthesis pin (Sonic Weld Pin - KLS Martin) is placed under a membrane to provide stabilization in the same way as a tent roof. The resulting space is filled with a mixture of Algipore or KLS martrix, blood, harvested bone chips and possibly with PRP or BMP preparations and is held in that position with the aid of a film, fixed with small titanium tacks or sonic weld pins.

Elevation of maxillary sinus mucosa in the maxilla (sinus lift)

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Where bone height is poor in the posterior maxilla, the mucosa of the maxillary sinus can be carefully lifted and the resulting space filled with a mixture of Algipore - KLS martrix, blood, harvested bone chips and possibly with a platelet-rich plasma (PRP) or BMP (bone morphogenetic proteins) preparation. The material is held in that position with the aid of a film, fixed with small titanium tacks or sonic weld pins. Depending on bone height, this procedure can be minimally invasive, i.e. performed with simultaneous implant insertion through the implant hole (minimally invasive sinus lift) or via a lateral access with later implant insertion.

Onlay plasty

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In cases of extreme bone loss, where neither distraction nor PSP can be performed, onlay of the patient’s own bone must be carried out. As it causes fewer complications, the aim is usually to obtain bone from the angle of the lower jaw. In rare cases, bone is taken from the iliac crest. However, we prefer to harvest bone from the angle of the mandible.

With all these augmentative methods, around 3 to 4 months are needed for incorporation of the newly formed bone so that the implants can eventually be inserted. After a further waiting period of 3 to 4 months, the restoration work can be done with crowns or bridges. The period of incorporation is dependent on the extent of the operation, the patient’s age and state of health.