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Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva
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1/35 - Initial situation – Treatment plan: Replace the adhesive upper left central incisor bridge with a dental implant
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
2/35 - Advanced bone loss after traumatic tooth loss more than 10 years ago
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
3/35 - CBCT: Advanced bone loss after traumatic tooth loss more than 10 years ago
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
4/35 - Patient used to have a diastema in the area which she no longer wanted to be recreated. Treatment plan: implant for UL1 and a veneer for the UR1 to match the space analysis and achieve acceptable and symmetrical aesthetic outcome
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
5/35 - Three-sided full thickness flap and cleaning the surgical area from the granulation tissue
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
6/35 - Three-sided full thickness flap and cleaning the surgical area from the granulation tissue
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
7/35 - Shaping and preparing the uni-cortical maxgraft® block using straight hand-piece under copious irrigation to fit the surgical field and to ensure good adaptation
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
8/35 - Shaping and preparing the uni-cortical maxgraft® block using straight hand-piece under copious irrigation to fit the surgical field and to ensure good adaptation
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
9/35 - Stabilisation of the bone block with two 10 mm fixation screws placed oblique. Sharp edges of the block were polished to avoid defeasance in the soft tissue healing
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
10/35 - Stabilisation of the bone block with two 10 mm fixation screws placed oblique. Sharp edges of the block were polished to avoid defeasance in the soft tissue healing
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
11/35 - Layer of maxgraft® cancellous particles used to fill any gaps and to allow smooth contour medially and distally and covering with Jason® membrane
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
12/35 - Layer of maxgraft® cancellous particles used to fill any gaps and to allow smooth contour medially and distally and covering with Jason® membrane
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
13/35 - Soft tissue adjustment - frenulum adjustment and muco-periosteal release to achieve full closure under no tension to allow the flap margins to heal with primary intension
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
14/35 - Soft tissue adjustment - frenulum adjustment and muco-periosteal release to achieve full closure under no tension to allow the flap margins to heal with primary intension
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
15/35 - Flap closure using 5/0 monofilaments Prolene sutures
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
16/35 - Flap closure using 5/0 monofilaments Prolene sutures
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
17/35 - Six months healing period was allowed - healthy soft tissue contour, satisfactory convexity
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
18/35 - Six months healing period was allowed - healthy soft tissue contour, satisfactory convexity
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
19/35 - Post op CBCT shows well integrated and remodelled bone block with sufficient augmentation
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
20/35 - Post op CBCT shows well integrated and remodelled bone block with sufficient augmentation
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
21/35 - Osteotomy prepared revealing a well integrated and nourished bone block. Prostheticly driven implant placement (Straumann Roxolid BLT - RC 4.1x 10 mm) - using a pre-fabricated surgical guide of the approved wax up
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
22/35 - Osteotomy prepared revealing a well integrated and nourished bone block
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
23/35 - Implant is placed 3 mm away from the cementoenamel junction. Good primary stability was achieved with a torque of 35 Nom at placement and good block integration
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
24/35 - 4.5 mm diameter x 4 mm height healing abutment
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
25/35 - GBR at the time of the implant placement - added cerabone® 0.5 cc small particles to increase the convexity and insure stability of the soft tissue. Jason® membrane stabilised with titanium pins and sutured palatally
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
26/35 - GBR at the time of the implant placement - added cerabone® 0.5 cc small particles to increase the convexity and insure stability of the soft tissue. Jason® membrane stabilised with titanium pins and sutured palatally
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
27/35 - Exposure of the UL1 implant and fitting a chair side temporary crown
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
28/35 - Exposure of the UL1 implant and fitting a chair side temporary crown
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
29/35 - Final implant impression with Straumann RC customised impression pick up with an open tray for final screw retained implant crown on UL1 and Porcelain veneer on UR1
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
30/35 - Final implant impression with Straumann RC customised impression pick up with an open tray for final screw retained implant crown on UL1 and Porcelain veneer on UR1
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
31/35 - Final fit of final screw retained implant crown with CAD/CAM Ti abutment on UL1 and Porcelain veneer on UR1. Lab work was provided by Ceramist Guglielmo Parziale - Napoli - Italy
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
32/35 - 5 years clinical review – stable outcome
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
33/35 - 5 y post op CBCT - Axial view at the coronal 2mm level
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
34/35 - 5 y post op CBCT - Coronal view showing the upper left central incisor implant
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva -
35/35 - 5 y post OP CBCT -Sagittal view
Block grafting in the aesthetic zone with maxgraft®, Jason® membrane and cerabone® - Dres. H. Maghaireh and V. Ivancheva
Initial clinical situation. Atrophic maxillary ridge.
Initial x-ray showing bone loss around implants placed 5 years ago in another dental clinic
Initial view of the case. Discoloration of 1.1 and mild class I gingival recession
Situation after tooth removal.
Initial clinical situation with gum recession and labial bone loss eight weeks following tooth extraction
Three implants placed in a narrow posterior mandible
Pre-operative clinical situation.
Clinical situation with narrow alveolar ridge in the lower jaw
Initial clinical situation showing bone wall defect.
Initial clinical situation.
Pre-surgical situation.
Initial situation: missing teeth #11 & 12 and badly broken #21 root
Pre-operative OPG shows deep vertical intrabony defects on the distal aspects of teeth 13 and 14.
Instable bridge situation with abscess formation at tooth #15 after apicoectomy
Initial clinical situation.
Implant insertion in atrophic alveolar ridge
Preoperative clinical situation
Pre-operative OPG
Pre-operative X-ray. Hopless tooth 21.
Pre-surgical situation. Teeth 26 and 27 missing.
Extraction of tooth 21 after endodontic treatment
Pre-surgical probing reveals a deep intrabony defect on the distal aspect of the upper canine.
Initial clinical situation with single tooth gap in regio 21
Pre-operative radiographic view. Intrabony defect on the distal aspect of the lateral incisor.
Clinical situation before extraction and implantation
Pre-operative radiographic view.
