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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
Preoperative Ortopantomogram of the teeth planned for extraction
DVT image demonstrating horizontal and vertical amount of bone available
Extraction of tooth 21 after endodontic treatment
Implant insertion in atrophic alveolar ridge
Initial clinical situation with broken bridge abutment in regio 12 and tooth 21 not worth preserving
Initial clinical situation with gum recession and labial bone loss eight weeks following tooth extraction
Situation after tooth extraction.
Initial clinical situation
Initial situation after extraction of tooth 21 after 6 months
Situation after tooth removal.
Bone defect in area 11-21 due to two lost implants (periimplantitis) after 15 years of function
Pre-operative clinical situation: severe atrophy of the maxillary bone
60-year-old female patient presented with a chronic infection on tooth #11.
Since she has a high lip line matching the gingival margins of the adjacent central incisor and creating a root eminence is extremely important. For these reasons, the treatment of choice was an allograft bone ring enabling immediate placement of the dental implant with simultaneous regeneration of her ridge.
Initial clinical situation: 9 mm pocket depth associated with root fracture
Initial presentation of failing post retained crown with previous history of failed apicectomies and amalgam tattooing and scar tissue
Initial clinical situation with pronounced vertical and horizontal bone defect
Clinical view 8 weeks after extraction of teeth 25 and 26
Pre-operative: loss of interdental papilla between 12 and 11 associated with gingival inflammation and pus
Preoperative x-ray, multiple residual cysts of the upper jaw
Clinical situation at baseline: Situation after tooth extraction UR1 due to a failed endodontic treatment 3 months previously
Situation before extraction of the teeth
Atrophic alveolar ridge in the left mandible
Instable bridge situation with abscess formation at tooth #15 after apicoectomy
Preoperative clinical situation
Pre-operative radiographic view.
Initial situation pre-op: Central incisors with mobility 3
Initial clinical situation.
Initial situation: X-ray scan reveals eggshell thin sinus floor (1-3 mm) on both sites of the maxilla; green areas indicate the planned maxgraft® bonerings and red areas the planned implants
Pre-surgical situation. Teeth 26 and 27 missing.
Pre-op picture of affected teeth 11 and 21
Preoperative radiological situation
Clinical view of the case.
Preoperative situation – Maxillary defect in area 14-16 (loss of implant 16 due to periimplantitis, tooth 14 extracted recently and area 15 already edentulous for a while)
Initial x-ray showing bone loss around implants placed 5 years ago in another dental clinic
Initial clinical situation
Initial situation - endodontically failing tooth 22, very thin biotype, high lip line and esthetic expectations
Loss of teeth in anterior maxilla caused by periodontitis
Initial situation after root channel treatment
Preoperative CBCT analysis
Preparation of a single tooth defect with severely resorbed vestibular wall
Three implants placed in a narrow posterior mandible
Initial clinical situation with single tooth gap in regio 21
Clinical situation: 71-old patient with atrial fibrillation and Warfarin medication
Initial situation 57-year old female patient. X-ray scan reveals severe bone loss due to inflammation in region 13. Treatment plan was extraction of teeth 13 and 14 and augmentation after healing.
Initial clinical situation, regio #16
Model of the initial defect computed from a CBCT scan - buccal view
Clinical situation
Lateral view of the defect in the posterior right maxilla.
Initial clinical situation.
The patient presented with pathologic mobility of upper left central incisor. Radiographic examination revealed significant circumferential attachment loss with an unfavorable crown to root ratio.
Initial situation – Treatment plan: Replace the adhesive upper left central incisor bridge with a dental implant
Preoperative CBCT: vertical bone defects in the 3rd & 4th quadrant
Initial clinical situation: Free end situation in quadrant three and four
Initial x-ray, tooth 25 compromised and to be extracted
Preoperative x-ray, severe bone atrophy
The patient presented with severe pain in the lateral incisor and a deficient adhesive provisional. Bruxism resulted in canine loss and premature contact in the lateral incisor.
Initial x-ray, ten years post implantationem alio loco, large peri-implant bone loss
