Partner Magazine logo 15

logo 39 • the CAMLOG Partner Magazine • November 2016 13 CASE STUDY replacing tooth 37. Splint therapy [2] should be performed in cases of advanced loss of vertical reaction with existing craniomandibular dysfunction to provide gradual adaptation of the masticatory system. Final restoration of the posterior teeth and the implant should take place after a temporary phase of up to 12 months. The patient was fully informed of every step so that he could understand the benefit of therapy at every point in time. Regular prophylaxis and follow-up sessions were a precondition. Surgical phase Due to the acute fistula on tooth 11 a two-stage augmentation procedure was selected. The lacking integrity of the vestibular lamella after extraction, combined with pronounced pressure of the M. orbicularis oris, led to an osseous buccal defect after healing (Figs. 8 to 10) . Defects of this magnitude can be treated reliably and with long-term stability using autologous bone grafts. In this case, a bone graft from tuber region 18 as well as particles of cancellous bone were used for build-up (Figs. 11 and 12) . A classical interim prosthesis without pontic was chosen as temporary restoration. The pontic-like shaping leads to a thinning of the gingiva, making dense primary wound closure difficult (Fig. 13) . Fig. 4: Abrasion and the resulting reduced clinical crown height can be observed in the posterior region. Fig. 6: The X-ray of tooth 11 shows apical brightening. Fig. 12: The precise fixation of the graft with two micro-screws is checked via X-ray. Fig. 9: A buccal bone defect can already be detected occlusally in the soft tissue. Fig. 5: The end-to-end bite was caused by compensatory ad- vancement of the mandible. Fig. 11: An autologous bone graft was harvested from the tuber region to reconstruct the horizontal deficit. Fig. 8: Due to the fistula on tooth 11 a two-stage augmentation procedure was selected. Representation of the clinical situation three months after extraction. Fig. 7: Initial situation in the orthopantomogram: multiple fillings with caries in the marginal region. Fig. 10: The buccal bone defect in regio 11 is illustrated.