This patient presented with a significant number of missing teeth and a collapsed bite with loss of vertical dimension. The facial changes include muscle atrophy, facial asymmetry and a turned down lip profile.

The following radiographic series outlines the oral changes.

video 2

video 3

The treatment plan included regeneration of the right and left posterior mandible and R sinus augmentation. A model of the mandible was created from the ct scan in order to build the mandibular bone grafts in the laboratory on the model. Once constructed in the laboratory the bone grafts are simply inserted into the patient limiting time and patient morbidity.

Pre op left mandibular photo

Pre op left mandible. Note the position of the radiolucency near the crest for future reference.

The buccal OsseoConduct Cortical Plate is in place showing the area to be grafted.

Buccal and lingual OsseoConduct Cortical Plate

Occlusal view showing overlap of buccal and lingual cortical plates.

Two week post op appointment showing plate and graft in place.

4 months after grafting the implants are placed and 3 months after implant placement healing abutments are placed as shown in this radiograph.

Radiograph with final restorations in place. Distal to the bicuspid implant approximately 10 mm from the crest is what remains of the radiolucency noted in the preop radiograph indicating the amount of vertical bone growth achieved.

Pre op radiograph of the right mandible.

4 month post grafting of the right mandible.

Implant and restoration in place on the right mandible.

Preop of the right sinus. Sinus augmentation and placement of two bicuspid and one molar implant is planned at the same appointment.

This radiograph shows the sinus grafted with Sinus Graft using the minimally invasive microsurgical Steiner Sinus Lift. The first bicuspid will be placed in bone and the second bicuspid and molar will be placed in graft material. The ct scan and periapical radiographs indicate approximately one to two millimeters of crestal bone in the area of the second bicuspid and first molar.

Day of surgery. Due to the extreme thinness of the lateral wall of the sinus, the sinus membrane was perforated immediately. The sinus membrane was friable and tore away on contact. The membrane was removed from the vicinity of the graft and the site was grafted with no membrane present.

Three months after grafting and implant placement, the implants were loaded and have been in function for over a year. Sinus Graft produces reactive bone that will increase in density where needed and resorb where the bone is not needed just as happens in the bone surrounding normal sinuses.

Restoration of the maxilla with first molar occlusion.

Restoration of the mandible with first molar occlusion.