Clinical Case: Neoss ProActive® Implants
3D bone regeneration on the posterior maxilla
using Neoss ProActive Implants and Khoury´s SBB technique
Dr. David González
DDS, M.Sc., PhD
Master in Periodontics and PhD Doctor at Complutense University of Madrid.
Private practice at Clínica Ortoperio in Murcia, Spain.
Facts
Patient:
40 years old woman, non-smoker, medically healthy.
Clinical problem:
Patient presented bone atrophy at left posterior maxilla missing 26 and 27.
Clinical solution:
Treatment plan:
- Patient was referred to Clínica OrtoPerio due to severe bone atrophy caused by endodontic failures.
- After CBCT assessment disclosing an atrophied ridge with a 9 mm vertical bone defect a Khoury´s SBB surgical procedure was carried out using autogenous bone blocks harvested from the external oblique line of the right side of the mandible. The block was split using a disc. Autogenous bone chips harvested with a bone scraper was used as a filling material to fill the “box” made with the blocks.
- 6 months later: Reentry was carried out and 2 Neoss® implants (4.5 x 11 mm) were placed.
- 2 months later: a Free Gingival Graft was placed at buccal aspect to reposition the mucogingival line and to create a band of keratinised mucosa.
- 1 month later (3 months after implants placement): 2 screw-retained zirconia-porcelane crowns were delivered.
- 2 years later: Clinical and radiographic status of the implants was healthy.
Products:
2 Neoss ProActive® Straight implants (4.5 x 11 mm)
Conclusion:
Step by step
Step by step
Figure 1.
Palatal view of the left posterior maxilla showing severe bone atrophy. Full thickness incision to expose the alveolar ridge.
Figure 2.
Bone harvest from the right external oblique line.
Figure 3.
Block at the resorbed left posterior maxilla before raising the flap.
Figure 4.
After raising the flap a 9 mm vertical defect was found.
Figure 5.
A split bone block was fixed by screws at the coronal aspect of the alveolar ridge from peak to peak.
Figure 6.
The gap between the block and the alveolar ridge was filled with scraped bone chips.
Figure 7.
Another split block was used to cover the exposed scraped bone chips.
Figure 8.
Coronal view of the bone graft.
Figure 9.
Sutures.
Figure 10.
After 4 months of healing reentry was carried out.
Figure 11.
Lateral view showing complete bone regeneration.
Figure 12.
Complete vertical bone regeneration
Figure 13.
2 Neoss ProActive® Straight implants (4.5 x 11 mm) were placed.
Figure 14.
Occlusal view of the implants.
Figure 15.
2 months later a Free Gingival Graft was placed to reposition the mucogingival line.
Figure 16.
Final crowns at 26 and 27 two years after loading.
Figure 17.
Periapical x-ray 2 years after loading.
"3D bone regeneration performing the SBB technique by using 100% autogenous bone (blocks and scraped chips bone) is a fully predictable treatment for the severe bone atrophy on the posterior maxilla and Neoss® ProActive Implants can be placed confidently to restore severely atrophied alveolar ridges."
Dr. David González Spain 
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