case_images: PMC6594337_01
case_images: Orthopantomography previous to dental extractions.
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case_images: fig1
case_images: A 45-year-old man presented mobility of a metal-ceramic fixed bridge in the second quadrant after ten years of function (Figure 1).
case_images: Previous CBCT.
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case_images: fig2
case_images: After the exploration, the bridge and the pillar teeth were considered nonrestorable, and in the Cone Beam Computed Tomography (CBCT), a severe loss of the alveolar bone of the second quadrant is evidenced (Figure 2).
case_images: Intraoral view before guided bone regeneration surgery.
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case_images: fig3
case_images: After the teeth extraction, we decided to wait a month to make sure the healing and stabilization of the soft tissues (Figure 3).
case_images: Appearance of the bone after the mucoperiosteal flap. There is a great defect with horizontal and vertical component, not suitable for the placement of dental implants.
case_images: CRID2019-5216362.004.jpg
case_images: PMC6594337_01_CRID2019-5216362.004.jpg
case_images: fig4
case_images: Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
case_images: (a) Measurement of the most severe defect. (b) Measurement of the most severe defect.
case_images: CRID2019-5216362.005.jpg
case_images: PMC6594337_01_CRID2019-5216362.005.jpg
case_images: fig5
case_images: Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
case_images: Bone scraper to decorticate and to collect autologous bone.
case_images: CRID2019-5216362.006.jpg
case_images: PMC6594337_01_CRID2019-5216362.006.jpg
case_images: fig6
case_images: Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
case_images: Cortical lamina fixed with microscrews in its palatal portion.
case_images: CRID2019-5216362.007.jpg
case_images: PMC6594337_01_CRID2019-5216362.007.jpg
case_images: fig7
case_images: Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
case_images: Autologous bone and xenograft.
case_images: CRID2019-5216362.008.jpg
case_images: PMC6594337_01_CRID2019-5216362.008.jpg
case_images: fig8
case_images: Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
case_images: Bone graft placing taking as buccal limit the canine eminence conserved from the patient.
case_images: CRID2019-5216362.009.jpg
case_images: PMC6594337_01_CRID2019-5216362.009.jpg
case_images: fig9
case_images: Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
case_images: Buccal fixation of the cortical bone membrane with microscrews and covering of the mesial defect with a resorbable collagen membrane.
case_images: CRID2019-5216362.010.jpg
case_images: PMC6594337_01_CRID2019-5216362.010.jpg
case_images: fig10
case_images: Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
case_images: Suture without stress using monofilament suture.
case_images: CRID2019-5216362.011.jpg
case_images: PMC6594337_01_CRID2019-5216362.011.jpg
case_images: fig11
case_images: Tecnoss ) was decided to be used instead of other barrier techniques, such as a titanium mesh, because of its resorbable condition. The surgical procedure was as follows: (i) mucoperiosteal flap with vertical discharges (Figures 4, 5(a), and 5(b)); (ii) periosteoplasty techniques; (iii) decorticalization and bone collection with a bone scraper (Figure 6); (iv) palatal fixation of the cortical lamina with two microscrews:no previously hydration is needed:(Figure 7); (v) filling of the defect with mixture of autologous bone and heterologous bone (OsteoBiol Apatos  from Tecnoss ) (Figures 8 and 9); (vi) vestibular fixation with two microscrews; (vii) mesial sealing with heterologous collagen membrane and resorbable polyglycolic acid suture (Serapid  from Serag-Wiessner ) (Figure 10); (viii) hydration with physiological serum prior to suture; and (ix) closure by first intention, without tensions, using monofilament suture, with simple and mattress stiches that relieve stress when inflamed (Figure 11).
case_images: Orthopantomography after the surgery.
case_images: CRID2019-5216362.012.jpg
case_images: PMC6594337_01_CRID2019-5216362.012.jpg
case_images: fig12
case_images: Immediately after the surgery, a control orthopantomography was taken (Figure 12).
case_images: CBCT after healing during 6 months.
case_images: CRID2019-5216362.013.jpg
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case_images: fig13
case_images: Six months after the surgery, a new CBCT was performed (Figure 13) for implant planning and three internal conical connection implants (Galimplant  Sarria, Lugo, Spain) were placed in positions 22, 24, and 25 (3.5 x 12 mm, 4 x 12 mm, and 4.5 x 8 mm, respectively), with an insertion torque of 30 N/cm (Figures 14 and 15).
case_images: Clinical view after 6 months during dental implant placement.
case_images: CRID2019-5216362.014.jpg
case_images: PMC6594337_01_CRID2019-5216362.014.jpg
case_images: fig14
case_images: Six months after the surgery, a new CBCT was performed (Figure 13) for implant planning and three internal conical connection implants (Galimplant  Sarria, Lugo, Spain) were placed in positions 22, 24, and 25 (3.5 x 12 mm, 4 x 12 mm, and 4.5 x 8 mm, respectively), with an insertion torque of 30 N/cm (Figures 14 and 15).
case_images: Orthopantomography after dental implant surgery.
case_images: CRID2019-5216362.015.jpg
case_images: PMC6594337_01_CRID2019-5216362.015.jpg
case_images: fig15
case_images: Six months after the surgery, a new CBCT was performed (Figure 13) for implant planning and three internal conical connection implants (Galimplant  Sarria, Lugo, Spain) were placed in positions 22, 24, and 25 (3.5 x 12 mm, 4 x 12 mm, and 4.5 x 8 mm, respectively), with an insertion torque of 30 N/cm (Figures 14 and 15).