Part 3 | Guided Bone Regeneration of a Post-Orthodontic Case

Part 3 Of An Eight-Year Dental Odyssey in the Life Of a 22-Year-Old Patient.

In this article, I will show a completed orthodontic case of a patient who was congenitally missing his maxillary lateral incisors and whose bone width (labial to lingual) in these sites was insufficient to place root form implants. I will show the guided bone regeneration augmentation procedures performed to convert these sites to properly accommodate root form implants. I have no financial or any other relationship other than being a consumer with any manufacturers of the products discussed in this article.

My background in root form implantology includes graduation in 2011 from the Externship Program at the Midwest Implant Institute⁹ in Columbus, Ohio. In 2013, I graduated from the Master Clinician Program at the gIDE Global Institute for Dental Education⁴ in Los Angeles, CA. I’ve also completed intensive studies under Dr. Istvan Urban6 for the past several years in the United States and in his home city of Budapest, Hungary.

I have been fortunate to learn from many top implantologists including Drs. Duke and Robert Heller, Dr. Sascha Jovanovic, Dr. Egon Euwe, Dr. Joseph Kan, and others, but it wasn’t until I studied under Dr. Istvan Urban that I was able to put implant concepts together from A to Z. This included guided bone regeneration, soft tissue grafting, implant placement and definitive restoration. Dr. Urban is a PhD, MD, dentist, oral surgeon, periodontist and has extensive knowledge in biology and histology. He received these various degrees from Semmelweis University and St. Istvan Hospital in Budapest, Hungary, University of California, and Loma Linda University.

Many references in this article come from Dr. Urban’s recently published book, Vertical and Horizontal Ridge Augmentation- New Perspectives.¹⁶ For those of you who desire to learn more about guided bone regeneration and related procedures, I strongly recommend that you read this book.

Using the case shown in this article, I will discuss the following concepts:

1. At what age can a patient have root form implants?
2. What are the labial/buccal to lingual bone width requirements for implant stability and longevity in the esthetic zone?
3. What flap design should be used when performing guided bone regeneration?
4. What are the ideal bone grafting materials to use in guided bone regeneration (GBR)?
5. What membranes do I use when performing GBR?
6. How is the periosteum released to allow primary closure of the grafted site?
7. What is the suturing technique used to close the site?
8. What provisionalization is used in this case?
9. How much time should there be between GBR and implant placement?