Vertical & Horizontal Bone Augmentation

Case Study 12

CASE DESCRIPTION:

This case involved the management of a challenging complication following advanced ridge augmentation in the posterior mandible. The patient had previously undergone vertical and horizontal bone augmentation; however, eight weeks post-operatively, early exposure of a non-resorbable D-PTFE membrane was identified. Such complications require careful, timely intervention to preserve the integrity of the graft and prevent infection or failure of the regenerative process.

Upon clinical evaluation, Dr. Nik proceeded with a controlled and minimally invasive approach. The exposed membrane was carefully removed, revealing an underlying graft that, although still immature, remained stable and well-contained. Recognising the importance of preserving the regenerative environment, Dr. Nik focused on maintaining graft viability while reducing the risk of contamination.

A thorough yet gentle curettage and irrigation of the grafted site were performed to eliminate any potential debris or bacterial load. To further support infection control, doxycycline putty was locally applied, providing targeted antimicrobial action while promoting a favourable healing environment. This step was critical in stabilising the site and preventing further complications.

To protect the graft and facilitate continued regeneration, a native collagen membrane was carefully placed over the area, acting as a secondary barrier. Dr. Nik then meticulously re-adapted the soft tissue flap, ensuring tension-free primary closure through precise suturing techniques. This allowed for optimal protection of the graft during the subsequent healing phase and supported predictable tissue regeneration.

Following a healing period of seven months, which progressed smoothly and without further complications, the site was reassessed. Clinical and radiographic evaluation revealed substantial bone gain, with adequate width and volume achieved to support implant placement. The regenerated ridge provided a stable and reliable foundation for the next phase of treatment.