GBR in the distal mandible

(Case by Associate Prof Darko Božić, Zagreb (Croatia))

1a. Patient with an edentulous distal mandible requiring implant treatment to replace the missing first molar. A narrow chronic ridge defect with a thin and narrow zone of keratinized tissue is visible.

1b. Following flap elevation a knife-edge defect that is only 1-1.5mm in width becomes apparent.

2a. Multiple cortical perforations.

2b. Smartbrane fixed with 2 pins and subsequently stabilized with two additional pins.

3a. Xenogenic bone mixed with auto-genous bone and Hyadent BG was placed into the defect to a width of

3b. Re-entry after 6 months revealing a 7-8mm wide ridge of bone like appearance and consistency with grafting particles well embedded into the newly developed tissue.

4a. 4mm diameter implant placed into the site of the first molar. During implant bed preparation the bone density was between class II and III.

4b. During implant integration a free gingival graft was placed to reconstruct the keratinized tissue and thicken the tissue around the implant.


5a. Clinical appearance of a screw-retained metal ceramic crown.


5b. One-year follow-up radiograph showing stable marginal bone levels.