Fig . 7 Suture with 6 / O monofilament thread .
Fig . 8 Reopening after 6 months for implant placement . We can observe the good horizontal bone augmentation .
Fig . 9 Crestal approach in the canine region for subnasal membrane elevation . Two contiguous holes are opened for better access . The preparation begins with the usual implant drills until we reach the cortical bone plate on the nasal floor . The cortical bone plate is opened with a round piezosurgical insert , exposing the same diameter of subnasal membrane as the preparation .
Fig . 10 Geistlich Bio-Oss ® Collagen ( 100 mg ) is divided into smaller blocks . The blocks are slowly inserted into the implant site one by one and compressed with vertical and lateral pressure to detach the subnasal membrane and fill the preparation cavity contiguous to the implant site .
Fig . 11 The Geistlich Bio-Oss ® Collagen absorbs blood and takes a spongy consistency . This is ideal for exerting pressure on the membrane without any risk of injury . After graft placement we can confirm the resistance of the membrane by exerting pressure with a round instrument .
Fig . 12 Implant 13 is slowly screwed into the bone and into the graft by hand . The implant sites 15 , 16 and 17 are prepared .
Fig . 13 Four implants in situ with excellent primary stability .
Fig . 14 The four implants with cover screws in place .
Fig . 15 Final panoramic X-ray showing all implants in place . a ) b )
Fig . 16 a ) Apical x-ray showing the sub-nasal elevation with Geistlich Bio-Oss ® Collagen . b ) Apical x-ray after 8 month showing graft consolidation .
5 I CASE 2