Implant Placement After Ridge Reconstruction Using Autogenous–Xenogeneic Grafting and Titanium-Reinforced d-PTFE With Controlled Management of Wide Exposure in the Esthetic Zone: Case Report

International Osteology Symposium Vienna 26, Vienna, Avusturya, 23 - 25 Nisan 2026, ss.1, (Özet Bildiri)

Aim: To present a staged ridge reconstruction approach specifically performed to

create favorable conditions for implant placement in the esthetic maxillary zone,

utilizing a titanium-reinforced dense PTFE membrane and emphasizing the controlled

management of early wide membrane exposure.

Material & Methods: A 65-year-old non-smoking male patient with a history of

periodontitis presented with a compromised maxillary central incisor requiring ridge

augmentation.The adjacent lateral incisor(#12) exhibited advanced periodontal bone

loss, insufficient periodontal support, and mobility consistent with attachment loss, and

was therefore removed during surgery, increasing the overall complexity of the

defect.(Figure1 A-O)

Augmentation was performed using autogenous cortical bone chips harvested from the

symphysis combined with deproteinized bovine bone mineral (Geistlich Bio-Oss®).

The graft was stabilized with a titanium-reinforced d-PTFE membrane secured with

fixation screws, and the flap was closed with PTFE sutures to enhance soft-tissue

stability.

At the two-week follow-up, a wide early membrane exposure was observed (class II)1

(class C)2 limited to superficial plaque accumulation without signs of infection. The

patient attended strict, closely scheduled follow-up visits, during which plaque control

was maintained using gentle saline irrigation. Despite the exposure, the membrane

remained stable throughout the 6-month healing period, allowing undisturbed graft

maturation.

At six months, membrane removal and CBCT imaging confirmed substantial ridge

volume improvement.To optimize peri-implant soft tissue, a free gingival graft (FGG)

was performed three months before implant placement. Implant placement in sites #11

and #12 (Osstem) was accomplished, followed by uneventful healing at nine months.

Results: Ridge contour and volume were preserved, resulting in a mature and stable

augmentation (vertical gain; 5mm ,horizontal gain ;3mm) that allowed successful

implant placement in the esthetic zone. At 3 months, definitive prosthetic rehabilitation

was completed, yielding stable peri-implant tissues and favorable functional and

esthetic outcomes.