Case Report: Augmentation of large defect in the maxilla and implantation

Case Presented By: Dr. Rolf Ewers. Dr. Ewers is Chairman and Head of the University Hospital of Cranio-Maxillofacial and Oral Surgery of the Medical School, University of Vienna, Austria. He received the Oral & Maxillofacial Surgery Foundation Research Recognition Award 2005, and has over 100 scientific publications.
Technology: This case uses algae-derived (phycogenic) bone forming material, the first and only natural biological product on the market based on plant origin. The phycogenic (algae-derived) bone grafting material are marketed under the tradenames: Algisorb (formerly, C-Graft) in the US and Algipore in Europe.
![]Large Bone Defect](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/09/case5_1.jpg)
Patient: female, 73 years. Large bony defect after removal of two implants in the anterior lateral maxilla

![]Augmentation](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/09/case5_2.jpg)
Augmentation with a small monocortical onlay graft from the tuberosita and filling with phycogenic apatite.

![]Titanium Membrane](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/09/case5_3.jpg)
Onlay and augmentation material covered and stabilised with a titanium membrane fixed with 3 titanium pins. Please note the wrinkle in the titanium membrane (arrow).

![]Reopening](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/09/case5_4.jpg)
Reopening six months later (arrow points to the wrinkle in the titanium membrane).

![]Filled defect with newly formed bone](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/09/case5_5.jpg)
Filled defect with newly formed bone. The osseointegrated but not completely resorbed phycogenic material shines through the newly formed bone. The gap under the wrinkle of the titanium membrane has been filled with newly formed bone (arrow).

![]After implant insertion.](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/09/case5_6.jpg)
After implant insertion.

![]histology](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/09/case5_7.jpg)
Histology after six months healing time.

a) Two times magnification of the core specimen. Below = alveolar ridge, top = apical region.

b) Red box: 40 times magnification.

c) Blue box: Transverse section of b) (black line) also in 40 times magnification.

d) Yellow box: 40 times magnification from a). Excellent new bone formation around and in between the granule with little signs of beginning resorption.

![]telescopic crowns](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/09/case5_8-e1348510632966.jpg)
Telescopic crowns 9 years later.

The bone forming materials used in this case are the first and only natural biological products on the market based on plant origin. In general, they are either a monophasic (pure) hydroxyapatite or biphasic tricalciumphosphate-hydroxyapatite (TCP-HA) composites. The algae derived products are very similar to the human bone. All algae derived (phycogenic) materials demonstrate a high specific porosity up to 1.1 cm3/g. Their unique interconnecting porous structure, a “honeycomb like” channel system and their specific chemistry is decisive for the high in-vivo bioactivity of the phycogenic materials. That results in a complete bone remodelling resorption. The phycogenic bone forming materials are used specifically in the field of cranio- maxillofacial surgery. Their main clinical applications are as bone forming material for reconstruction or filling of bone defects and sinus lift augmentations.
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