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Bernhard Giesenhagen: Vertical augmentation and simultaneous implantation of Straumann® Bone Level Implants (botiss maxgraft® bonering technique)

  • botiss maxgraft® bonering technique

Dr. Bernhard Giesenhagen has developed an augmentation technique which allows bone transplantation and implantation to be performed on large three-dimensional bone defects in a single operation. Today, the bone ring technique can be used for nearly all indications. In the following article, the author describes the use of the botiss allogenic maxgraft® bonering (a further development with Dr. Orcan Yüksel). Use of the maxgraft® bonering technique is now established worldwide and offers an alternative to vertical augmentation with an autologous bone block.

Implant treatment is often accompanied by bone augmentation procedures. In addition to guided bone regeneration (GBR), the most common techniques used to expand bone volume and height of the alveolar ridge are distraction osteogenesis, bone splitting as well as apposition and onlay osteoplasty. Harvesting autologous bone blocks for vertical augmentation is a very complex and invasive procedure. The author therefore developed the bone ring technique using autologous bone and unveiled his concept in 2003. The technique with allogenic bone (maxgraft® bonering by botiss biomaterials) was further developed in collaboration with Dr. Orcan Yüksel and presented in 2010. When using this allogenic bone ring technique, treatment for the patient is optimized as the extra surgical stage and risks involved with harvesting autologous bone at a second site, can be avoided. The author has now performed almost one thousand augmentations with autogenous bone harvested intraorally and over two hundred augmentations with maxgraft® allograft bonering.

The maxgraft® bonering
The maxgraft® allograft bone ring offers a safe alternative to autologous bone. It is made entirely from donor bone from Germany, Austria and Switzerland, and is manufactured under pharmaceutical conditions by Cell+Tissuebank Austria (C+TBA). The maxgraft® bonering has a high biologic regeneration ­capability, as the natural collagen matrix is preserved during processing. This supports the rapid remodelling process during bone formation. The clinical results in my practice to date show that there is no difference between autologous bone rings and the allogenic maxgraft® bonering.

The botiss maxgraft® bonering technique
The maxgraft® bonering technique is a one-stage procedure in which the maxgraft® bonering is pressed into a bone bed that has been prepared precisely with a trephine drill. The implant is then placed through the inner hole of the maxgraft® bonering.

Read Dr. Giesenhagen’s corresponding cinical case report on the bone ring technique described above

The bone ring technique has significant benefits over conventional procedures with autologous bone blocks:

  • Reduction in treatment time of between 45 and 60 minutes
  • Second procedure to harvest an autologous bone block and its associated risks can be avoided
  • Treatment time until the start of prosthetic restoration is reduced by three to six months


Augmentation with bone rings is possible in the  following cases, among others:

  • Vertical augmentation (three-dimensional defects with low-volume horizontal defect)
  • Single-tooth gaps
  • Interdental spaces
Dr. med. dent. Bernhard Giesenhagen


Graduated from the University of Kiel, Germany Scientific researcher in the prosthetics department of the University of Kiel. Implantology practice in Kassel. Training activity as the founder of the Pro Implant Institute in Melsungen, Germany. Speaker at international conferences on the bone ring technique and other areas in implantology. Honorary professor at the Johann Wolfgang Goethe University Frankfurt am Main.

By | 2017-08-17T08:29:51+00:00 March 30th, 2016|Dental Biomaterials, Dental Implants|2 Comments


  1. Andrea Tedesco April 1, 2016 at 10:42 pm - Reply

    It’s absurd remove real bone to insert artificial bone!

    • Starget May 19, 2016 at 3:25 pm - Reply

      Dear Andrea: “In bone block augmentation, a good fitting of the transplant to the local bone is crucial. It is important to remove small parts of the local vital bone to achieve a perfect fitting of the ring and a bleeding bed of spongious bone for a fast revascularization.” (Dr. Marco Schwan, Oral Surgeon, Switerland). “Ringbed preparation is only a bone refreshment to get bleeding bone, similar to the drilling of bleeding points into the bone for augmentation.” (Dr. B. Giesenhagen, Germany, author of the article). Best regards, STARGET


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