Maxillary Autogenous Bone Grafting

Reconstruction of the atrophic maxilla for dental implant placement has many unique considerations. There are several methods available to augment the atrophic maxilla. Of these, autogenous bone grafting offers a well-proven predictable method for ridge augmentation and defect repair for dental implant placement. There are several advantages of using autogenous bone grafts. This article primarily focuses on the use of autogenous onlay bone grafts to reconstruct the atrophic maxilla.

Reconstruction of the atrophic maxilla for dental implant placement has many unique considerations ( Figs. 1–20 ). After tooth extraction, the greatest loss of bone in the maxilla occurs facially. Horizontal bone resorption can approach 50% of the ridge width at 12 months. The use of a soft tissue borne–prosthesis causes continued medial resorption and loss of vertical bone height. As a result, the atrophic residual ridge may be significantly palatal to the prosthetic tooth position. Efforts to reconstruct the atrophic maxilla to its original form usually require buccal bone augmentation. The surgeon must also contend with the maxillary sinuses and nasal cavity as anatomic limitations that may need bone grafting. The maxillary bone is often less dense than the mandible, especially in the posterior regions below the sinuses. Aesthetic zone reconstruction in the partially edentulous anterior maxilla can be especially challenging when a high lip line exposes gingiva.

Fig. 1
Traumatic avulsion of maxillary teeth and resulting defect. A CT scan template is fabricated with barium teeth to reveal the planned tooth position.

Fig. 2
A 3-dimensional view of the CT scan of maxillary teeth with the barium template, revealing the maxillary defect and augmentation requirements.

Fig. 3
Maxillary defect with horizontal and vertical bone deficiencies.

Fig. 4
Reconstruction of the maxillary defect using an iliac bone graft.

Fig. 5
A CT scan of the healed graft, showing minimal resorption and favorable bone volume for implant placement.

Fig. 6
Removal of the fixation screws through a mucosal incision for implant placement after a 4-month healing period.

Fig. 7
Placement of the implants into the incorporated bone graft.

Fig. 8
Provisional tooth replacement using an immediate provisional bridge.

Fig. 9
Reconstruction of the severely atrophic maxilla using corticocancellous block bone grafts.

Fig. 10
Well-incorporated bone graft for implant placement after a 4-month healing period.

Fig. 11
Splinting of the 4 maxillary implants for support of an overdenture using an implant connecting bar.

Oct 29, 2016 | Posted by in General Dentistry | Comments Off on Maxillary Autogenous Bone Grafting
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