Horizontal Augmentation in the anterior Maxilla

179 Rating(s).


Posted on By Jose Luis Dominguez Mompell In Bone Grafting

Dear colleagues in DentalXp,
Although there are many ways to face these kind of situations (Membranes, biomaterials, BMPs, Ti meshes...) and IBH (Interproximal Bone height) It's on our side intros particular case. As many of you know, we are a "Split Bone Block Technique" Lovers. We think the results we obtain, in terms of bone vitality, are amazing.

What would you have done with this patient?
32 year-old woman, very cooperative, coming to our office some weeks after a traumatic lost of both, central and lateral incisor. Not a very High lip line.
Thanks for your comments!

Jose D. Mompell. (Madrid, Spain)
Juan L. Chao. (Madrid, Spain)

Intra Op defect
Occlusal view

Buccal View of the reconstruction
Occlusal view of the reconstruction


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13 Comments

Excelente caso Dr. Mompell . Muy bonito su trabajo !! En su experiencia clínica que tasa de reabsorción tiene este tipo de procedimiento ? Gracias por compartir . Saludos Eduardo.


Reply

Hola Eduardo!
La tasa de reabsorción es muy baja, ya que buscamos una rápida vascularización de todas las partes que componen el injerto. La parte más susceptible de sufrir algo de reabsorción son las finas láminas de hueso autólogo, es por ello que es muy importante que sean muy finas. Las utilizamos a modo, permíteme la expresión de "Membranas óseas autónomas revascularizables"

Our friend Eduardo is asking about resorption rates. And my answer was that these rates are very low. By using this technique we look for a fast vascularization of the graft. Rapid vascularization of all the components of this graft. The part which is the most suitable to suffer some resorption is the outside cortical (Dense) part of the graft, that is why the should be very thin. We have to keep in mind that we are using these thin bone blocks as (allow me the expression) "Autogenous revascularizable membranes".


Reply

Muchas gracias José Luis!! Impecable su trabajo !! Saludos Eduardo!


Reply

Beautiful case. I love these Khoury plates. Nice case, I am sure you will have great results.

Regards Naheed


Reply

Excellent case management, like always!
Love the expression "Autogenous revascularizable membranes"!
Cheers
Snjezana


Reply

JL,

Nicely executed and very beautiful soft tissue closure as you noted many different ways to manage this case where did you harvest graft ?from and if you did not use as revascularization membranes what would’ve been your second choice. I also see where you have the patient in orthodontics what is your plan and when When willyou start movement of teeth as to not disrupt envelope of healing

Cheers,

Richard


Reply


Richard, Thanks for your comment my friend. Bone was harvested from the retromolar area, but I had to do the very same case again I would really consider the sinus bone wall (Our friend Snjezana Pohl has a great number of cases using these technique with that donnor site with incredible results)
As a second choice I would have considered a Ti mesh (Also with some autogenous bone, No BMPs would have been used as far as their use is not allowed in Spain) I will post a similar case treated this way.
You are rigth, the patient was under ortho treatment, and she was about to finish. So, we did the reconstruction, wait for 4 months (She will continue with ortho to avoid teeth movement) Implants and 12 weeks later, prosthodontic work.
It is a pity but her ortho treatment is going to be 6 months longer (Although no dental movement is planned) An essix used as retainer could also be an option, but with brackets she has fixed temporaries teeth and there is no need to "remove" them when eating.

Jose Mompell


Reply

Snjezana! I´m glad you like it! I think is a quite good description! And like "membranes should be used. No contact should exist in between the thin bone block ("Membrane") and the implant.


Reply

Pepo and Juan. Very well managed the case. Love this approach, in my hands the best option.
thanks for posting!
Jorge


Reply

Thanks for oyur kind words Jorge! I really apreciate it. But tell us, what would you have done? I´m sure that your approach would have been different...
Hehehe
Hope to see you soon my friend!

Jose Mompell (Pepo)


Reply

JL, thank you for response-handful of choices here let’s talk to Snjezana on this and see if she would recommend sinus bone for anterior maxilla as I believe the muscular forces of masrication and facial expression play a different role in the anterior versus posterior as far as resorption

Cheers,

Richard


Reply

Harvest site? Number of screws and size? Addition of growth factors? great case for discussion.


Reply

Thanks for your comment Maurice,

In this case bone was harvested from the retromolar area. Chin or lateral wall of the sinus would have been other possiblities?
1.2mm Screws from Stryker were used to fix the bone plates. Although we normally try to use at least 2 microscrews on each bone blade, in this particular case we thought that the risk of bone fracture was high if 2 crews were placed.
We are now also using 0.9-1.1 diameter screws from Meissinger with very good results. What do you all think is the best diameter for bone fixation?
And no BMPs or GF were used. In this case I think that IBH is cruzial giving us a good prognosis.

Thanks for your comments!

J.Mompell


Reply


Hu-Friedy
Augma Bio