Bilateral Vertical Ridge Augmentation With Block Grafts and Guided Bone Regeneration in the Posterior Mandible: A Case Report
The aim is to describe bilateral vertical ridge augmentation with intraoral block grafts and guided bone regeneration in the posterior mandible in preparation for implant placement. A 61-year-old woman, edentulous in the posterior mandible, presented for implant rehabilitation. The radiographic study showed 3 to 6 mm of bone height from the ridge to the mandibular canal. Autogenous bone block grafts from the chin and the mandibular ramus, harvested with ultrasonics, were used to augment the alveolar ridge. To reduce resorption, the grafts were covered with particulate alloplastic material and a collagen membrane. Delayed implants were placed 6 months after vertical augmentation, and 3 months later implants were loaded with a fixed prosthesis. A temporary sensory complication occurred, but 12 months after implant loading, there were no failures. In this case report block bone grafting was a feasible option to vertically augment the alveolar ridge in the posterior mandible.
Clinical and radiographic study. (a) Intraoral view; note the augmented prosthetic space due to bone resorption. (b) Orthopantomographic view. (c and d) Computerized tomographic sections showing substantial vertical bone loss.
Vertical augmentation surgery. (a) Flap raised, showing both mentonian nerves. (b) Chin graft with piezoelectric technique. (c) Alveolar ridge. (d) Perforations in the reception bed. (e) Graft adapted on the top of the ridge. (f) Mandibular ramus block graft. (g) Graft adapted to the reception site. (h) Alloplastic material covering the grafts. (i) Collagenous membrane covering the graft. (j) Chin block graft. (k) Perforations in the reception bed. (l) Graft adapted with microscrews. (m) β-tricalcium phosphate covering the graft. (n) Collagen membrane covering the graft. (o) Suture with monofilament.
Preoperative study, implant surgery, and implant loading. (a) Intraoral view of the right alveolar ridge after vertical augmentation. (b) Intraoral view of the left alveolar ridge after vertical augmentation. (d) Orthopantomography after block bone augmentation. (d) Orthopantomography with implants placed. (e) Intraoral view of the inferior right prosthetic rehabilitation. (f) Intraoral view of the inferior left prosthetic rehabilitation. (g) Occlusal view of both implant-supported restorations. (h) Orthopantomography 12 months after implant loading.
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