Editorial Type:
Article Category: Other
 | 
Online Publication Date: 01 Aug 2014

Calvarial Autogenous Bone Graft for Maxillary Ridge and Sinus Reconstruction for Rehabilitation With Dental Implants

DDS, PhD,
DDS, PhD,
DDS, PhD,
DDS,
DDS, PhD,
DDS, PhD,
DDS, PhD, and
DDS, PhD
Page Range: 469 – 478
DOI: 10.1563/AAID-JOI-D-11-00090
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Autogenous bone grafting is the gold-standard technique for bone augmentation procedures prior to implant placement. If the amount of available intraoral donor bone is insufficient, it is necessary to harvest bone graft from extraoral sites, such as calvaria. Although this technique is well established, only a few case reports show the histological analysis of the grafted bone at the moment of implant placement. This article reports the case of a 48-year-old female patient with a critical atrophic maxillary ridge reconstructed using autogenous calvarial bone graft prior to implant placement, with clinical and histological evaluation. Bone was collected under general anesthesia from the parietal bone. The outer cortical originated the bone blocks, and the medullar bone layer between was collected to be used in the sinus augmentation procedure, together with 5 of the bone blocks triturated. Six months after bone augmentation, 8 implants were placed in the grafted area and 2 biopsies were retrieved (anterior and the posterior regions), allowing the visualization of the bone-remodeling process in the grafted areas. The patient had a stable recovery. Our results showed that although necrotic bone could still be seen in the outer layer of the grafted area, the interface between this necrotic bone and the already remodeled bone was consistent with biocompatibility. Two-year radiographic evaluation showed success of the grafts and the implants in supporting an esthetic and functionally stable prosthesis. Summarizing, calvarial bone grafts are a viable alternative for the attainment of adequate bone volume prior to implant placement.

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  <sc>Figures 1–3.</sc>
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Figures 1–3.

Figures 1–2. Initial clinical and radiographic situation. Figure 3. A full-thickness flap was obtained (a). The depth limit of the bone harvesting was the internal cortical, and the blocks were designed according to the programmed necessity (b). The inner cortical bone was completely preserved (c).


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  <sc>Figures</sc>
  4–10.
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Figures 4–10.

Figure 4. Clinical aspect of the grafted region. Sinus was filled bilaterally, and 7 bone blocks were used to promote width gain. Figures 5–6. Aspect of the grafts 6 months after the first surgery. The implants placed over this area. Figure 7. General view of one of the retrieved biopsies, showing the clear difference between the newly-formed bone and the remaining necrotic-bone layer. Figure 8. The interface between the grafted material, which was still necrotic (*), and the newly-formed bone (▴) was full of exuberant osteocytes and permeated with a highly cellularized connective tissue, with the absence of inflammatory cells. Figure 9. Biopsy retrieved from the maxillary sinus, in an advanced remodeling stage, showing dense and osteocyte-rich newly-formed bone and small amounts of necrotic bone. Figure 10. Panoramic radiographic evaluation of the patient, 24 months after prosthesis installation.


Contributor Notes

Corresponding author, e-mail: elciojr@foar.unesp.br
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