The Importance of Immediate Bone Block Autograft to Successfully Restore the Function and Aesthetic of the Anterior Alveolar Process and Teeth
Maxillofacial traumatic injuries can damage the jaw, teeth, and soft tissues of the head and neck region. When these injuries occur, best practice is to reconstruct as comprehensively as is clinically prudent at time of injury. Smart and efficient procedures during the initial surgery can minimize subsequent reconstructive procedures in scope and number, minimize expense, and result in a better final aesthetic and functional outcome. Restoration of anterior alveolar jaw fractures with comminuted or avulsed segments becomes a complex prospect when left untreated after initial trauma or injury and can result in alveolar ridge defects that are difficult, costly, and cumbersome to repair. This case report details one 19-year-old woman who had a traumatic injury in these areas and has a best result outcome because of immediate reconstruction efforts involving a bone block autograft to preserve alveolar process anatomy.
Figure 1. Front image of patient's face 1 week after initial injury. Figure 2. The bone block was grafted from the region directly inferior to the avulsed teeth. This autograft preserved a soft tissue ridge for future implants. Figure 3. An incision from first molar to first molar was made to create a full-thickness flap during placement of the autograft. Figure 4. The 8 × 15 mm bone block autograft was secured by 4 Stryker screws and a square light plate, shown here. Note the near seamless integration of the graft and native bone. Figure 5. The initial fall caused severe fractures in the crowns of teeth 8, 9, and 10. Figure 6. Cone beam computerized tomography image of the buccal process at tooth 8, 1 week after injury. Note the fracture in the maxillary alveolar process. Figure 7. View of semirigid wire and resin splint in place.
Figure 8. Pre- and postoperative radiographs of endodontic therapy performed on teeth 8 and 9. Figure 9. Note the small, exposed piece of bone (blue circle). One month after the initial incident, this dehiscence was ablated with an Er,Cr:YSGG laser. Figure 10. Implant fixtures are shown replacing teeth numbers 22 and 24 which are the left lower canine and left central incisor. There was insufficient space to replace tooth number 23 as well and therefore a 3 unit splinted fixed partial denture was planned and fabricated. Figure 11. A full-thickness flap cut was raised to remove the mini fixation plate and screws. Note the maintenance of the soft tissue alveolar ridge. Figure 12. Teeth 8 and 9 were also prepared for permanent crowns 12 weeks after injury. Figure 13. Image shows the transfers copings in place for teeth 22 and 24. Figure 14. Final restoration of all teeth after 6 months of treatment.
Figure 15. Comparative cone beam computerized tomography scans of the buccal process at teeth 8 and 22 from just after to over 3 years after injury. Note the healed fracture in the maxillary alveolar process. Figure 16. Panoramic scans from June 6, 2010 (top), and August 8, 2013 (bottom).
Figure 17. Three-year postoperative photograph with recently healed subepithelial computerized tomography graft. Figure 18. Three-dimensional bone density images highlighting the noticeably increased tilt in the jaw line between June 6, 2010 (left), and August 8, 2013 (right).
Computerized tomography scans of the left and right condyles from June 6, 2010, and August 8, 2013.
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