Full Regeneration of Maxillary Alveolar Bone Using Autogenous Partially Demineralized Dentin Matrix and Particulate Cancellous Bone and Marrow for Implant-Supported Full Arch Rehabilitation
Autogenous partially demineralized dentin matrix (APDDM) has been reportedly used as a superior bone graft material. A 52-year-old Japanese man who exhibited severe periodontitis was referred for oral rehabilitation. He underwent wide-range anterior maxillary alveolar bone and bilateral sinus floor augmentation by grafting of a mixture of APDDM and particulate cancellous bone and marrow (PCBM); subsequently, he underwent implant-supported full arch rehabilitation. He has been followed up for 4 years after placement of the final restoration without any complications, and his physiological bone volume has been maintained. APDDM constitutes an alternative treatment that may increase the volume of graft material and might prevent rapid resorption of PCBM, because APDDM served as a scaffold for osteoblasts from PCBM. When possible, it may be useful to apply APDDM as a graft material with PCBM for large-volume alveolar bone regeneration.
Figure 1. Orthopantomography before bone augmentation. All residual teeth were planned to undergo removal because of severe periodontitis. Figure 2. Intraoral appearance before bone augmentation. (a) Frontal view of occlusal position. The bimaxillary clearance remains. (b) Maxilla (mirror imaging). The width of the posterior region is sufficient for dental implantation. Figure 3. Cone-beam computerized tomography images before bone augmentation. (a) The bone height of the posterior region was insufficient, and the width was sufficient for dental implantation. (b) Severe alveolar bone atrophy was observed in the anterior maxillary region (b).
Intraoperative findings. (a) Alveolar bone after mucoperiosteum elevation. The surgical stent was set (b), and guide pins were inserted (c). (d, e) Sinus floor augmentation with autogenous partially demineralized dentin matrix (APDDM) and particulate cancellous bone and marrow (PCBM). APDDM (left) and PCBM (right) were (h) mixed and (i) gelatinized. (f) Bone augmentation at the anterior region with the absorbable membrane and the titanium mesh. (g) Temporary implants were placed, and the wound was closed.
Figure 5. Cone-beam computerized tomography images taken 3 months after bone augmentation. Sufficient bone for dental implantation was observed (a) in the posterior region on images of the axial plane and (b) in the anterior region on images of the sagittal plane. Figure 6. Maxillary dental implantation at 3.5 months after bone augmentation. (a) Seven implants were inserted without additional bone augmentation. (b) Orthopantomography after implant placement. Figure 7. Intraoral appearance at 4 years after the final restoration. No implants disintegrated during the 4-year follow-up period. No implantitis occurred.
Figure 8. Orthopantomography at 39 months after final restoration. The bone level surrounding the dental implants was consistent. Figure 9. Cone-beam computerized tomography images taken at 47 and 58 months after final restoration and bone augmentation. (a) Axial plane and (b) at the anterior region in the sagittal plane.
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