Modified 3-Dimensional Alveolar Ridge Augmentation in the Anterior Maxilla: A Prospective Clinical Feasibility Study
Vertical and horizontal reconstruction of the alveolar ridge, especially in the anterior maxilla, is considered a clinical challenge for dentists. There is still a lack of a standard technique to address the hurdles in 3-dimensional bone regeneration in the anterior maxilla. In this clinical feasibility study, we aimed to modify Khoury’s technique by combining the conventional guided bone regeneration standards with the principles of this technique. The autogenous bone blocks were harvested from the retromolar area and grafted into the deficient anterior maxillae by mini-screws, and the gap was filled with xenogenic bone particles. The grafted site was covered with multilayered resorbable collagen membranes. Cone-beam computerized tomographic scans were obtained at the 6-month follow-ups, and the changes in ridge width and height were measured. Five subjects with multiple missing teeth at the anterior maxilla were included. The radiographic outcomes of the 6-month follow-ups revealed 1.2 mm of height and 3.5 mm of width gain. Between the 4- and 6-month visits, approximately 2 mm resorption in height and 0.3 mm in width occurred. No complications occurred. The proposed modification for Khoury’s technique can serve as a feasible method in the 3-dimensional reconstruction of the anterior maxilla without additional autogenous bone particles.
Preoperative clinical photographs of one of the subjects indicate missing 4 anterior teeth. (a) Frontal view. (b) Occlusal view. (c) Baseline cone-beam computerized tomographic images. Note the 3-dimensional loss of alveolar ridge in the anterior maxilla.
(a) Intraoperative photograph after flap reflection, depicting advanced atrophy in the anterior maxillary region. (b) The autograft blocks were harvested from the retromolar area as described by Khoury et al.
(a) Autogenous bone blocks were fixated according to Khoury’s technique using mini-screws. (b) The gaps between the blocks were filled with Bio-Oss small-sized particles. (c) The grafted area was covered by a multilayered approach using resorbable (collagen) membranes. (d) Tension-free closure of the flap using 6-0 Seralon sutures.
Cone-beam computerized tomographic images 4 months after the surgery showed optimal 3-dimensional ridge reconstruction.
Reentry surgery. (a) Split-thickness flap and leaving the periosteum intact at the crestal region. The papillae were also preserved. Note fixation of the flap to the mucosal area by micro-holding sutures. (b) The mini-screws were removed, the implants were placed, and (c) the flap was closed.
(a) Cone-beam computerized tomographic image of the case 2 weeks after implant placement. (b) Custom-made poly-methyl meta-acrylate healing caps were placed following the second-stage surgery. Coronally repositioned flaps were also performed to enhance tissue adaptation. (c) Emergence profile 6 weeks after the second-stage surgery. (d) Individually designed milled zirconia abutments were fabricated and placed. De-epithelialization of the soft tissue was also performed. (e) Final restoration was delivered.
Mean alveolar ridge width and height changes at 3 different time points according to the cone-beam computerized tomographic images: 1 week before 3-dimensional ridge augmentation (PRE-OP), 4 months after 3-dimensional ridge augmentation (time of implant insertions), 6 months after 3-dimensional ridge augmentation (2 months after implant insertions).
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