Guide Bone Grafting Techniques for Maxillary Implants

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This book explores the potential of bone grafting techniques to rehabilitate the maxilla through the placement of dental implants. As implant dentistry becomes.
Table of contents

Grafting procedures are presented depicting a variety of bone harvest sites, followed by onlay and inlay grafting techniques. Approaches to sinus lifting, segmental osteotomy and distraction osteogenesis for augmentation protocols are provided. Bone Grafting Techniques for Maxillary Implants. E-Book Information about e-books: Description This book explores the potential of bone grafting techniques to rehabilitate the maxilla through the placement of dental implants. As implant dentistry becomes increasingly well established and sophisticated, this book will help experienced surgeons to involve implant solutions as part of more challenging reconstructions in the upper jaw.

In terms of continuing education, Professor Kahnberg's courses on bone grafting for dental implants have attracted a wide international audience. Nowadays, with the advent of guided bone regeneration, studies show that large reconstructions in the very near future may be performed with bone substitutes. It is known that autogenous bone will always be the gold standard for grafting.

However, in view of the surgical morbidity and some inherent technical drawbacks, the use of allografts alone or associated with to xenografts will be more and more indicated. The homologous bone may be frozen, dried, demineralized or not, and also lyophilized. By lyophilization it is understood the removal of moisture from the previously degreased bone, allowing its storage for long periods Currently, the most used homogenous bone is the dry frozen bone.

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It is readily available in large quantities, but revascularization takes longer compared with the autogenous bone and it has no osteoinductive potential An alternative homologous bone is the fresh frozen bone. It is aseptically collected from living donors or cadavers, and then frozen. There is no additional preparation, and osteoinductive proteins are preserved.

The demineralization process is used to expose the collagen of the graft organic matrix, and thus the BMP.

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The objective is to increase the osteoinductive potential of the graft In the attempt to compare the clinical outcomes involved with the use of autogenous bone grafts from intraoral donor sites for reconstruction of the atrophic maxilla, the literature is quite extensive. However, there are no clinically significant differences between them. The results were satisfactory in all cases, with no great differences between them. Misch 17 , on his turn, reports some advantages in obtaining teh graft from the mandible branch over the mental area, mainly due to postoperative complaints and complications.

However, he points out the disadvantages of difficult access and the possibility of injuring the neurovascular bundle of the inferior alveolar. One must admit that the technique for obtaining intraoral grafts is much related to the skill of the surgeon, and especially to the characteristics of the graft that the case demands. Complications and surgical risks are thus minimized. The ease of obtaining the graft and of accessing the maxillary tuberosity region is greater than it is in other intraoral areas. The bone tissue is characteristically medullary spongy bone , of low volume and bone density, being more suitable for filling small bone defects 2.

It should be borne in mind that the X-ray analysis of the removed portion is mandatory in view of the high incidence of cellular extensions of the maxillary antrum, which could cause buccosinusal communication during grafting. Therefore, if the region of the maxillary tuberosity radiographically presents a greater proximity to the maxillary sinus floor, removal of bone tissue is contraindicated 2 , In major reconstructions, whereby a quite considerable amount of bone is required, removal of grafts from extraoral areas is indicated.

Initially, in all cases one should perform preoperative clinical and radiographic studies to determine the size of the bone defect in the maxilla and the amount of bone needed for reconstruction There are also reports in the literature of computed tomography to better 3D studying and more accurate planning 18 , The donor sites used in most cases of large bone defects are the iliac crest and the cranial vault, both of which promoting adequate amount of both cortical and medullary bone.

The iliac crest is less recommended as donor site due to the greater morbidity associated to changes in motor function and the patient's need to remain hospitalized 10 , 12 , However, they emphasized its disadvantage in relation to the level of bone resorption.

In contrast, Dice and Izquierdo reported that there are advantages in the use of grafts of membranous origin vault and jaw over the ones of endochondral origin ilium, tibia and rib when considering bone resorption This difference is probably due to the more cortical characteristic of the bone of membranous origin. Regarding this controversy, widely discussed by the literature authors, the ones of this work, relying on clinical experience, agree that the features in regards to the type of ossification do not influence the type of bone graft repair.

For the bone, after reaching the embryonic ossification process, is "bone tissue", with its sui generis characteristics, be it more cortical or more medullary. This is perhaps most associated with the rate of resorption of the different donor sites.

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The quest for replacement by allogenic bone autografts has been increasingly growing, especially in reconstructions requiring a second surgical access, with the intent of reducing surgical morbidity 5. However, there is still no concrete biological foundations for its use in isolation, especially in the reconstruction of atrophic maxilla.

The literature is unanimous on the concept of its association with autogenous gafts, or even in the isolated filling of small bone defects 5 , 7 - 9 , Thus, in cases of severe bone resorption or even bone defects of various causes, there are surgical resources that enable the improvement of local conditions for placement of dental implants in a more favorable position for prosthetic rehabilitation.

Autogenous bone grafts remain in most cases the best method for repair of alveolar atrophy and bone defects. For the major reconstruction of atrophic maxilla, grafts from the cranial vault and iliac crest should be indicated. Medium and small bone defects should be treated with intraoral grafts, with good predictability of success.

The donor area to be chosen is associated with the experience and skill of the surgeon and the characteristics of the region to be rebuilt. Regional thickness of parietal bone in Korean adults. Int J Oral Maxillofac Surg. Rev Fac Odontol Lins.

Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am.

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The use of marrow-cancellous grafts in the regeneration of mandibular bone. Trans Int Conf Oral Surg. Report of consecutive ridge augmentation procedures: Int J Oral Maxillofac Implants. A chemosterilized antigen-extracted autodigested alloimplant for bone banks. A classification of the edentulous jaws.

Bone Grafting Techniques for Maxillary Implants

Maxillary bone grafting form insertion of endosseous implants: Clin Oral Implants Res. Reconstruction of the atrophic edentulous maxilla with free iliac crest grafts and implants: Clin Implant Dent Relat Res. Volume changes of autogenous bone grafts alveolar ridge augmentation of atrophic maxillae and mandibles.

Comparison of homogenous freeze-dried and fresh autogenous bone grafts in the monkey mandible. Induced osteogenesis-the biological principle and clinical applications. The lower border rib graft for mandibular atrophy.