Treatment of a horizontal bone deficiency with autologous bone augmentation prior to implant placement

Background

The excessive bone loss usually prohibits the placement of dental implants in the ideal prosthetic position and compromises the protection of peri-implant health The defected area has been shown to be treated either with xenografts supported with different type of membranes, with autogenous bone blocks or with the mix of autogenous and xenografts. Among these, autogenous bone still remains as the gold standard because of its osteoinductive characteristics.

Aim/Hypothesis

The aim of this case presentation is to show the short-term clinical outcomes of the implant placement in an edentulous area where augmented with autologous bone graft harvested from the mandibular ramus.

Material and Methods

32-year-old male patient came to Istanbul University Faculty of Dentistry Department of Periodontology with a missing teeth complaint. He was a healthy non-smoker and did not use any medication. Following clinical and radiographic evaluation, alveolar crest in the edentulous area have been found to be horizontally extremely thin (3 mm) for the implant placement. A standard two-stage surgical protocol was planned. On the operation day, following the local anesthesia, a bone block graft harvested from the retromolar region was fixed with titanium screws to the recipient site as onlay graft. Following placement of a bone level implant 4.1 in diameter 12 mm length (Straumann) the wound closed by the sutures. Antibiotics and analgesics were prescribed postoperatively. The healing has been observed with control appointments during 2 months of osseointegration process. The swelling, pain and patient morbidity was completely eliminated at 2 weeks and the sutures were removed.

Results

First operation was needed to increase the amount of the horizontal bone in order to apply an appropriate implant placement. The bucco-lingual dimension of the bone crest was 3 mm initially and it increased to 7 mm (bu 7 den emin miyiz?) at 6th month of healing. The second procedure was the implant surgery. The augmented bone crest was perfectly integrated and implantation could be performed without any complication. There were a little edema and pain on the operation area on very early period of the healing, but these were eliminated at 2 weeks. Osseointegration phase of the healing and control appointments are still continuing.

Conclusion and Clinical Implications

Horizontally defected alveolar ridge is a common problem after a tooth loss and it might be a contraindication for implant placement. Autogenous bone still remains as the gold standard for bone augmentation procedures because of its osteoinductive, osteoconductive and nonimmunogenic characteristics. These type of defects may be treated with augmentation procedures with appropriate methods and materials usage and become recipient areas to be able to allow implant placement.