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Discussion : Sandwich bone graft for vertical augmentation of the posterior maxillary region: a case report with 9-year follow-up [2]

Discussion : Sandwich bone graft for vertical augmentation of the posterior maxillary region: a case report with 9-year follow-up [2]

author: Kenko Tanaka, Irena Sailer, Yoshihiro Kataoka, Shinnosuke Nogami, Tetsu Takahashi | publisher: drg. Andreas Tjandra, Sp. Perio, FISID

In this case, the alveolar ridge was Seibert class II, and septa and a thickened sinus membrane were evident within the maxillary sinus. Sinus floor elevation was limited because of the condition of the floor morphology, the presence of septa, and the thickness of sinus floor membrane [22, 23]. Considering these issues, we selected the interpositional bone graft technique using autologous bone in preference to short implants or the use of a biomaterial.

The inlay bone graft technique, first described by Schettler and Holtermann in 1977 [15] which presented the reconstruction of a severely atrophic edentulous mandible, has great potential for bone graft incorporation. The technique is relatively simple and provides satisfactory results both in terms of surgical success and predictability [15,16,17,18,19]. The technique is predicable because the four walls of the graft are in contact with live tissue, increasing vascularization and reducing resorption [17]. A box-style gap opens between the segments, which borders on an open bone marrow cavity on two sides. This space offers excellent conditions for vascularization of the graft and bone healing. Thus, a temporary prosthesis can be used in the early postoperative period. Since that first report, several reports on research outcomes, technological progress, and the good results obtained with this technique have been published. This technique is now regarded as a good way to correct vertical deficiencies prior to placement of dental implants [15,16,17,18,19].

On the other hand, alveolar augmentation depends on the operator’s experience and is technically sensitive [3]. The most common difficulty is how to manage the soft tissues to preserve the blood supply to the cranial segment; releasing incisions make tension-free closure possible so that the segment does not move palatally.

Nevertheless, in this case, the procedure was carried out successfully, and two regular implants were successfully placed in the alveolar ridge after its enhancement with an autologous bone graft. Those implants survived over 9 years of follow-up.

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