Total Reconstruction of the Atrophic Maxilla with Bone Substitutes

PURPOSE: The rehabilitation of the severely resorbed maxilla remains a significant challenge. The present study evaluated by the aid of cone beam computed tomography (CBCT) in the use of biomaterials for total reconstruction of the atrophic maxilla.

MATERIALS AND METHODS: Consecutive cases of partial or total edentulism of the maxilla (Cawood and Howell classes IV - VI) treated with bilateral sinus floor elevation, nasal floor elevation, allogeneic bone block-grafts, biomaterials and bone morphogenetic protein were evaluated. Implants were placed 4 to 6 months after grafting. Each patient received a CBCT scan prior to bone grafting and prior to implant placement.

RESULTS: Significant bone volume increase and adequate stability of the augmented areas prior to implant placement were found with CBCT analysis. The grafted bone provided sufficient mechanical support to permit implant placement for fixed implant-supported reconstruction. This technique enabled the restoration of function and esthetics with a fixed rehabilitation. Successful graft integration, implant placement and prosthetic reconstruction occurred in all cases, with no major complications.

CONCLUSIONS: The results of this study suggest that the use of allogeneic bone blocks in combination with biomaterials and bone morphogenetic protein is an effective, reliable procedure for the rehabilitation of the severely resorbed partially or complete edentulous maxilla.