From Oral to Facial Surgery

Objectives: Alveolar bone deficiency, especially in the anterior maxillary area, can prevent ideal implant placement and jeopardize the esthetic outcome. The anatomic configuration in the atrophic site, creates acquired Angle Class III malocclusion influencing the surgical choices. The objective of the present study is to compare the methods used for treating severe maxillary atrophy

Methods: Clinical cases of severe maxillary atrophy are described: A combination of sub-nasal, sinus elevation procedure and intra-oral autogenous onlay bone graft were used for ridge augmentation prior or simultaneously with dental implant placement combined with bovine bone substitutes mixed with platelets rich plasma (PRP) or bone-marrow aspirate concentrate (BMAC) and covered with platelets-poor-plasma (PPP) as a biological membrane. Le Fort I Osteotomy was performed in few cases, simultaneously with dental implantation and immediate loading or as a separate procedure.

Results: The combination of several augmentation and surgical procedures, enables better correction of the alveolar ridge in 3D (ridge height, width and trajectory), which results in a better prosthetic and face esthetics outcomes.

Conclusion: Techniques that are described in this presentation should be considered a reliable, safe and very effective to obtain high bone graft survival rate following high long-term implants` survival rate. Moreover, we believe that PRP and BMA as an autologous source of growth factors and stem cells, mixed with osteoconductive bone substitute and covered with PPP as a biological membrane may offer a novel therapy with greater efficacy than any other combination or single therapies that were used in bone regeneration up to now.