The article presents a less invasive surgical technique for the reconstruction of the atrophic anterior upper jaw, with the goal to provide the patient an implant-supported denture and to increase quality of life.
The patient aimed for an alternative to his conventional removable denture in the maxilla. Assessment of the baseline situation by clinical and radiographic measures revealed extensively reduced bone volume in the upper jaw with pronounced pneumatization of the maxillary sinuses and shallow vestibule. Based on the patient anamnesis and consultation with a prosthodontist, augmentation of the missing bone employing nasal floor elevation and later placement of four implants as support for a bar-retained overdenture was planned.
A full thickness flap was raised and two bony windows were created on the vestibular bone, one on each side of the inferior piriform rim. The nasal mucosa was elevated and the created space was filled with cerabone® granules pre-mixed with platelet concentrate, which was also used to cover the graft and bone windows. The flap was repositioned and sutured to achieve primary wound closure. Eight months post-surgery re-entry was performed and four implants were placed at the positions of the central incisors and canines. Implants were exposed two months later for abutment connection. Finally, impressions were taken for manufacture of the overdenture.
RESULTS & CONCLUSION
Uneventful healing at all intervention steps and recall appointments
Significant increase in bone volume supporting all placed implants
Stable outcome 2 years post-surgery
Nasal floor elevation demonstrated to be a valid alternative to complex procedures, e.g. block grafting
Avoidance of additional donor site morbidity by the use of cerabone®