a. Monoblock bone graft fixed with osteosynthesis screws
In this situation, bone atrophy is extremely severe (large quantity of resorbed bone) and can be restored with:
- Large fragments of autograft collected extra-oral (generally from the hip bone/iliac crests) by our specialists in maxillo- facial surgery and orthopedic surgeons, intra-orally fixed in the receptor area with special titanium screws (osteosynthesis screws); surgical intervention is complex and involves additional special techniques of obtaining soft tissue (gum) with which the massive graft will be totally covered; after approximately 1 year, when monoblock autograft has “stuck” to the receptor bone, dental implants will be inserted and missing teeth will be replaced;
- Multiple small fragments of intra-orally collected graft of parallelepiped or cylinder shape (from the chin, mandible branch, maxillary tuberosity or palate) and stabilized next to each other by osteosynthesis screws; in this case also, the most delicate issue remains obtaining soft tissue (gingival) with which bone grafts will be fully covered until their complete healing (approximately 1 year);
- Monoblock alograft, processed and manufactured exactly on the defect shape with special technology (cad/cam) – called “bone builder” and produced by the German company Botiss (doctor sends the patient’s dental tomography to the center in Germany and receives a fully manufactured bone piece);
b. Nerve lateralization (alveolar inferior)
To avoid bone addition and secondary surgical trauma (autologous bone collection), dental implant insertion into a severely atrophied bone can be accomplished by modifying local anatomy.
For the mandible (inferior maxillary) the inferior limitation factor is represented by the mandibular nerve. This means that we don’t have enough vertical bone above the nerve to place dental implants of corresponding height, nerve being on the dental implant insertion way. But, if we move the nerve out of the implant trajectory, we can obtain the necessary bone height for implantation, without affecting it. The procedure is extremely delicate and complex and can only be accomplished by experimented surgeons and advanced technology. This operation requires general anesthesia and an operating block, being successfully performed in Implantodent clinics. It still remains an intervention with several risks, the most important being nerve damage.
c. Monoblock bone graft fixed with dental implant screws
In this situation also (the same as the situation presented above) patient’s own bone is being used (autograft), collected from the mouth or outside the mouth. Collected bone, in block shape, is fixed this time to the defect with the dental implant’s aid.
d. Osteodistraction grafting (vertical crest elongation)
This procedure requires using a bone stretching (elongation) device. It uses patient’s own bone, the success potential being fairly high. Practically, the superior bone fragment from the atrophied bone is cut and detached from the rest of the bone, and the two fragments (cut and remaining) are attached to the distractor, a device fitted with a periodically activated screw, removing the two fragments from each other. In the resting period, between the two removed fragments, bone is deposited the same as in the fracture healing process. Space is filled up with bone; fragments are again removed by screw activation until the superior fragment reaches the desired height for implant insertion. After bone consolidation, dental implants are inserted over which crowns will be placed.
It is a technique performed by experimented surgeons with advanced technology leading to excellent results, requiring patience on behalf of the patient. This operation requires general anesthesia and an operating block, being successfully performed in Implantodent clinics.