Insufficient bone volume for dental implant placement in the maxillary anterior segment is a constant challenge in oral surgery. Several techniques have been suggested to reconstruct deficient alveolar ridges and to facilitate dental implant placement. These techniques include bone splitting osteotomy, distraction osteogenesis, inlay and onlay bone grafting. Guided bone regeneration (GBR) is also a promising alternative that increases the bone volume by the use of a subperiosteal barrier.
Aim: The aim of this case was to demonstrate that the use of rigid titanium occlusive barrier is a reliable alternative to perform a lateral alveolar bone augmentation and treat localized ridge deformities before reaching an ideal implant placement.
Observation: A 25-year-old healthy male was referred for implant placement in the maxillary central incisor. The alveolar bone width at the implant site 21 was less than 5mm. Hard tissue augmentation was accomplished using guided bone regeneration. A rigid titanium occlusive barrier was customized to desired shape of future alveolar ridge then secured with tent and fixing screws. Autogenous bone graft harvested with an auto-chip-maker adjacent to the surgical site were mixed with a xenograft and putted under the barrier. The wound was closed using a vestibular mucoperiosteal flap. At 4 months, the rigid barrier was removed, and a 7mm crestal width transversal bone was observed. At the same time, a fixture (4×10mm) was placed. A definitive ceramometal crown was completed after full osseointegration with periodical clinical maintenance. The exposure of the titanium mesh occurred in this case and was visible with a circular flap dehiscence at 1-month follow-up visit. This exposure did not affect the successful regenerative outcomes. After removal of the titanium mesh from the grafted defects, the space beneath the membrane enclosure was seen to be almost completely filled with new hard tissue covered by a thin layer of soft tissue. The postoperative follow-ups revealed that the implant was stable with excellent osseointegration and the buccal depression of the surgical area was reconstructed.
Conclusion: The use of rigid titanium occlusive screwed barrier with autogenous and bovine bone graft might be a reliable technique for alveolar ridge reconstruction. This approach achieve excellent final esthetic outcome of the implant-supported restoration.
Published by Elsevier Masson SAS.