logo 18 • CAMLOG Partner Magazine • July 2018 18 Dr. Karina Lohr, Karlsruhe RESTORATION OF AN EDENTULOUS UPPER JAW COMBINED PROCEDURE WITH FACIAL SINUS LIFT Fig. 1: The initial situation. Fig. 3: X-ray orthopantomography (OPT) before bone formation in the maxilla: low bone height in the posterior region with deep recessus alveolares. The edentulous jaw is the most common indication for the use of augmentation procedures and occurs in 36 percent of all cases. The upper jaw dominates with 75 percent of all cases. Many patients with minimal residual dentition or edentulous jaws would like a fixed restoration. For a long-term stable implantsupported reconstruction, complex surgical measures are often necessary to create an adequate implant site. The following describes the therapy of an upper jaw after progressive periodontal disease with autologous bone block augmentation [1]. Bone defects in the upper and lower jaw due to trauma or pronounced atrophy of the jaw after tooth loss can significantly impair the function and esthetics of the affected patients. This can even lead to stigmatization or social isolation. The extent of the defect influences the surgical and prosthetic restoration options. In dentistry as well as in the field of reconstructive oral and maxillofacial surgery, adequate functional rehabilitation is required in addition to the anatomical reconstruction of hard and soft tissue. Besides the ability to speak and eat, the quality of life and social acceptance are determined by facial expressions and esthetics. The present case of a 61-year-old female patient already shows the distinct loss of the vestibular bone wall after extraction of the remaining teeth, which had to be removed due to progressive periodontal disease and which further atrophied as part of the healing process (Figs. 1 and 2). Combined bone augmentation After healing, the typical centripetal atrophy of the upper jaw with extensive recessus alveolares on both sides, a narrow frontolateral alveolar ridge and flattening to the distal side is impressive both radiologically and clinically. (see Figs. 3 and 4). Bone augmentation is indispensable to obtain a sufficiently stable implant site. Various bone or bone replacement materials are available today for this purpose. These can be obtained interoperatively as blocks, shells, cylinders, granules, chips or shavings or supplied industrially. In our practice, we prefer autologous bone for augmentation. After an alveolar ridge incision and forming a mucoperiosteal flap, the frontolateral region was built up horizontally with autologous grafts. These grafts have the advantage that partially vital cells survive in the cancellous bone [2] in order to support the new formation of bone. This only osteogenic graft material is still considered the gold standard in dental surgery. Two bone blocks were harvested from the retromolar region (Fig. 5), which were adapted as precisely as possible to the situation. Since revascularization in cancellous bone is faster than in compact bone [3;4] and the blood vessels and mesenchymal cells grow exclusively from site tissue (70%) and periosteum (30%), the graft should rest tightly [5]. The grafts were fixated with one osteosynthesis screw each (Fig. 6). In the distal upper jaw, the recessus alveolaris expanded and the alveolar process thinned out below the maxillary sinus and the connection to the pneumatic system of the nose, due to tooth loss. To achieve an adequate implant site, a lateral sinus lift in window and sandwich technique (Figs. 7 and 8) CASE STUDY Fig. 2: After extraction of all remaining teeth in the upper jaw, the missing vestibular bone wall appears frontolaterally in region 14-24.
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