Читать книгу Bone and Soft Tissue Augmentation in Implantology - Группа авторов - Страница 64

With the use of the SBB technique, it is possible to harvest sufficient bone, allowing for the grafting of multiple horizontal and vertical bony defects. Since with this technique every harvested bone block is split into two or three blocks, one can multiply the number of blocks available for the grafting procedure. In some situations, with a well-pronounced external oblique line, and when following the SBB technique, block harvesting from one retromolar area can be sufficient to graft large areas (Fig 2-24a to d). If there is a need for more bone blocks, the harvesting procedure can be performed from both the right and left mandibular retromolar areas (Fig 2-25a to e). For a complete oral rehabilitation with multiple bone grafting in the maxilla and mandible, bone grafts can also be harvested from the chin and molar areas in addition to the mandibular retromolar areas (Fig 2-26a to h).

Fig 2-25a Two donor sites in the retromolar area of the right and left mandible for two augmentation procedures in the right and left maxilla.

Fig 2-25b Radiographic control 14 years postoperatively.

Fig 2-25c Two donor sites in the retromolar area of the right and left mandible for multiple augmentation areas in the maxilla and mandible.

Fig 2-25d Recall radiograph 2 years postoperatively with implants that show good osseointegration.

Fig 2-25e Control radiograph 12 years postoperatively.

Fig 2-26a Severe periodontal disease with many mobile teeth.

Fig 2-26b Multiple bone grafting in various areas of the maxilla and mandible after periodontal rehabilitation with extraction of the hopeless teeth and a fixed temporary restoration using provisional implants. The bone grafts were harvested from the retromolar area on the right and left mandible as well as from the chin area.

Fig 2-26c Clinical situation of the vertical grafted bone in the right maxilla (3D reconstruction) 4 months postoperatively.

Fig 2-26d Control radiograph 7 years postoperatively.

Fig 2-26e Clinical situation 7 years postoperatively.

Fig 2-26f The long upper lip covers the pink ceramic and the cleaning canals.

Fig 2-26g Clinical appearance 17 years postoperatively with poor oral hygiene: patients must stay in a regular recall program to help them to maintain good oral hygiene.

Fig 2-26h Control radiograph 17 years postoperatively.

Only in exceptional cases, such as extensive vertical bone defects with severely scarred soft tissue and a history of uncontrollable smoking, is it advisable to use a cortico-spongy iliac crest graft due to its high regeneration potential. In addition, if there is insufficient bone in the mandible for harvesting in the case of extensive defects, a sufficient donor area is always available in the iliac crest to enable the reconstruction of difficult defect geometries (Fig 2-27a to f).

The selection of the appropriate method is thus determined by the various parameters and depends on the individual patient findings.