Successful restoration of skeletal missing segments by autogenous bone grafting has been described. Corticocancellous and cranial bone grafting for anatomic restoration of maxillomandibular bone loss is an acceptable and technically improving treatment modality. Combined procedures of bone grafting and endo-osseous implants are thus reliable.
LOCALIZED ATROPHY
- Upper jaw
When the atrophy is localized near the maxillary sinus increasing of the sinus is reccomended. It consists in grafting (iliac crest or calvaria) the sinus preserving the mucosa. Sinus grafting has been described and used in a variety situations to provide available posterior maxillary implantable bone. The sinus to be augmented can be grafted with allogenous bone, compressed cancellous autogenous bone, corticocancellous block. In a second stage implants will be positioned. Atrophy of the anterior maxillary crest can be correct using small onlay grafts from different donor sites like iliac crest, calvaria, chin, mandibular ramus, gonion. Nowadays the modern maxillo facial surgeon may use the distraction techniques for increasing bone also soft tissue.
- Mandible
Onlay bone grafts are usually harvested to correct localized mandibular atrophy.
SEVERE ATROPHY
- Upper jaw
In old patients, and sometimes in the young, upper jaw atrophy may be present often associated with atrophy of the mandible. In these cases a III class malocclusion is the result. Le Fort I osteotomy can be performed. Maxillary downfracture with interpositional autogenous grafting and delayed placement of fixtures for treatment of severe atrophic maxilla has been described. After downgraft, maxillary advancement, and fixture placement, vertical and anterior projection is improved. Atrophic alveolar processes may also be augmented by onlay bone grafts fixed with screws or implants. Small osseous defects at the alveolar crest can be treated with grafted bone followed immediately by fixture placement.
- Mandible
The surgical techniques for the atrophic mandible include partial osteotomies with inlay or onlay bone grafts. Alveolar nerves transposition may be necessary.