Clinical case | Bone reconstruction

Prof. Dr. David Peñarrocha Oltra

Specialty: Oral Surgery

Training:

  • Degree in Dentistry, University of Valencia, (Extraordinary Award)
  • Master in Oral Surgery and Implantology, University of Valencia,
  • Doctorate in Dentistry with International Mention, Universitat de Valéncia – University of Pisa, (Extraordinary Prize)
  • Scholar ITI (International Team for Implantology), Universidad Nacional Autónoma de México.
  • Titular Professor of Oral Surgery and Implant Surgery, University of Valencia.
  • Director of the University Expert in Implantology, University of Valencia.

Websites of interest:

3D BONE RECONSTRUCTION WITH THE KHOURY TECHNIQUE OF A VERTICAL BONE DEFECT IN THE POSTERIOR MANDIBULAR AREA

58-year-old patient with no relevant medical history, with a vertical bone defect at the 3637 level caused by peri-implantitis. The patient comes to us after the implant has been removed.

Treatment: 3D bone reconstruction with the Khoury technique (autologous bone sheets) and placement of 2 Galimplant IPX® implants at 4 months. Bridge 36-37 in monolithic zirconia on rotational aesthetic straight abutments.

Initial clinical situation in which the absences of 36 and 37 and bone atrophy in that area are observed.

Figure 1 (A, B and C)

Figure 1 (A)

Figure 1 (B)

Figure 1 (C)

Two- and three-dimensional radiographic study of the vertical bone defect in the third quadrant. The patient brought an acetate orthopantomography prior to the removal of the implant, which was performed at another dental clinic. Figure 2 (A, B and C)

Figure 2 (A)

Figure 2 (B)

Figure 2 (C)

Full thickness flap to access the external oblique line at the level of where the third molar would be.

Figure 3 (A, B y C)

Figure 3 (A)

Figure 3 (B)

Figure 3 (C)

Osteotomies using round handpiece bur, piezoelectric motor and diamond disc to obtain the bone block.

Figure 4 (A, B y C)

Figure 4 (A)

Figure 4 (B)

Figure 4 (C)

Obtaining particulate autologous bone with a scraper.

Figure 5 (A, B y C)

Figure 5 (A)

Figure 5 (B)

Figure 5 (C)

Figure 6 (A)

Figure 6 (B)

Figure 6 (C)

Obtaining the autologous bone block and dividing it into 2 sheets of 1-2mm thickness.

Figure 6 (A, B, C, D y E)

Figure 6 (C)

Figure 6 (C)

Preparation of a full-thickness tunnel at the level of 36 and 37, accessed by a vertical discharge in distal 35.

Figure 7 (A, B y C)

Figure 7 (A)

Figure 7 (B)

Figure 7 (C)

Figure 8 (A)

Figure 8 (B)

Figure 8 (C)

Fixation of a plate by vestibular with 2 microscrews, filling with particulate autologous bone and particulate B-tricalcium phosphate, and fixation of the second plate occlusally.

Figure 8 (A, B, C, D y E)

Figure 8 (C)

Figure 8 (C)

Placement of A-PRF membranes over the bone graft, suture and postoperative radiographic control.

Figure 9 (A, B y C)

Figure 9 (A)

Figure 9 (B)

Figure 9 (C)

Soft tissue healing at 2 weeks.

Figure 10 (A y B)

Figure 10 (A)

Figure 10 (B)

Bi- and three-dimensional clinical and radiographic view of the vertical gain of the alveolar process 4 months after grafting. Weeks.

Figure 11 (A, B y C)

Figure 11 (A)

Figure 11 (B)

Figure 11 (C)

Surgery for the placement of 2 implants in positions 36 and 37. The fixation screws of the bone plates are also removed and a postoperative control periapical radiograph is performed.

Figure 12 (A, B, C, D, E y F)

Figure 12 (F)

Figure 12 (A)

Figure 12 (B)

Figure 12 (C)

Figure 12 (D)

Figure 12 (E)

Soft tissues healed after implant exposure surgery and placement of 2mm height rotational aesthetic rectus multiposition abutments. The band of keratinized mucosa was 1-2mm. We would have preferred to perform a free graft to increase the keratinized mucosa, but the patient did not want to undergo such surgery.

Figure 13

Figure 13

Placement of the definitive monolithic zirconia prosthesis. The patient had a crossbite at 35 and the antagonist molars palatinized, so it was decided to do a rehabilitation of 36-37 also in a crossbite as the patient’s natural teeth were probably before losing them.

Figure14 (A, B y C)

Figure 14 (A)

Figure 14 (B)

Figure 14 (C)

Clinical and radiographic control 12 months after the placement of the prosthesis.

Figure 15 (A y B)

Figure 15 (A)

Figure 15 (B)

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