Atrophic posterior maxilla and mandible: alveolar ridge reconstruction with mandibular block autografts.

A utogenous bone grafts have been used for many years for alveolar ridge augmentation and are still considered to be the gold standard for jaw reconstruction. 1,2 The use of these grafts with osseointegrated implants was originally discussed by Brånemark et al., who used the iliac crest as the donor site. 3 For repair of most localized alveolar defects, however, bone grafts from the mandible offer advantages over iliac crest grafts. These include the proximity of donor and recipient sites, convenient surgical access, decreased donor site morbidity and decreased cost. There is usually loss of alveolar bone height in the posterior maxilla and mandible secondary to trauma, pathology and periodontal disease and after tooth removal. Tooth loss results in buccal plate compromise and a reduction in alveolar width. This bone resorption process continues in a medial direction until a knife-edged ridge forms and precludes implant placement. The cortical plate may be minimal or absent, further complicating implant placement. In addition, alveolar height is decreased in the posterior maxilla as a result of pneumatization (partial or complete) of the maxillary sinus after tooth loss. Finally, occlusal forces are greater in the posterior than in the anterior area of the mouth, necessitating appropriate surgical and prosthetic treatment planning for long-term success. The recipient site must be evaluated for both hard and soft tissue deficiencies, esthetic concerns and the overall health of the adjacent teeth. Some cases require soft tissue procedures to be done prior to or simultaneous with block grafting, as well as in conjunction with implant placement or stage II surgery. These include use of connective tissue grafts, palatal epithelial grafts and human dermis. Conventional radiographs are obtained and include periapi-cal, occlusal, panoramic and lateral cephalometric views. Computed tomography and interactive software are also used for many cases. Mounted models are used to evaluate interocclusal relationships and Dr. Pikos has extensive experience in implant surgery having placed more than 9,000 implants. He performs numerous hard and soft tissue graft procedures and emphasizes principles of prosthetics and biomechanics that dictate the ultimate success of implants. He is a well published author who has lectured extensively on implants in North and South America, Europe, Asia, and the Middle East. Dr. Pikos is the founder of the MAP Implant Institute. Since 1990, Dr. Pikos has been teaching an Advanced Bone Grafting Course and a Soft Tissue Grafting Course to clinicians that now number more …