Alveolar cleft bone graft in the second stage of surgery was a crucial part of the cleft palate treatment protocol with many advantages: reconstructing bone for tooth eruption, supporting the periodontal structure for the teeth adjacent to the cleft, supporting and lifting the arch and preventing from collapsing of maxillary arch. Grafting technique and material are selected based on the treatment purpose that for orthodontic moving tooth into the arch or for dental implant rehabilitation. Cancellous material provides rapid vascularization and healing facilitating for tooth moving into the cleft site but easy to resorb that unsuitable for dental implant placement. While dense material is difficult to move teeth into the cleft but increase initial stability. Therefore, we offered a method that limit bone resorption, easily obtain the implant initial stability, quick osseointegration called two iliac cortical bone blocks sandwich technique for a purposes of dental implant rehabilitation. Treatment protocol started with orthodontic treatment prior alveolar bone grafting to create proper space for implant restoration. Our clinical experience with 32 cleft sites using two iliac cortical bone blocks sandwich had shown potential clinical application in follow-up time up to 96 months. Evaluation criteria of bone grafting for alveolar cleft included soft tissue condition of graft area, nasal fistula closure, bone grafting outcome, success in osseointegration and implant prosthesis. This chapter described in detail treatment procedure and outcomes of a new technique of two iliac cortical bone blocks sandwich for alveolar cleft in patients with unilateral cleft palate.
The use of short implants as a single tooth replacement has become quite common over the past several years. The recent European Consensus Conference on short implants has stated that short implants have the same predictability as traditional length implants. Recently, it was found that there are seven factors that are associated with crestal bone gain in single tooth implants. Among these factors are the use of non-steroidal anti-inflammatory drugs and the presence of an opposing natural tooth.
So far, atrophic alveolar ridge defect has been remained a big challenge for implant surgeons. Correct technique indication and proper material selection plays an important role for the long term success and further complications prevention. Numerous donor site for bone reconstruction prior and during implant placement have been proposed such as autogenous, homogenous allogenous or synthetic marterial. Among them, autologous graft is considered the "gold standard" as it meet three factors for the bone augmentation's success due to its osteogenic, osteoinductive, and osteoconductive properties that others donor site could not obtain.In this report, we would like to present the clinical results, the advantages and disadvantages, as well as the complications of different 3D bone grafting techniques and materials in reconstruction of severely atrophic maxilla and mandible in implant rehabilitation.
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