Computer‐guided calvarial mono‐cortical bone blocks harvest: A novel approach for three‐dimensional alveolar reconstruction of atrophic maxilla

Abstract

Background Calvarial bone grafts have been one of the grafting options that provides predictable results for three‐dimensional reconstruction of severely atrophied ridges owing to their low resorption and rapid revascularization, thus providing adequate volume for implant insertion. The aim of this study was to introduce a computer‐guided technique for calvarial graft harvest to minimize the complications known with grafting from this donor site. Materials and Methods Eight patients, suffering from severely atrophied, completely edentulous maxillary ridges, with an age range (21‐30 years) were operated on (six males and two females). A custom‐made guide for each patient based on preoperative computed tomography (CT) was fabricated for harvesting the outer table cortical bone blocks from the parietal bone, then particulate bone was collected with an auto‐chip maker. Bilateral sinus lifting was indicated in all cases. The bone blocks were fixed intraorally and the bone particulates filled the gaps and the volume created by sinus lifting, then the whole complex was covered with collagen membranes fixed with titanium tacks. Immediate and 6 months CT were requested for evaluation of the guide accuracy and the graft integration, respectively. Results In all cases, the guide was found to accurately fit into its preplanned position and to correctly locate the anticipated harvest site with the needed dimensions of the bone blocks. No intraoperative complications were encountered such as breakage through the inner table or cerebrospinal fluid leakage. Postoperatively, all the cases showed uneventual healing except one case that had an anterior dehiscence. Conclusion The computer‐guided calvarial bone blocks harvest from the parietal bone is safe and predictable technique for three‐dimensional reconstruction of severely atrophic edentulous maxilla.

Advancements in alveolar bone reconstruction: A systematic review of bone block utilization in dental practice

“…The studies were categorized according to the type of bone biomaterial into autologous, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] allogeneic [39][40][41] and xenogeneic 26,31,33,34,42 groups to facilitate the description of each type. It should be noted that a single study may investigate more than 1 type, which allows for a comprehensive description of each.…”

“…With regard to extraoral donor sites, bone can be harvest ed from the calvarium, anterior iliac crest, tibia, fibula, rib, and olecranon (proximal ulna). 26,28,[30][31][32][33]35 Intraoral donor sites encompass the mandible (chin/symphysis, ramus, retromolar area), zygoma and maxilla (tuberosity). [23][24][25]29,34,[36][37][38]43,44 With regard to one of the most common donor sites, the mandible, the utilization of the ramus as a donor site, as opposed to the symphysis, has been associated with several advantages.…”

“…On the other hand, bone harvesting from an extraoral site is associated with a number of complications, including scarring, postoperative pain, hematomas, delayed muscle motility, the risk of cutaneous nerve injury, and higher hospitalization costs. 28,[47][48][49] Furthermore, general anesthesia, particularly when grafts are harvested from calvarial donor sites, 30,32 may result in increased stress for patients, leading to increased postoperative pain and an extended hospital stay. 42 Differences between cancellous and cortical autografts should be considered in the decision-making process for managing bone augmentation.…”

Ridge augmentation using autologous concentrated growth factors enriched bone graft matrix versus guided bone regeneration using native collagen membrane in horizontally deficient maxilla: A randomized clinical trial

“…1,2 Chappuis et al suggested that the greatest amount of bone loss is in the horizontal dimension and occurs mainly on the buccal aspect of the ridge. 3 Depending on the type of atrophy, different treatment modalities have been attempted for horizontal alveolar bone defect augmentation, including the use of particulate and block grafting materials, 4 distraction osteogenesis, guided bone regeneration (GBR), growth, and differentiation factors. 1 Recombinant human bone morphogenic protein (rhBMP) was also used for the reconstruction of horizontal bony defects: in 2009, Buser et al reported that GBR has become a predictable and well-documented surgical approach, it depends on the use of barrier membranes over a defect, promoting the ingrowth of osteogenic cells and preventing the migration of epithelial cells and fibroblasts from the overlying soft tissues into the wound.…”

Assessment Of The Sticky Bone Preparation Of BioActive bone Glass in Grafting Critical-Sized Surgical Bony Defects.

“…Autogenous bone is the gold standard. [7][8][9] However, it costs an extra donor site morbidity and a longer surgical time for harvesting. The bones harvested from the iliac crest, the mandible, and the tibia were investigated by Holtgrave and Spiessl 10 , Mi Hyun Seo et al 11 , and Fethi Atil 12 , respectively.…”