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O.261 Bone augmentation in atrophic maxilla. New limits
Oral Presentations Conclusions: The application of a wide spectrum of alternative reconstructive treatment options for the atrophic maxilla, guarantees satisfaction of both the patients and the implantology team. O.260 Retrospective study of 30 cases of lefort 1 procedure with bone grafting aiming implants insertions J. Ferri, G. Raoul, L. Lawers. Service de Stomatologie et Chirurgie maxillofaciale, CHRU, 69037 Lille Cedex, France Introduction: In case of important atrophy of the maxilla many procedures have been proposed to provide bone aiming implant insertions. The lefort 1 osteotomy with bone grafting is one of these procedures. We present a retrospective study of 30 cases treated by lefort 1 osteotomy and bone grafting. Material and Methods: Thirty patients underwent le fort 1 osteotomy with bone grafting to treated important bone atrophy and class III jaws relationship. The bone was harvested from the calvaria. It was fixed on the sinus roof. Six months later the implants were inserted in the new bone (two-steps procedure). 235 implants were inserted. The follow-up ranges from 1 to 6 years. The investigations were done by CT scanning of the sinus floor (before and 6 months after the surgery) and by the recording of the implant failure rate. Results: All the patients had over denture or fixed bridges. The average increase of the bony high is 11 mm. 218 implants were osteointegrated (93%). Discussion: The lefort 1 procedure with bone grafting and secondary implants insertion is a reliable procedure to solve important atrophy of the maxilla. In our study all the patients had good prosthetic rehabilitation with an acceptable implant osteointegration rate. Other solutions are available: • The sinus grafting: It provides good quantity and quality of bone but it doesnot solve the jaws discrepancy which is often present in case of important maxillary atrophy. • The zygomatic implants needs classic implants in the premaxilla requiring bone grafting in this place. It doesnot solve the jaws discrepancy. Conclusion: The lefort 1 osteotomy with bone grafting harvested from the calvaria appears to be a good solution to treat major atrophies of the maxilla with jaws class III relationship. O.261 Bone augmentation in atrophic maxilla. New limits C. Miera1 , J. Rueda1 , N. Pi˜neiro2 . 1 Maxillofacial surgeons, 2 Prosthodontic Implantology Unit, Instituto Bucofacial RP&M, Madrid, Spain Purpose and introduction: Implant placement in the posterior maxilla may often be contraindicated because of insufficient bone volume and the presence of the maxillary sinus. In these situations sinus floor lifting and grafting had been proposed as the best treatment. The bone limit for these procedure traditionally were marked in less than 10 mm. The aim of this lecture is to demonstrate a new limit in 4 mm. Below 4 mm bone grafting is the gold standard. Between 4 and 10 mm we use endopore dental implants. Materials and Methods: Fifty patients with atrophic posterior maxilla were treated in our service since 1998 to 2005. One hundred and fifty five implants were placed. In 15 cases we performed sinus lift augmentation with bone harvesting from the iliac crest. In 10 cases we use mixture of 1:1 autogenous and
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xenograft bone. The other cases were performed with endopore implants. Results: No complications were observed during the surgical procedures; all patients healed uneventfully. No signs of symptoms of maxillary sinus disease were observed. No significant differences were observed in the patients treated with bone grafting (standard implants) and those treated with no graft and endopore implants. Conclusions: It could be concluded that endopore implants can be used safely in those patients with 4–10 mm of bone. For less than 4 mm forces we have to perform a sinus lift augmentation with bone grafting. O.262 Le fort i osteotomy plus total onlay bone graft for treatment of the atrofied edentulous maxilla F. Carlino. Department of maxillo-facial surgery II, hospital “Galeazzi”, Milan, Italy Introduction and Objectives: The edentulous atrophic maxilla is reconstructed either with sinus lifting and transversal/vertical onlay grafts or, if the maxilla is retruded, via Le Fort I osteotomy and interpositional-bone graft in the sagittal gap and on the sinus/nasal floor. In the osteotomy cases, a certain resorption of the sinus graft occurs, probably because it is uncovered by antral mucosa, cut during the osteotomy, and is contaminated from the nasal cavities. This paper presents a technique for correcting the retruded cases that combines the two techniques described. Material and Methods: The Le-Fort I advancement is performed without interpositional bone graft. Bone is grafted vertically and transversally along the whole alveolar crest, like in the total onlay-graft technique. No bone is positioned in the sinus floor. The osteotomy gap is filled with bone, if still available; otherwise, adsorbable membranes are laid on it for spontaneous bone healing. Results: The operation has always given good results: bone was sufficient for implantation and the inter-maxillary relationships satisfactory. Conclusions: The technique is easier than the classic Le-Fort I-interpositional augmentation, where bone was inserted on the sinus/nasal floor, fixing the bone plates to the jaw and graft simultaneously or, as sometimes proposed, using dental implants for fixation. The result is more predictable, the amount of bone needed for the reconstruction is practically the same for every maxilla, no matter how great is the sagittal/vertical resorption, which is corrected by the osteotomy, not by the graft. This means that every alveolar atrophy can be corrected by a simple iliac graft, virtually with no need of other heavy operations (e.g. free grafts).
Implants: maxilla
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xenograft bone. The other cases were performed with endopore implants. Results: No complications were observed during the surgical procedures; all patients healed uneventfully. No signs of symptoms of maxillary sinus disease were observed. No significant differences were observed in the patients treated with bone grafting (standard implants) and those treated with no graft and endopore implants. Conclusions: It could be concluded that endopore implants can be used safely in those patients with 4–10 mm of bone. For less than 4 mm forces we have to perform a sinus lift augmentation with bone grafting. O.262 Le fort i osteotomy plus total onlay bone graft for treatment of the atrofied edentulous maxilla F. Carlino. Department of maxillo-facial surgery II, hospital “Galeazzi”, Milan, Italy Introduction and Objectives: The edentulous atrophic maxilla is reconstructed either with sinus lifting and transversal/vertical onlay grafts or, if the maxilla is retruded, via Le Fort I osteotomy and interpositional-bone graft in the sagittal gap and on the sinus/nasal floor. In the osteotomy cases, a certain resorption of the sinus graft occurs, probably because it is uncovered by antral mucosa, cut during the osteotomy, and is contaminated from the nasal cavities. This paper presents a technique for correcting the retruded cases that combines the two techniques described. Material and Methods: The Le-Fort I advancement is performed without interpositional bone graft. Bone is grafted vertically and transversally along the whole alveolar crest, like in the total onlay-graft technique. No bone is positioned in the sinus floor. The osteotomy gap is filled with bone, if still available; otherwise, adsorbable membranes are laid on it for spontaneous bone healing. Results: The operation has always given good results: bone was sufficient for implantation and the inter-maxillary relationships satisfactory. Conclusions: The technique is easier than the classic Le-Fort I-interpositional augmentation, where bone was inserted on the sinus/nasal floor, fixing the bone plates to the jaw and graft simultaneously or, as sometimes proposed, using dental implants for fixation. The result is more predictable, the amount of bone needed for the reconstruction is practically the same for every maxilla, no matter how great is the sagittal/vertical resorption, which is corrected by the osteotomy, not by the graft. This means that every alveolar atrophy can be corrected by a simple iliac graft, virtually with no need of other heavy operations (e.g. free grafts).