Two groups of patient with horizontally deficient anterior maxilla indicated for bone augmentation ,one will be subjected to autogenous onlay bone block from retromolar bone and the other to cortical shell from retromolar bone also.
Patients in both sex with partial edentulism of the maxilla and requiring horizontal ridge augmentation
The ages of the patients ranged from 20 to 60 years.
The residual ridge width in these patients are less than 4.m
Sufficient bone in intra-oral donor sites are available (external oblique ridge)
Subjected to irradiation in the head and neck area less than 1 year before implantation.
Poor oral hygiene and motivation.
Uncontrolled diabetes.
Pregnant or nursing.
Parallel
Autogenous onlay bone block harvesting from retromolar bone in anterior maxilla
Procedure/SurgerySurgical protocol ( retromolar bone harvesting) After injecting local anesthesia a crestal incision is done, from a point on the occlusal surface along the external oblique ridge and extending anteriorly and inferiorly through the buccal mucosa, parallel to the gingival margin of the mandibular molars. The subperiosteal dissection extend to expose the ascending ramus and the retromolar region With the aid of surgical carbide burs, two proximal vertical cuts penetrating the cortex of the external oblique ridge. The depth of penetration of the posterior cut did not exceed 2.5 mm to avoid injury to the inferior alveolar nerve. By using microsaw , an inferior cut of 3.2 mm in depth joining the anterior and posterior vertical cuts was done. Small perforations of 3-4 mm in depth were performed on the superior aspect of the external oblique ridge using 1 mm drill bur. Finally, the block was sheared off using a chisel.
Autogenous cortical shell technique from retromolar bone in anterior maxilla
Procedure/SurgeryThe harvested cortical plate was then split longitudinally in two parts using a microsaw, and thinned with the bone scraper to achieve a plate of 1 mm thickness. The plate was fixed at a distance from the residual ridge with 2 screws. Autogenous bone particles, collected with the bone scraper, were tightly packed into the gap between the plate and the recipient site.
radiographic analysis
calculation of bone width gain using cone beam computed tomography
histomorphometric analysis
to assess the bone quality for each technique
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