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Zygomaticomaxillary buttress as a donor site

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  • Implant site was exposed through crestal incision and grafting site exposed through a Sub-sulcular incision extending from 2ndpremolar to the distal of 1stmolar mucoperiosteal flap raised
  • Implant site was exposed through crestal incision and grafting site exposed through a Sub-sulcular incision extending from 2ndpremolar to the distal of 1stmolar mucoperiosteal flap raised
  • Implant site was exposed through crestal incision and grafting site exposed through a Sub-sulcular incision extending from 2ndpremolar to the distal of 1stmolar mucoperiosteal flap raised
  • Implant site was exposed through crestal incision and grafting site exposed through a Sub-sulcular incision extending from 2ndpremolar to the distal of 1stmolar mucoperiosteal flap raised

Transcript

  • 1. A CLINICAL STUDY AND REVIEW OF LITERATURE Guided by DR. SUNIL C DUTT, Prof. & HOD DR. M. SATISH, Reader DR. DEEPAK THAKUR, Reader DR. MANISH PANDIT, Senior Lecturer Presented by – DR. SHEETAL KAPSE 2ND YEAR P.G. STUDENT 2
  • 2.  INTRODUCTION  AIM & OBJECTIVE OF STUDY  ANATOMY  CLINICAL PRESENTATION  DISCUSSION WITH REVIEW OF LITERATURE  CONCLUSION  RESOURCES 3
  • 3. • Augmentation of maxillary alveolar bone defects for placement of implant still poses a clinical challenge for the surgeons. • In addition to autogenous bone & alloplastic materials, synthetic bone substitutes as well as denatured bovine bone & coral structures, are all possible alternatives available for use as augmentation material. 4
  • 4. • But the use of autogenous bone graft still remains the ‘gold standard’ for both cancellous & cortical bone grafting applications. 5
  • 5. Maxillary Tuberosity • After bone harvesting from this area, postoperative trismus as well as injury to the adjacent soft tissues with profuse hemorrhage can occur. Gellrich NC, Held U, Schoen R, Pailing T, Schramm A, Bormann KH. Alveolar Zygomatic Buttress: A New Donor Site for Limited Preimplant Augmentation Procedures J Oral Maxillofac Surg .2007;65:p275-280. 6
  • 6. Palatal Graft 7
  • 7. Osteodistraction • This method might be considered by some clinicians and patients alike to be a rather involved and timeconsuming alternative. Schlegel KA, Neukam FW: Augmentationen, Knochenersatzmaterialien, Membranen, in Reichart PA, Hausamen J-E, Becker J, Neukam FW, Schliephake H, Schmelzeisen R (eds): Zahnärztliche Chirurgie I. 8
  • 8. 9
  • 9. • Why the Zygomaticomaxillary buttress…… • Advantages and limitations …….. 10
  • 10. 11
  • 11. 12
  • 12. • Vase shaped • Boundaries  Inferiorly- alveolar process and roots of teeth  medially - roots and sinus  superiorly joins the zygoma  posteriorly infratemporal fossa • Bone quality – cortical & cancellous • Intramembranous ossification • Function - Provides pressure absorption and transduction in the facial skeleton. • Pathologies and variations not known 13
  • 13. 14
  • 14. • Subsulcular or Extended crestal incision • Elevation…superiorly till the ZM suture • These designs will expose the entire buttress. 15
  • 15. • The minimum donor site surface area should be approximately 10 mm X 15 mm and accessible with the instrument at an angle between 5° and 50°. Peleg M, Garg AK, Misch CM, Mazor Z. Maxillary sinus and ridge augmentations using a surface-derived autogenous bone graft. J Oral Maxillofac Surg. 2004 Dec;62(12):1535-44. 16
  • 16. Technical note • Use of ultrasound based dissection with piezosurgery causes no trauma to sinus membrane. Gellrich NC, Held U, Schoen R, Pailing T, Schramm A, Bormann KH. Alveolar Zygomatic Buttress: A New Donor Site for Limited Preimplant Augmentation Procedures J Oral Maxillofac Surg .2007;65:p275-280. 17
  • 17. 1. Accessibility to site & excellent visibility. 2. Same morphology & Same architecture. 3. Good quality & adequate quantity. 4. No muscular or neurovascular injury. 5. Less prone to resorption. 6. 1.5 to 2 cm - not compromise the strength of the lateral midface frame. 18
  • 18. • • • • Damage to maxillary sinus membrane. Damage to tooth root. Limited volume of graft. Contraindicated in patients with sinus problem Montazem A, Valauri D, St-Hilaire H, Buchbinder D. The mandibular symphysis as a donor site in maxillofacial bone grafting: a quantitative anatomic study. J Oral Maxillofac Surg 2000: 58: 1368–1371. Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant placement. Int J Oral Maxillofac Implants 1997: 12: 767–776. Sindet-Pedersen S, Enemark H. Reconstruction of alveolar clefts with mandibular or iliac 19 crest bone grafts: a comparative study. J Oral Maxillofac Surg 1990: 48: 554–558.
  • 19. Case report....... 20
  • 20. • A 26 year old male visited us for rehabilitation of lost teeth following RTA, Was treated in 2010 for pan facial fractures by ORIF. 21
  • 21. Treatment plan • Following clinical, radiological and model assessments Maxillary rehabilitation was planned using implants supported prosthesis bridge . 22
  • 22. • Bone height was found satisfactory except in the canine region where a crater of about 1cm was present. • Zygomaticomaxillary buttress grafting under local anesthesia. 23
  • 23. • Zygomaticomaxillary buttress grafting under local anesthesia. 24
  • 24. • Implant site was exposed through crestal incision and grafting site exposed through a Subsulcular incision . 25
  • 25. • A 5mm trephine was used to harvest the graft from the buttress region. 26
  • 26. • A hole for accommodating implant drilled in the graft. 27
  • 27. • Graft was held in place and a 3.75 X 16 mm implant was carefully inserted into the previously prepared site. 28
  • 28. 29
  • 29. Follow up visits......... Weekly for 1 month • found healing uneventful. 30
  • 30. 4 months • prosthetic rehabilitation. 31
  • 31. CBCT –1 year Post-Operative 1 year • No mobility, resorption or any other complications were noted. 32
  • 32. Discussion & review of literature 33
  • 33. • To achieve a good esthetic result and long-term functional stability, positioning of the implant is crucial. • Alveolar crest defects have been particularly scrutinized because they are the limiting factor in optimal implant positioning. • If the bony recipient site does not fulfill the later implant- based prosthodontic requirements, failure of the whole treatment is likely to occur. 34
  • 34. Supporting articles 35
  • 35. Peleg et al in 2004 Michael Peleg, Arun K. Garg, Craig M. Misch, Ziv Mazor, Maxillary Sinus and Ridge Augmentations Using a Surface-Derived Autogenous Bone Graft. J Oral Maxillofac Surg. 2004; 62:1535-1544. Gellrich et al in 2007 Gellrich NC, Held U, Schoen R, Pailing T, Schramm A, Bormann KH. Alveolar Zygomatic Buttress: A New Donor Site for Limited Preimplant Augmentation Procedures. J Oral Maxillofac Surg .2007;65:p275-280. 36
  • 36. Conclusion 37
  • 37. References 1. Gellrich NC, Held U, Schoen R, Pailing T, Schramm A, Bormann KH. Alveolar Zygomatic Buttress: A New Donor Site for Limited Preimplant Augmentation Procedures J Oral Maxillofac Surg .2007;65:p275-280. 2. Schlegel KA, Neukam FW: Augmentationen, Knochenersatzmaterialien, Membranen, in Reichart PA, Hausamen J-E, Becker J, Neukam FW, Schliephake H, Schmelzeisen R (eds): Zahnärztliche Chirurgie I. Berlin, Quintessenz, 2002, pp 434-459 3. Michael Peleg, Arun K. Garg, Craig M. Misch, Ziv Mazor, Maxillary Sinus and Ridge Augmentations Using a Surface-Derived Autogenous Bone Graft. J Oral Maxillofac Surg. 2004; 62:1535-1544. 4. Kainulainen VT, Sàndor GK, Oikarinen KS, Clokie CM. Zygomatic bone: an additional donor site for alveolar bone reconstruction. Technical note. Int J Oral Maxillofac Implants. 2002 Sep-Oct;17(5):723-8. 38
  • 38. References 5. Montazem A, Valauri D, St-Hilaire H, Buchbinder D. The mandibular symphysis as a donor site in maxillofacial bone grafting: a quantitative anatomic study. J Oral Maxillofac Surg 2000: 58: 1368–1371. 6. Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant placement. Int J Oral Maxillofac Implants 1997: 12: 767–776. 7. Sindet-Pedersen S, Enemark H. Reconstruction of alveolar clefts with mandibular or iliac crest bone grafts: a comparative study. J Oral Maxillofac Surg 1990: 48: 554–558. 39
  • 39. 40
  • 40. 41