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implants - international magazine of oral implantology

case report I I 33implants2_2014 from a functional and aesthetic viewpoint. A reduced amount of bone in the surgical area, in terms of height andwidth,duetoatrophyofthemaxillaecandetermine the success of the implant.5 The atrophic maxillary ridges can be treated with bone grafts, followed by os- seointegrated implants to obtain aesthetic and func- tional oral rehabilitation. In order to overcome this problem,variousmethodstoaugmentthebonevolume of deficient sites have been described: inlay or onlay bonegrafts,guidedboneregeneration,splitridge/ridge expansion techniques, and alveolar distraction osteo- genesis are common methods to re-establish and cor- rectintermaxillaryrelationshipsandproduceadequate bonemorphologyandvolumeforimplantplacement.6,7 Autologous and non-autologous options are available forverticalandhorizontalbonedeficiencies,butautol- ogousbonegraftshavetheadvantageofprovidingos- teogenic cells to the recipient site.8, 9 When a limited amount of bone is needed, local grafts harvested from themandibularsymphysisorramushavebeenusedex- tensively.10–13 However, when less traumatic surgeries are possible, combination with biomaterials is a good choice.Alargevarietyofbiomaterialsareavailableinthe market, such as calcium phosphates. Materials such as TCPareosteoconductivebecauseosteoblastsadhereto themanddepositbonytissueontheirsurface.Thebio- material forms a scaffold for closing the bony defect.14 Calcium phosphates have a high affinity for proteins (such as bone morphogenetic proteins).15 The pores of these bioceramics have a filter effect and accumulate thegrowthfactorsfromthesurroundingbodyfluidin- sidethemicropores.16 Osteoclastsresorbboneorother resorbable calcium phosphate materials by releasing acids to dissolve the mineral portion. This action forms resorption lacunae17 by dissolving the inorganic cal- ciumphosphatecomponentsofthevitalboneorgraft. Materials degrade owing to their physical characteris- tics or mechanical forces, or they can be dissolved hy- drolytically by fluids in the body milieu.18 Bone substi- tute materials are intended to be implanted during a surgicalprocedureandovertimebecomeapartofvital bone. Hydroxyapatite materials made of bovine bone, processed or partially synthetic, are not ideal bone grafting materials because they are non-resorbable.19 Moreover,theriskofdiseasetransmissioncannotbeto- tallyexcluded.Thiscasereportaimstodemonstratethe viability of the combination of autologous bone blocks and calcium phosphate granules for grafts in the restorationofacriticallyatrophiedmaxilla,reducingthe amount of bone to be removed from the donor site. A controlCBCTscanfouryearsafterthegraftisshownin order to evaluate the long-term performance of this graft. _Case report A 52-year-old male patient presented with a miss- ing upper left canine at the dental clinic of the Bioface Institute(SantaMaria,Brazil).Accordingtothepatient's report, several unsuccessful orthodontic traction at- temptsweremadetoprovokeeruptionoftheimpacted tooth. Then, surgery was performed to remove the ca- nine;duringtheprocedure,alargequantityofbonetis- sue had to be removed, leaving the area with quite a large defect, as shown in Figs. 1 and 2. Based on these preoperative examinations, severe resorption in this Figs. 5 & 6_Removal of the blocks using the Transfer-Control kit. Figs. 7 & 8_The blocks were positioned and fixed; two on the buccal side and one on the palatine side. Fig. 5 Fig. 6 Fig. 7 Fig. 8

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