Guided transpositional bone blocks in esthetic zone: Surgical technique and case report.

Abstract

Background: The ultimate objective of implant dentistry is to position the implant in a three-dimensional, prosthetic-driven location. This case highlights a guided approach for harvesting and positioning an autogenous bone block to restore a horizontal bone defect in the anterior maxilla.

Methods: This case report describes a 55-year-old patient with horizontal bone deficiency in the anterior maxilla following teeth loss. Using specialized software, a surgical guide was designed to facilitate the harvesting of an autogenous bone block from the subnasal region in the same location where implants were planned to be placed. The graft was then repositioned and fixed with titanium screws, and the gaps were grafted with xenogenic bone particles and covered with an absorbable collagen membrane. After 6 months, the implants were placed, followed by prosthetic restoration.

Results: A one-stage implant placement was performed after an uneventful healing period. The bone augmentation resulted in a ridge width of 8 mm for a net gain of 5 mm. After 4 months, the implants were loaded with a screw-retained zirconia bridge.

Conclusion: Guided transpositional bone blocks offer a predictable approach to treating horizontal bone defects in the esthetic zone. Utilizing digital planning and surgical guides enhances precision, making the result more predictable.

Key points: This case provides new information as it highlights a novel guided approach for harvesting and positioning an autogenous bone block to restore a horizontal bone defect in the anterior maxilla using a surgical guide. The keys to successful management of this case include using precise digital planning, the design and use of a surgical guide to accurately harvest the autogenous bone block, proper fixation of the graft and ensuring an uneventful healing period before implant placement and prosthetic restoration. The primary limitations to success in this case could involve the challenge of having adequate distance away from the nasal floor for harvesting and repositioning the autogenous bone block and potential complications during the healing period.

Plain lanuage summary: This report describes a modern technique for addressing bone loss in the upper front part of the mouth, crucial for placing dental implants correctly. A 55-year-old patient with insufficient bone was treated using a digital plan to precisely guide the movement of a bone piece from a nearby area to where it was needed. This guided approach involved designing a custom guide with computer software, securely attaching the bone, and using special materials to aid healing. After 6 months, the dental implants were successfully placed and fitted with new teeth, resulting in a stable and natural-looking outcome.