Successful multiple implant-supported prosthetic rehabilitation of Siebert class I alveolar defect at mandibular posterior site utilizing Khoury split bone block graft technique and free gingival grafting.

Abstract

Insufficient dimension of alveolar bone and reduced width of keratinized gingiva may be the consequence of tooth loss accompanied by adaptive transformation. It creates a challenging situation for the clinician, especially in terms of implant-supported prosthetic rehabilitation. The present case of a 66-year-old female patient presented with an edentulous span of the right mandibular posterior edentulous site with Siebert class I defect. Literature recommended different bone augmentation procedures for such a clinical situation but are associated with a variety of risks and complications too. Adequate alveolar ridge dimensions are a prerequisite to achieve proper osseointegration; Khoury split bone block (KSBB) technique utilizing combination of thin split autogenous bone and bone particles is a popular intervention that is highly recommended in the literature and was executed in this case. Four months postoperatively Densah bur-assisted osteotomy preparation was done under osseodensification mode followed by implant fixture placement w.r.t tooth no. 45,46,47. Three months postimplant placement, insertion buccal site showed a lack of sufficient width of keratinized tissue. Therefore, free gingival grafting (FGG) was executed in order to maintain the peri-implant tissue health at the buccal aspect of tooth no. 45-47 region, followed by prosthetic rehabilitation at 12 months postoperatively. Clinically, peri-implant tissue was healthy, and no marginal bone loss was observed on radiovisual graph evaluation taken at 1.5 years, postoperatively. It was concluded that KSBB, osseodensification and FGG contributed in the excellent clinical and functional outcome of multiple implant-supported prosthetic rehabilitation at the mandibular posterior edentulous site with Siebert class I defect.