“BONE GRAFTING IN ORAL IMPLANTOLOGY” Techniques & Clinical ApplicationsOriginal Title: _Injertos Oseos en Implantologla Técnicas y Aplicaciones Clinicas by Federico Hernandez Alfaro MD, DDS, PhD, FEBOMS: Bone Grafting in Oral Implantology Techniques and Clinical Applications © Federico Hernandez Alfaro © 2006 Quintessence Publishing Co.Ltd. (UK) Al rights reserved. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher. ISBN: 1-85097-103-X Printed in SpainBone Grafting in Oral Implantology Techniques and Clinical Applications EDITOR FEDERICO HERNANDEZ ALFARO, MD, DDS, PhD, FEBOMS Clinical Professor, Oral and Maxillofacial Surgery & Coordinator Program in Oral Implantology, Universitat Internacional de Catalunya, Barcelona, Spain Chief, Department of Oral and Maxillofacial Surgery, Hospital General de Catalunya & Teknon Medical Center, Barcelona, Spain 7 Quintessence Publishing Co.Ltd. \ ) London, Berlin, Chicago, Tokyo, Barcelona, Beijing, Istanbul, Milan, gene Moscow, Mumbai, Paris, Prague, Sio Paulo, Seoul, WarsawCONTRIBUTORS CARLOS ARRANZ, MD Associate Professor, Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Barcelona, Spain Staff, Department of Oral and Maxillofacial Surgery Teknon Medical Center, Barcelona, Spain MARIA JOSE BIOSCA, MD, DDS Associate Professor, Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Barcelona, Spain Staff, Department of Oral and Maxillofacial Surgery, Hospital General de Catalunya & Teknon Medical Center, Barcelona, Spain ELOY GARCIA, MD, FEBOMS Staff, Department of Oral and Maxillofacial Surgery, Hospital Clinic & Teknon Medical Center, Barcelona, Spain JAVIER GIMENO, MD Associate Professor, Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Barcelona, Spain Staff, Department of Oral and Maxillofacial Surgery, Hospital General de Catalunya & Teknon Medical Center, Barcelona, Spain CARLOS MARTI, MD Associate Professor, Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Barcelona, Spain Staff, Department of Oral and Maxillofacial Surgery, Hospital General de Catalunya & Teknon Medical Center, Barcelona, Spain ACKNOWLEDGMENTS The authors are indebted to Laura Garcia Arana, MD, for her assistance in preparing the manuscript. We also want to thank Emilio Gonzdlez Matheu, MD, DDS, and Luis Aullé for their superb drawings.FOREWORD Rehabilitation of the lost alveolar bone is today inherent in preprosthetic implantology. Optimal implant positioning is essential to achieve normal anatomical relationships within the oral cavity. Oral and maxillofacial surgery techniques have been incorporated into routine implant practice to restore normal anatomy, thus allowing ideal implant positioning. This book clearly presents, in an orderly way, different alternatives for bone harvesting. Both intra- and extraoral sources have been analysed thoroughly, using a very practical approach. The description of varied clinical applica- tions in each chapter is extremely useful for the clinician facing multiple reconstructive situations in the preprosthetic surgical practice. The authors are to be commended for their systematic and detailed description of all the harvesting techniques. It is noteworthy that a vast array of clinical examples has been incorporated for each harvesting site. This proves the fact that surgeons must have competence in all harvesting techniques. In this way optimally tailored solutions can be found for a spe- cific clinical case. Dr. Hernéndez Alfaro and his co-authors have established a standard in preprosthetic bone surgery and convey it in the clearest possible terms. In summary, this book may be relied on as an emminently practical guide to sound clinical practice. Carlos Navarro-Vila Full Professor of Maxillofacial Surgery Medical School Universidad Complutense de Madrid Chief Department Oral and Maxillofacial Surgery Hospital Gregorio Marafion Madrid, SpainPREFACE Bone reconstruction in implantology constitutes a challenge for the surgeon. The time when lack of bone in the oral region constituted a contraindication for implant therapy are over. Oral and maxillofacial surgery techniques allow harvesting of bone from diffe- rent locations in the body in order to reconstruct defective areas in the oral region. Contemporary implant prosthetics have increased aesthetic and functio- nal demands, and normalisation of alveolar architecture must be a goal. This book is a direct consequence of our clinical activity for the past 12 years. Our postgraduate students have been a stimulus in their desire to have a com- prehensive manual for their daily practice. On the other hand, our courses on the subject have obliged us to compile and systematically organise our clinical material. Our approach overall has been pragmatic. The goal is to allow surgeons involved in implant therapy to incorporate different procedures for oral bone reconstruction. When designing the book, we decided that organising it by donor sites could facilitate understanding of the pros and cons of each of them, still giving a clear view of all the different indications. We strongly believe that when approaching advanced oral reconstruction one has to know all the sources for autogenous bone grafts in order to choose the best option for a given defect. We will show how similar clinical situations can be managed with different stra- tegies and donor sites. In each chapter a brief anatomical review of the site is followed by a thorough description of the harvesting technique. The third part of each chapter is devoted to clinical applications of a given graft, followed by a list of potential complications of the harvesting technique. Finally, a bibliography is provided. | am very grateful to Drs. Arranz, Biosca, Garcia, Giméno and Marti for their con- tribution to the book. It has been a pleasure to share with them my clinical as well as academic activity for the past 12 years. Federico Hernandez Alfaro MD, DDS, PhD, FEBOMSCONTENTS CHAPTER 1 CHAPTER 2 CHAPTER 3 CHAPTER 4 CHAPTER 5 CHAPTER 6 CHAPTER 7 CHAPTER 8& CHAPTER 9 CHaPTER 10 CuapTeR 11 Contributors Acknowledgments Foreword Preface BioLocy oF Bone GRAFTING GENERAL PRINCIPLES OF BONE GRAFTING SYMPHYSIS AscenbING Ramus AND Boby CoroNoID Process MAXILLARY TUBEROSITY ‘Sinus WALL ZyGomaric BUTTRESS CALVARIUM Iuiac Crest TIBIA 9 17 27 85 107 121 133 145 151 165 209