augmentation with autogenous bone is required to restore
the alveolar dimension and provide the necessary facial
support. Bone is harvested from the iliac crest.
To determine the quantity of bone to be harvested, the
selected tooth position is related to a stone cast of the
edentulous ridge by means of a plater matrix. Silicone can be
used to form a template to facilitate both the harvesting of
bone from the iliac crest area and also to adapt the graft to
the recipient site.
The onlay graft is stabilized using position screws.
Tension-free closure is obligatory and is facilitated with a
periosteal release incision. Implant placement should be
delayed for at least three months.
CLASS VI MAXILLA
Resorption of the maxillary alveolar process eventually leads
to a relatively posterior and cranial position of the maxilla
resulting in a reversed intermaxillary relationship and
increased vertical intermaxillary distance. Reconstruction
of the class VI maxilla aims at restoration of interarch
relationship and augmentation of the alveolar bone to
provide support for the collapsed facial musculature and
implant placement (Figure 2.8.3).
SURGICAL TECHNIQUE
A horseshoe incision is made high in the vestibule from first
molar to first molar. The mucoperiosteum is reflected and
the lateral sinus wall and nasal aperture are exposed. A No.
5 round bur is used to make the horizontal osteotomy cut.
The thin sinus membrane is elevated (preferably intact). The
bone cuts are completed, including the medial sinus wall
and nasal septum. The tuberosity is detached from the
pterygoid plate using a small osteotome. Due to the fragile
nature of the maxilla, the ‘down fracture’ procedure must
be carried out gently. In cases of severe rupture of the sinus
membrane, the exposed sinus is sealed with a cortical plate
bone stabilized with a microplate. The mobilized maxilla is
fixed in the planned position with four microplates. The
intervening space is packed with particulate cancellous
bone. Tension-free closure of the soft tissues is obligatory
and periosteal release incision may be required for this to be
achieved. Implants are placed at least three months later in
the planned position using a surgical guide (Figure 2.8.11).
ATROPHIC MANDIBLE
Unlike the maxilla, which is composed of trabecular bone
predominantly with a thin cortex, the mandible has a thick
cortical layer. This provides superior support for endosteal
implants, particularly in the anterior mandible. Following
tooth loss, the blood supply of the edentulous mandible
differs from that of the dentate mandible. In the dentate
mandible, blood supply is principally centrifugal arising
2.8.9 Class IV anterior maxilla augmented with a veneer
graft and stabilized lag screws. From Atlas of Craniomaxillofacial
Osteosynthesis. Reproduced with permission from Thieme.
2.8.10 Mandibular ramus veneer graft. From Atlas of
Craniomaxillofacial Osteosynthesis. Reproduced with permission
from Thieme.
the alveolar dimension and provide the necessary facial
support. Bone is harvested from the iliac crest.
To determine the quantity of bone to be harvested, the
selected tooth position is related to a stone cast of the
edentulous ridge by means of a plater matrix. Silicone can be
used to form a template to facilitate both the harvesting of
bone from the iliac crest area and also to adapt the graft to
the recipient site.
The onlay graft is stabilized using position screws.
Tension-free closure is obligatory and is facilitated with a
periosteal release incision. Implant placement should be
delayed for at least three months.
CLASS VI MAXILLA
Resorption of the maxillary alveolar process eventually leads
to a relatively posterior and cranial position of the maxilla
resulting in a reversed intermaxillary relationship and
increased vertical intermaxillary distance. Reconstruction
of the class VI maxilla aims at restoration of interarch
relationship and augmentation of the alveolar bone to
provide support for the collapsed facial musculature and
implant placement (Figure 2.8.3).
SURGICAL TECHNIQUE
A horseshoe incision is made high in the vestibule from first
molar to first molar. The mucoperiosteum is reflected and
the lateral sinus wall and nasal aperture are exposed. A No.
5 round bur is used to make the horizontal osteotomy cut.
The thin sinus membrane is elevated (preferably intact). The
bone cuts are completed, including the medial sinus wall
and nasal septum. The tuberosity is detached from the
pterygoid plate using a small osteotome. Due to the fragile
nature of the maxilla, the ‘down fracture’ procedure must
be carried out gently. In cases of severe rupture of the sinus
membrane, the exposed sinus is sealed with a cortical plate
bone stabilized with a microplate. The mobilized maxilla is
fixed in the planned position with four microplates. The
intervening space is packed with particulate cancellous
bone. Tension-free closure of the soft tissues is obligatory
and periosteal release incision may be required for this to be
achieved. Implants are placed at least three months later in
the planned position using a surgical guide (Figure 2.8.11).
ATROPHIC MANDIBLE
Unlike the maxilla, which is composed of trabecular bone
predominantly with a thin cortex, the mandible has a thick
cortical layer. This provides superior support for endosteal
implants, particularly in the anterior mandible. Following
tooth loss, the blood supply of the edentulous mandible
differs from that of the dentate mandible. In the dentate
mandible, blood supply is principally centrifugal arising
2.8.9 Class IV anterior maxilla augmented with a veneer
graft and stabilized lag screws. From Atlas of Craniomaxillofacial
Osteosynthesis. Reproduced with permission from Thieme.
2.8.10 Mandibular ramus veneer graft. From Atlas of
Craniomaxillofacial Osteosynthesis. Reproduced with permission
from Thieme.
CLASS V MAXILLA
The class V maxilla is characterized by loss of the alveolar
process resulting in a vertical, transverse and anteroposterior
The class V maxilla is characterized by loss of the alveolar
process resulting in a vertical, transverse and anteroposterior
alteration of the interarch relationship. Extensive
مطلوب زيادة مع العظم ذاتي المنشأ لاستعادة
البعد السنخية وتوفير ما يلزم من الوجه
دعم. يتم حصاد العظام من عرف الحرقفة.
لتحديد كمية من العظام إلى أن تحصد، في
ويرتبط الموقف الأسنان اختيارها ليلقي الحجر
ريدج أدرد عن طريق مصفوفة الحصان الرديء. السيليكون يمكن أن تكون
تستخدم لتشكيل قالب لتسهيل كل من حصاد
العظم من منطقة قمة الحرقفي وأيضا للتكيف مع الكسب غير المشروع إلى
موقع المتلقي.
واستقرت الكسب غير المشروع راصعة باستخدام مسامير الموقف.
البعد السنخية وتوفير ما يلزم من الوجه
دعم. يتم حصاد العظام من عرف الحرقفة.
لتحديد كمية من العظام إلى أن تحصد، في
ويرتبط الموقف الأسنان اختيارها ليلقي الحجر
ريدج أدرد عن طريق مصفوفة الحصان الرديء. السيليكون يمكن أن تكون
تستخدم لتشكيل قالب لتسهيل كل من حصاد
العظم من منطقة قمة الحرقفي وأيضا للتكيف مع الكسب غير المشروع إلى
موقع المتلقي.
واستقرت الكسب غير المشروع راصعة باستخدام مسامير الموقف.
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