#Esthetics 29. Oct 2020

Hard tissue augmentation using an allogenic bone block: a clinical case report

A clinical case report by Laurent Marchand, Irena Sailer, Stefan Paul Hicklin, Geneve, Switzerland

The high clinical survival rates has led to the fact that dental implants are often the treatment of choice for the treatment of single tooth gaps in the posterior region, where more minimally invasive and adhesive restorations are not indicated1. Unfortunately, severely atrophied alveolar crests are frequently observed after traumatic extraction of teeth, resulting in a lack of bone which may complicate the implant placement2. In such situations, an autologous bone block grafting procedure may be considered the golden standard of care, with high survival rates of both the bone block as well as the implants placed into it3.

Allogenic bone blocks offer similar osteoconductive properties compared to autologous bone due to the preserved microstructure of human bone 4. The main advantage of allogenic products is, that there is no need of a donor site and therefore significantly less patient morbidity 5. Recent studies focusing on allogenic bone grafting show overall excellent survival rates of these block grafts of 96.7% 4. Furthermore, the implants placed into allogenic blocks also show a high survival rate of 97.36% 6. At the same time, however, they may exhibit some drawbacks. It has been shown that allogenic graft sites show histologically less revascularization and bone gain when compared to autologous bone grafting 7. Additionally, a sensitization to human leucocyte antigen (HLA) and thus a higher immunological response to allogenic grafts is reported 8 9. In spite of these drawbacks, the shorter surgical intervention, reduced patient morbidity and predictable bone quality are highly advantageous aspects for both dentists and patients.

The present case demonstrates a primary bone augmentation using allogenic bone grafting material with subsequent implant placement and reconstruction with a screw-retained monolithic single crown on a titanium bonding base.

Initial Situation

A 41-year old patient presented at the University clinics of dental medicine of Geneva (Division of Fixed Prosthodontics and Biomaterials) with the primary wish to replace the missing tooth 24 which was extracted more than a decade ago. The patient was healthy, she took no medication and was a non-smoker. The visible single tooth gap at site 24 impaired the patient’s smile and was, therefore, of aesthetical concern. The intraoral examination revealed a severe hard and soft tissue defect at site 24 (Fig. 1 & 2). The tissue conditions however looked favorable, with ample keratinized tissue and a rather thick biotype. An amalgam staining in the keratinized mucosa at site 26 can also be observed.

Treatment Planning

To better assess the bony situation at site 24, a CBCT radiograph was performed. It revealed a very thin bone crest with a width of approximately 3mm and a height of 16mm (Fig. 3). Several treatment options were discussed:

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