Purpose: Loss of alveolar bone in the anterior maxilla may preclude implant or compromise positioning and thus diminish the final esthetic result of restoration. Bone augmentation can overcome such difficulties but may affect osseointegration. The aim of this study was to report the outcome of buccal onlay bone grafting in the anterior maxilla in routine dental implant practice.
Materials and Methods: Seventeen consecutive patients (12 men and 5 women, mean age 31.4 years) received autogenous bone grafts from the mandibular symphysis to the anterior maxilla. A total of 35 Brånemark System MK II implants were placed in grafted bone.
Results: Fifteen patients had a mean period of graft consolidation of 19.7 weeks (range 13 to 32 weeks). Two patients had simultaneous graft and implant placement; 1 implant failed to integrate in this group. This represents a survival rate of 97.1% of implants in functional loading after a mean follow-up period of 153.6 weeks from occlusal loading (range 74 to 283 weeks).
Discussion and Conclusion: Mandibular block onlay grafts appear to be a predictable method for augmenting the width of the anterior maxilla prior to implant placement.

Purpose: To evaluate whether the combination of 5 surgical techniques in implant dentistry could be performed simultaneously in a predictable manner as effectively as each technique separately.
Materials and Methods: Immediately postextraction, 12 wide-diameter (WD) implants were placed in maxillary first and second molar sites. The residual vertical bone height ranged between 6 and 9 mm (average 7.8 mm). An internal sinus elevation, via the osteotomy site, was carried out in 10 sites using and osteotome tool. Implants were then self-tapped into the osteotomy site followed by insertion of a customize healing screw. Consequently, horizontal gaps between the bony walls and the implant neck were filled by either bovine bone mineral or tricalcium phosphate particles. Full soft tissue closure around the healing cap screw was achieved by coronal positioning of the buccal flap.
Results: Soft tissue healing around the 12 implants was immaculate. In 10 sites, internal osteotome sinus membrane elevation resulted in a height gain of between 2.5 and 6 mm (average 4.3 mm). Radiographically, bone-to-implant contact was evident. All implants were integrated and the prosthetic phase was completed after 6 months.
Discussion and Conclusion: The combination of 1-stage technique and immediate placement of WD implants, along with internal sinus floor elevation and no soft tissue reflection at the time of implantation, is an achievable task and can be performed predictably. Time, cost and morbidity are reduce, and the prosthetic solution is also eased for the benefit of the patient.

Vertical augmentation of the alveolar ridge is intended to restore resorbed alveolar ridges. This procedure is important for the placement of dental implants in a favorable position and also to enhance restoration esthetics. This article presents an approach for vertical ridge augmentation in the anterior maxilla utilizing symphyseal bone cores. A patient presented with 2 localized bony defects of 7 mm on the right and 6 mm on the left were observed in relation to the cementoenamel junction of the adjacent teeth. Two bone cores ewre harvested from the mandibular symphysis using a trephine. These bone cores were trapped into 2 predilled osteotomy sites with corresponding diameters until stabilization was achieved. The 2 sites were grafted with demineralized freeze-dried bone allograft and a titanium-reinforced expanded polytetrafluoroethylene membrane. After 5 months, the membranes wereremoved and vertical ridge augmentation of 5 mm on the right and 4 mm on the left was observed. The width of the ridge was increased as well. Two implants were placed in favorable positions, restored after 6 months, and followed successfully for 1 year after loading. This technique represents a viable approach for augmentation of deficient alveolar ridges prior to the placement of dental implants.