Custom allogeneic block graft for ridge augmentation: Case series.

INTRODUCTION: Alveolar bone deficiency is a common postextraction sequela that adversely affects implant placement. Therefore, ridge augmentation is often required to obtain proper bone quantity and quality for restoratively driven implant placement. This case series describes the successful horizontal and vertical alveolar ridge augmentation using custom-fabricated allogeneic block bone grafts. CASE SERIES: Two healthy partially edentulous patients presented to private practice seeking dental implant treatment. Initial clinical examination and cone-beam computed tomography (CBCT) radiographic analysis showed moderate to large horizontal ridge defects. Treatment options were discussed for alveolar ridge augmentation and the patients elected to undergo the custom allogeneic block graft procedure to regenerate the atrophied alveolar ridges. The CBCT scan in conjunction with computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to fabricate customized allogeneic block grafts based on alveolar ridge topography. The custom allogeneic block graft allowed less surgical time and decreased postoperative morbidity. The grafted area was allowed 6 months of healing time. Follow-up radiographs showed the stability of the graft followed by dental implant placement. The dental implants were functionally loaded, and successful implant esthetics and function achieved. CONCLUSION: Custom allogeneic block grafts could provide a promising innovative method for optimal ridge augmentation. Why are these cases new information? Less invasive procedure as an alternative conventional two-stage block augmentation. More predictable outcome due to customized block graft. What are the keys to successful management of these cases? It is important determining the type of bone defect. Vertical and horizontal bone loss. Primary closure. What are the primary limitations to success in these cases? Limited data from prospective clinical trials documenting the effectiveness of custom allogeneic block grafts. Limited data are available to confirm accuracy of the CAD/CAM process. Passive flap closure is needed.

Supernumerary tooth autotransplantation to replace missing maxillary central incisor using three-dimensional replica: A 6-year follow-up.

INTRODUCTION: Tooth autotransplantation is a viable surgical treatment option for patients with missing permanent teeth. Premolars are generally used for autotransplantation but often require extensive modifications. This case report evaluates the use of supernumerary tooth as an alternative option for premolar autotransplantation. This report shows successful supernumerary tooth autotransplantation with 6-year follow-up. METHODS: A 13-year-old male with non-contributory medical history was referred for a missing maxillary left central incisor (#9) and presence of a supernumerary tooth. The clinical and radiographic examination revealed presence of supernumerary tooth with similar dimensions to a central incisor. The treatment plan included autotransplantation of the supernumerary tooth to replace the missing central incisor (short-term) and future implant replacement of the autotransplanted tooth when jaw growth ceases (long-term). The patient and parents consented to treatment. A 3-D tooth replica was constructed based on CBCT analyses. Site #9 was prepared using split ridge technique to create a socket to house the 3-D replica. Upon achieving proper socket form, the supernumerary tooth was extracted and autotransplanted in the prepared socket. The supernumerary tooth was splinted, and the bite opened posteriorly using composite to eliminate any occlusal interferences. RESULTS: The patient was followed up clinically and radiographically. The autotransplanted supernumerary tooth integrated well within the newly created socket and remained functional at the 6-year follow-up. CONCLUSIONS: The current case presents successful management of supernumerary tooth autotransplantation with 6-year follow-up. The results show stable periodontium with satisfactory functional and aesthetic results.