Reconstruction of horizontal bone deficiency in maxillary anterior area with GBR technique – A case report

Background Periodontal diseases, trauma, tooth extraction, and long term edentulism can lead to soft and hard tissue defects. As a result, aesthetic and functional deficiencies may occur due to tooth loss. Reconstruction of alveolar ridge requires bone augmentation before implant placement. Various augmentation techniques to increase bone volumes are used with various biomaterials. Guided bone regeneration (GBR) technique has been widely tested with various materials and clinical approaches- bone grafting alone (including autografts, allografts, xenografts and alloplasts) membrane alone, and membrane in conjunction with grafting material. Aim/Hypothesis This case report describe to increasing of bone volume with GBR technique in a patient with a horizontal bone deficiency in the maxillary anterior region. Material and Methods The 18-year-old patient was admitted to our clinic with a history of trauma on the upper central teeth. Although the trauma occurred 2 years ago, the patient did not consult to any dental clinic. Clinical and radiographic examination revealed that both upper incisors had crown fractures, endodontic lesions and dehiscence defects in the buccal bone. Teeth extractions were performed. After 8 weeks of healing period, full thickness mucoperiosteal flap was elevated with a crestal and two vertical incisions under the local anesthesia. Buccal bone was decorticated with surgical round burs. Bovine bone substitute graft materials and autograft particles were covered with pericardium membrane, which was stabilized with titanium pins and stabilization sutures. A periosteal releasing incision connecting the two vertical incisions was made to gain elasticity of the flap until a completely tension-free closure was achieved. The flap was sutured with PGA suture and horizontal mattress sutures followed by single interrupted sutures. After 6 months of the healing period, two implants placement were placed. Results Six months after the first surgery, CBCT scan showed complete bone regeneration after augmentation, allowing implant placement. When the flaps were elevated for implant placement surgery, the regenerated tissue appeared as mineralized bone tissue. Transformation of bovine bone substitute graft materials into the newly formed bone was observed. Conclusion and Clinical Implications Horizontal bone augmentation with GBR is a predictable procedure for dental implant placement. Despite its limitations, this clinical case demonstrated that the combination of autogenous bone grafts, bovine bone substitute material and collagen membrane might be used successfully and safely for horizontal ridge augmentation.