case_images: PMC11757243_01
case_images: Pre-operative CBCT and surgical plan design (A) CBCT panoramic image. (B) Available bone height of implant sites #36. (C) Alveolar ridge width of implant sites #36 (taking the baseline 1 mm below the dental ridge crest). (D) Available bone height of implant sites #37. (E) Alveolar ridge width of implant sites #37 (taking the baseline 1 mm below the dental ridge crest). (F)
  In situ Onlay bone graft design.
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case_images: PMC11757243_01_fbioe-12-1535207-g001.jpg
case_images: F1
case_images: The width of alveolar bone and available bone height at sites 36 and 37 are illustrated in Figures 1A-E. To minimize neurological complications, a trapezoidal bone block of dimensions 12 mm*12 mm was planned for harvest, featuring a crest thickness of around 1.9 mm and an oblique end thickness of about 3.9 mm (Figure 1F).
case_images: The process of GBR assisted in situ Onlay grafting. (A) Preoperative morphology of the edentulous ridge. (B) Surgical incision. (C) Use of mechanical press to cut bone block according to preoperative planning. (D) Length measurement of the bone block (approximately 12 mm). (E) Width measurement of the bone block (approximately 12 mm). (F) Trabecular surface of the grafted bone block. (G) Use of mechanical press to trim the edges of the bone block. (H) Trabecular structure of the bone after bone extraction. (I) Embedding of the grafted bone block into the trabecular structure of the recipient area and fixing it with titanium pins. (J) Mixing CGF with Bio-oss bone powder particles. (K) Preparing the CGF membrane. (L) GBR enhancement: placing Bio-oss bone powder between the block-shaped graft and the jawbone, at discontinuous boundaries and on the surface. (M) Covering the collagen membrane. (N) Fixing the collagen membrane and covering the CGF membrane sheet. (O) Closing the incision with careful suturing.
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case_images: F2
case_images: Finally, buccal flap retraction was performed using a periosteal relaxer, and the wound was closed in a single-stage, tension-free manner utilizing 3-0 absorbable sutures (PDS, polydioxanone sutures; Ethicon, Somerville, New Jersey, United States) (Figure 2).
case_images: (A, B) Postoperative intraoral view on the seventh day. (C-F) Postoperative intraoral view on the sixteenth day (after suture removal). (C, D) Before suture removal. (E, F) After suture removal. (G-K) CBCT on the seventh month after the follow-up visit. (H, I) Implant sites #36. (J, K) Implant sites #37. (L-U) Titanium nail removal and implant surgery process.
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case_images: F3
case_images: At the 7-month follow-up appointment, the patient exhibited well-healed oral mucosa and complete restoration of the alveolar ridge (Figures 3G-K). Furthermore, a CGF membrane was applied over the crest of the alveolar ridge, followed by loose suturing of the wound (Figures 3L-U).
case_images: CBCT data of implant sites #36 (A) and #37 (B) 4 months after implant surgery. (C-F) Upper structure completed 4 months after implant surgery. (G-I) Alveolar bone width and changes of implant sites #36 (G) T0, (H) T1, (I) T2. (J-L) Alveolar bone width and Changes of implant sites #37 (J) T0, (K) T1, (L) T2. (M, N) 3D composite images of the mandible based on CBCT data before horizontal bone augmentation (blue), 7 months after horizontal bone augmentation (red), and 4 months after implant placement (yellow). (O, P) 3D composite images of implant sites #36 based on CBCT data before horizontal bone augmentation (blue) and 7 months after horizontal bone augmentation (red), along with a comparison of coronal bone volume (P). (Q, R) 3D composite images of implant sites #37 based on CBCT data taken at 7 months after horizontal bone augmentation (red) and at 4 months after implant placement (yellow), as well as a comparison of coronal bone volume (R).
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case_images: F4
case_images: At the 4-month follow-up post-implant surgery, a CBCT scan was conducted to check the two implants (Figures 4A, B). Ultimately, digital casting was employed for crown restoration (Figures 4C-F). The resulting data was imported into Mimics software (Materialise Mimics V24.0; Materialise; Geomagic 2013.0.1.1206, United States) for generating and fitting 3D models (Figures 4M-R), facilitating the evaluation of the impact of horizontal bone augmentation and subsequent bone resorption following Onlay implantation with GBR support at the site of bone grafting.