PMC8516546_01
(a) Three-dimensional computed tomography showing partial bony defect of the left maxillary bone. (b) Preoperative panoramic radiography showing a large radiolucent area at the left side of the maxilla.
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Clinical and radiological examinations (3D computed tomography [CT], orthopantomogram [OPG]) revealed a left maxillary bone defect, extending from the left upper central incisor to the left first molar and vertically to the floor of the maxillary sinus (Figure 1).
(a) Bone marrow aspirate concentrate. (b) Recombinant human bone morphogenetic protein 2 (rhBMP-2). (c) Maxillary extraosseous vertical ridge defect. (d) rhBMP-2, allograft, and bone marrow aspirate concentrate condensed inside prepared mesh covered by the platelet-rich fibrin.
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The BMA was centrifuged and BMAC was prepared by separating the plasma from the blood (Figure 2(a)). rhBMP-2 (Infuse Bone Graft, 8 cc; Medtronic, Minneapolis, MN) was prepared according to the manufacturer's recommendations (Figure 2(b)). Finally, the mesh was adapted to the recipient area and fixed to the maxillary bone from the buccal side with two screws (Figures 2(c) and 2(d)).
(a) Photographs showing the postoperative view of the maxillary defect. (b, c) Postoperative computed tomography and radiographic evaluation.
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A PRF membrane was placed over the mesh (Figure 3).
(a) Six months postoperation. (b) Exposing and removing the mesh. (c) Implant placement. (d) Radiograph of bone graft at 8-month follow-up. Note: the significant increase in bone augmentation of the maxilla and implant rehabilitation. (e) Complete regeneration in 3 years following reconstruction of the maxillary defect.
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There was no wound dehiscence or mesh exposure during this time (Figure 4(a)). Using a two-stage protocol, four implants (Biomet 3; Palm Beach Gardens, FL) were placed in the left maxilla (3.25 mm x 10 mm, 4 mm x 10 mm, 5 mm x 8.5 mm, 5 x 8.5 mm) and one implant (4 mm x 10 mm) in the left mandible (Figures 4(b) and 4(c)).