Inlay–onlay grafting for three-dimensional reconstruction of the posterior atrophic maxilla with mandibular bone

Bone harvesting from the mandibular ramus (a and b) and from the chin (c and d).

Inlay–onlay grafting in the posterior maxilla of a 53-year-old female patient with a failing prosthesis (a). The bony width was insufficient for the placement of implants (b and c). The bony height was not sufficient because of sinus pneumatization. The inter-arch distance was not increased. An inlay–onlay graft was prescribed: three blocks were harvested from the chin. One was milled and the resulting particulated bone was grafted into the sinus and two blocks were secured to the alveolar ridge for horizontal augmentation (d). Bone substitute was added at the periphery of the blocks and two layers of a collagen membrane were used to protect the graft (e). 4 months later a re-entry was performed: the augmented bone (f) permitted the placement of two implants. After their safe healing (g), a new prosthesis was delivered to the patient (g).

Radiographic images of the patient depicted in Fig. 2 before and after treatment. Panoramic X-ray and CT scan showed alveolar bone atrophy before treatment (a and b). Panoramic and periapical X-rays after treatment showed the perfect integration of the implants in the augmented bone (c and d).

Inlay–onlay grafting in the posterior maxilla of a 48-year-old female patient. The bony width in the canine and premolar region was not sufficient (a). The bony height was not sufficient because of sinus pneumatization and vertical resorption of the alveolar ridge with increased inter-arch distance in the first molar area. An inlay–onlay graft was planned: a block was harvested from the ramus and separated into three pieces: one was milled and the resulting particulated bone was grafted into the sinus, another was secured to the alveolar ridge for horizontal augmentation in the canine and premolar area, and the last block was secured in the molar area for vertical augmentation (b). 4 months later a re-entry was performed: the augmented bone showed only minimal resorption and allowed the placement of three implants in the canine, first premolar and first molar sites (c and d).