2. A CLINICAL STUDY AND REVIEW OF
LITERATURE
Guided by DR. SUNIL C DUTT, Prof. & HOD
DR. M. SATISH, Reader
DR. DEEPAK THAKUR, Reader
DR. MANISH PANDIT, Senior Lecturer
Presented by –
DR. SHEETAL KAPSE
2ND YEAR P.G. STUDENT
2

3.  INTRODUCTION
 AIM & OBJECTIVE OF STUDY
 ANATOMY
 CLINICAL PRESENTATION
 DISCUSSION WITH REVIEW OF LITERATURE
 CONCLUSION
 RESOURCES
3

4. • Augmentation of maxillary alveolar bone defects
for placement of implant still poses a clinical
challenge for the surgeons.
• In addition to autogenous bone & alloplastic
materials, synthetic bone substitutes as well as
denatured bovine bone & coral structures, are all
possible alternatives available for use as
augmentation material.
4

5. • But the use of autogenous bone graft
still remains the ‘gold standard’ for
both cancellous & cortical bone
grafting applications.
5

6. Maxillary Tuberosity
• After bone harvesting from this
area, postoperative trismus as well as injury
to the adjacent soft tissues with profuse
hemorrhage can occur.
Gellrich NC, Held U, Schoen R, Pailing T, Schramm A, Bormann
KH. Alveolar Zygomatic Buttress: A New Donor Site for Limited
Preimplant Augmentation Procedures J Oral Maxillofac Surg
.2007;65:p275-280.
6

7. Palatal Graft
7

8. Osteodistraction
• This method might be
considered by some
clinicians and patients
alike to be a rather
involved and timeconsuming alternative.
Schlegel KA, Neukam FW:
Augmentationen, Knochenersatzmaterialien, Membranen, in
Reichart PA, Hausamen J-E, Becker J, Neukam FW, Schliephake
H, Schmelzeisen R (eds): Zahnärztliche Chirurgie I.
8

9. 9

10. • Why the Zygomaticomaxillary buttress……
• Advantages and limitations ……..
10

11. 11

12. 12

13. • Vase shaped
• Boundaries  Inferiorly- alveolar process and roots of teeth
 medially - roots and sinus
 superiorly joins the zygoma
 posteriorly infratemporal fossa
• Bone quality – cortical & cancellous
• Intramembranous ossification
• Function - Provides pressure absorption and
transduction in the facial skeleton.
• Pathologies and variations not known
13

14. 14

15. • Subsulcular
or
Extended crestal incision
• Elevation…superiorly
till the ZM suture
• These designs will expose the entire buttress.
15

16. • The minimum donor site surface area
should be approximately 10 mm X 15 mm
and accessible with the instrument at an
angle between 5° and 50°.
Peleg M, Garg AK, Misch CM, Mazor Z. Maxillary sinus and
ridge augmentations using a surface-derived autogenous bone
graft. J Oral Maxillofac Surg. 2004 Dec;62(12):1535-44.
16

17. Technical note
• Use of ultrasound based dissection with
piezosurgery causes no trauma to sinus
membrane.
Gellrich NC, Held U, Schoen R, Pailing T, Schramm A, Bormann KH. Alveolar Zygomatic
Buttress: A New Donor Site for Limited Preimplant Augmentation Procedures J Oral
Maxillofac Surg .2007;65:p275-280.
17

18. 1. Accessibility to site & excellent visibility.
2. Same morphology & Same architecture.
3. Good quality & adequate quantity.
4. No muscular or neurovascular injury.
5. Less prone to resorption.
6. 1.5 to 2 cm - not compromise the strength of the
lateral midface frame.
18

19. •
•
•
•
Damage to maxillary sinus membrane.
Damage to tooth root.
Limited volume of graft.
Contraindicated in patients with sinus problem
Montazem A, Valauri D, St-Hilaire H, Buchbinder D. The mandibular symphysis
as a donor site in maxillofacial bone grafting: a quantitative anatomic study. J Oral
Maxillofac Surg 2000: 58: 1368–1371.
Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant
placement. Int J Oral Maxillofac Implants 1997: 12: 767–776.
Sindet-Pedersen S, Enemark H. Reconstruction of alveolar clefts with mandibular or iliac
19
crest bone grafts: a comparative study. J Oral Maxillofac Surg 1990: 48: 554–558.

20. Case report.......
20

21. • A 26 year old male visited us for rehabilitation
of lost teeth following RTA, Was treated in
2010 for pan facial fractures by ORIF.
21

22. Treatment plan
• Following clinical, radiological and model
assessments Maxillary rehabilitation was planned
using implants supported prosthesis bridge .
22

23. • Bone height was found satisfactory except in the
canine region where a crater of about 1cm was
present.
• Zygomaticomaxillary buttress grafting under local
anesthesia.
23

24. • Zygomaticomaxillary buttress grafting under local
anesthesia.
24

25. • Implant site was exposed through crestal
incision and grafting site exposed through a
Subsulcular incision .
25

26. • A 5mm trephine was used to harvest the graft
from the buttress region.
26

27. • A hole for accommodating implant drilled in
the graft.
27

28. • Graft was held in place and a 3.75 X 16 mm
implant was carefully inserted into the previously
prepared site.
28

29. 29

30. Follow up visits.........
Weekly for 1
month
• found healing uneventful.
30

31. 4 months
• prosthetic rehabilitation.
31

32. CBCT –1 year
Post-Operative
1 year
• No mobility, resorption or any
other complications were noted.
32

33. Discussion & review of
literature
33

34. • To achieve a good esthetic result and long-term
functional stability, positioning of the implant is
crucial.
• Alveolar crest defects have been particularly
scrutinized because they are the limiting factor in
optimal implant positioning.
• If the bony recipient site does not fulfill the later
implant- based prosthodontic requirements, failure of
the whole treatment is likely to occur.
34

35. Supporting articles
35

36. Peleg et al in 2004
Michael Peleg, Arun K. Garg, Craig M. Misch, Ziv
Mazor, Maxillary Sinus and Ridge Augmentations Using a
Surface-Derived Autogenous Bone Graft. J Oral Maxillofac
Surg. 2004; 62:1535-1544.
Gellrich et al in 2007
Gellrich NC, Held U, Schoen R, Pailing T, Schramm A, Bormann KH.
Alveolar Zygomatic Buttress: A New Donor Site for Limited Preimplant
Augmentation Procedures. J Oral Maxillofac Surg .2007;65:p275-280.
36

37. Conclusion
37

38. References
1.
Gellrich NC, Held U, Schoen R, Pailing T, Schramm A, Bormann KH.
Alveolar Zygomatic Buttress: A New Donor Site for Limited Preimplant
Augmentation Procedures J Oral Maxillofac Surg .2007;65:p275-280.
2.
Schlegel KA, Neukam FW: Augmentationen, Knochenersatzmaterialien,
Membranen, in Reichart PA, Hausamen J-E, Becker J, Neukam FW,
Schliephake H, Schmelzeisen R (eds): Zahnärztliche Chirurgie I. Berlin,
Quintessenz, 2002, pp 434-459
3.
Michael Peleg, Arun K. Garg, Craig M. Misch, Ziv Mazor, Maxillary
Sinus and Ridge Augmentations Using a Surface-Derived Autogenous
Bone Graft. J Oral Maxillofac Surg. 2004; 62:1535-1544.
4.
Kainulainen VT, Sàndor GK, Oikarinen KS, Clokie CM. Zygomatic
bone: an additional donor site for alveolar bone reconstruction. Technical
note. Int J Oral Maxillofac Implants. 2002 Sep-Oct;17(5):723-8.
38

39. References
5.
Montazem A, Valauri D, St-Hilaire H, Buchbinder D. The mandibular
symphysis as a donor site in maxillofacial bone grafting: a quantitative
anatomic study. J Oral Maxillofac Surg 2000: 58: 1368–1371.
6.
Misch CM. Comparison of intraoral donor sites for onlay grafting prior to
implant placement. Int J Oral Maxillofac Implants 1997: 12: 767–776.
7.
Sindet-Pedersen S, Enemark H. Reconstruction of alveolar clefts with
mandibular or iliac crest bone grafts: a comparative study. J Oral
Maxillofac Surg 1990: 48: 554–558.
39

40. 40

41. 41