1. Alveolar zygomatic buttress as a donor site
Topic: Implant therapy outcomes, surgical aspects
Alveolar zygomatic buttress as a donor site
for localised ridge augmentation - case report Marko Pejović, Jelena Stepić, Miroslav Dragović, Marko Magić, Snježana Čolić School of Dental Medicine University of Belgrade
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Abstract
Results
The gain of 3.2 mm in width was measured using cone beam CT image (Figures 8).
Prerequisite for optimal implant positioning and successful osseointegration is certainly adequate bone volume at the implant site. However it was estimated that around 50% of implant sites required bone augmentation before or at the same time with implant placement. The aim of this case report is to present advantages of alveolar zygomatic buttress block graft for ridge augmentation with simultaneous treatment of pseudo cystic lesion localised in maxillary sinus at the same side. With the help of piezosurgery the graft sized 12 x 7 mm was obtained. Then a bone transplant was fixed in the left cuspid region with two bone screws, each 1.5 mm in diameter and 10 mm long. Over the bone block graft xenogenic bone substitute and collagen membrane were placed. In the grafted region implant was placed after five months addition to other five ones in prostheticly driven positions. The gain of 3.2 mm was measured using cone beam CT image. In spite of not being so thick, a favourable convex graft shape provided secluded space for clot stabilization and satisfying regenerated ridge width. Alveolar zygomatic buttress is adequate as a source of block grafts only for short range defects. 2 8
Then a bone transplant was fixed in the left cuspid region with two bone screws, each 1.5 mm in diameter and 10mm long. The shape of the zygomatic crest bone graft required no additional changes in contour except the rounding of sharp edges. The name “CoCoon technique” refers to protective shell in which particulate graft is contained. Over the bone block graft xenogenic bone substitute and collagen membrane were placed. Concurrently, that newly formed opening was used for the pseudocyst aspiration providing its collapse owing to appropriately position the implant with closed sinus floor elevation according to Summers. In the grafted region implant was placed after five months addition to other five ones in prostheticly driven positions (Figures 3 – 7).  
Conclusions
Advantages of zygomatic buttress as a donor site:
easy access with excellent visibility
bone morphology and quality
graft shape
no muscle detachment
Only one operation field
Drawback:
amount of gained bone
Alveolar zygomatic buttress is adequate as a source of block grafts only for short range defects. 9
Background and Aim
Prerequisite for optimal implant positioning and successful osseointegration is certainly adequate bone volume at the implant site. However it was estimated that around 50% of implant sites required bone augmentation before or at the same time with implant placement. Despite the fact that there are a plenty of bone substitutes on the market, autogenous corticocancellous bone grafts have been remained the gold standard for the reconstruction of alveolar bone. Mandibular ascending ramus, chin area, lower border of the mandible or posterior maxillary region are common donor sites used for alveolar deficiency augmentation.
The aim of this case report is to present advantages of alveolar zygomatic buttress block graft for ridge augmentation with simultaneous treatment of pseudo cystic lesion localized in maxillary sinus at the same side. 3 4
References
Alveolar zygomatic buttress: a new donor site for limited preimplant augmentation procedures, J Oral Maxillofac Surg 65: ,2007
Containment and contouring (CoCoon) technique:a biologicallz adequate approach to less invasive autogenous preimplant augmentation of bone, British Journal of Oral and Maxillofacial Surgery 51: ,2013.
Methods and Materials
After midcrestal and vertical incisions the bone block graft harvesting from the left alveolar zygomatic buttress was carried out. With the help of piezosurgery the graft sized 12 x 7 mm was obtained
(Figure 1 – 2). 5 1 6 7
Presented at the 23rd Annual Scientific Meeting of the European Association for Osseointegration
25-27 September 2014, Rome, Italy