(82) The use of the “sandwich” technique for horizontal augmentation of a severely resorbed maxillary anterior ridge: A case report.

Introduction: Regeneration of severely resorbed alveolar ridges in anticipation of implant placement is a challenging clinical problem, especially in the esthetic zone. A variety of techniques and materials can be used for this purpose. One such procedure is the so-called “sandwich” technique in which an inner layer of cancellous bone allograft is placed over the residual native bone and then covered with cortical allograft. The concept is based on the normal in situ anatomic relationship between cortical and cancellous bone. In this case report we demonstrate the use of the sandwich technique to successfully regenerate a severely resorbed anterior maxilla.

Methods: A 42-year-old asian male with a non-contributory medical history presented with severe horizontal ridge resorption of his anterior maxilla. After administering local anesthesia, full-thickness mucoperiosteal flaps were elevated, residual soft tissue was removed and the bone was decorticated. Cancellous bone allograft (Puros®) was placed over the deficient bone and then covered with cortical allograft. A collagen membrane (Geistlich Bio-Gide®) was trimmed, anchored in place on the facial with bone tacks and the incisal aspect moved to the palate to cover the bone graft. Tension-free primary closure of the flaps was achieved. Post-operative instructions and prescriptions were reviewed. The patient returned for a two-week follow-up exam and healing was uneventful. Six-months post-surgically, a cone-beam computed tomogram (CBCT) was taken.

Results: Comparison between the pre- and 6 months post-surgical CBCT scans revealed ample of the previously deficient anterior maxilla. The augmentation was sufficient to allow implant placement.

Conclusions: The sandwich technique using a combination of cortical and cancellous bone allograft in conjunction with resorbable collagen membranes results in predictable horizontal augmentation of severe maxillary anterior ridge deficiencies.

Lead Author's Contributions to the Research Project. : The lead author was the surgeon performing the surgery for the case report and responsible the data collection