Journal of Oral Implantology December 2014 - (Page 707)

CASE REPORT Severe Mandibular Atrophy Treated With a Subperiosteal Implant and Simultaneous Graft With rhBMP-2 and Mineralized Allograft: A Case Report Cosimo Loperfido, DDS, MSc1* Juan Mesquida, DDS2 Jaime L. Lozada, DMD2 A 71-year-old patient was successfully rehabilitated by means of a 3D model-derived, hydroxyapatite-coated titanium subperiosteal mandibular implant. The implant was specifically designed to allow bone augmentation. The deficient bone was simultaneously grafted with mineralized bone allograft and recombinant bone morphogenetic protein À2 (rhBMP-2). The 32-month postoperative cone beam computerized tomography follow-up showed vertical bone augmentation beneath the implant frame. Key Words: subperiosteal implant, allograft, BMP, vertical augmentation INTRODUCTION R esorption of the alveolar ridge represents a challenge for dental implant placement. Through the years, different techniques have been used to allow dental implant placement in sites with deficient alveolar bone volume. In previous decades, subperiosteal implants were extensively utilized in patients with severe bone resorption.1,2,3 The subperiosteal implant was first described in the mid-1940s,4 then further refined by Goldberg5 and Linkow;1 throughout the years it has undergone significant changes and improvements in terms of materials and shape. One of the major problems attributed to the use of the early subperiosteal implants was the fibrous encapsulation that led to implant movement during occlusal load and eventually to bone loss and implant failure.6 Starting with the early 1970s, the researchers' attention focused on how to prevent bone resorption, improve bone volume, and allow 1 Private practice, London, United Kingdom. Loma Linda University School of Dentistry, Loma Linda, Calif. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-12-00132 2 the integration of the implant with the surrounding bone. In 1972, a preliminary human study demonstrated the feasibility of autogenous bone graft performed simultaneously with a subperiosteal implant.7 A few years later, the same authors showed in a Macaca mulatta monkey study that grafting the atrophic mandible with autogenous bone and hydroxyapatite, while simultaneously placing a subperiosteal implant, led to stable bone formation underneath the implant at the 6-month follow-up.8 During the same time period, similar studies showed encouraging results.9 The rationale of using a bone graft underneath a subperiosteal implant was based on the possibility of obtaining a more resorption-resistant alveolar ridge,2 allowing osseointegration of the implant,2 and protecting the alveolar nerve which, in these cases, is usually dehiscent.7 However, in the early 1980s, the utility of bone grafts performed alongside subperiosteal implants remained questionable, since long-term results had not shown substantial differences between grafted and nongrafted mandibles after implant placement.6 In recent years, interest in bone morphogenetic proteins (BMPs) has grown considerably. Bone Journal of Oral Implantology 707

Table of Contents for the Digital Edition of Journal of Oral Implantology December 2014

Effect of Splinting in Accuracy of Two Implant Impression Techniques
Assessment of the Stress Transmitted to Dental Implants Connected to Screw-Retained Bars Using Different Casting Techniques
Retentiveness of Various Luting Agents Used With Implant-Supported Prosthesis: An In Vitro Study
Role of rhBMP-2 and rhBMP-7 in the Metabolism and Differentiation of Osteoblast-Like Cells Cultured on Chemically Modified Titanium Surfaces
Coated vs Uncoated Implants: Bone Defect Configurations After Progressive Peri-implantitis in Dogs
Why Guided When Freehand Is Easier, Quicker, and Less Costly?
Advanced Platelet-Rich Fibrin: A New Concept for Cell-Based Tissue Engineering by Means of Inflammatory Cells
Flapless Alveolar Ridge Preservation Utilizing the ‘‘Socket-Plug’’ Technique: Clinical Technique and Review of the Literature
Implants Placed in the Nasopalatine Canal to Rehabilitate Severely Atrophic Maxillae: A Retrospective Study With Long Follow-up
Severe Mandibular Atrophy Treated With a Subperiosteal Implant and Simultaneous Graft With rhBMP-2 and Mineralized Allograft: A Case Report
Full-Mouth Rehabilitation of a Patient With Ectodermal Dysplasia With Dental Implants
The 2-Visit CAD-CAM Implant-Retained Overdenture: A Clinical Report
Assessment of Implant-Related Treatment With Edited Three-Dimensional Reconstructed Images From Cone-Beam Computerized Tomography: A Technical Note
Retrieval of a Separated Implant Screwdriver Fragment
Correction of Esthetic Complications of a Malpositioned Implant: A Case Letter
Fixed Partial Denture Treatment With Mini Dental Implants
Replacement of an Implant and Prosthesis in the Premaxilla Due to a Malposition and Prosthetic Failure: A Clinical Case Letter
A New Restorative Technique for the Perishing Implant Due to Abutment Screw Fracture
Fit of CAD/CAM Implant Frameworks: A Comprehensive Review

Journal of Oral Implantology December 2014