Oral Health Group

The Advantages of Block Grafting in Replacing the Bulk of Labial Bone Lost from Extractions

August 1, 2004
by Blake Nicolucci, BSc. DDS

If you’ll recall the July 2004 issue of Oral Health, my article dealt with ‘Pre-Implant Bone Manipulation for the General Practitioner’. I was concentrating on the actual preparation of the bone in the implant site so that the case could be ‘prosthetically’ driven rather than ‘surgically’ driven. Here, I would like to present a case from beginning to end — which will indicate how placing the implants in the appropriate positions can lead to an esthetically and functionally acceptable result. Some areas where patients want implants placed are, as we discussed in that last article, deficient of a good bone foundation. The idea is ‘not to place implants where there is sufficient bone’ but to ‘create enough bone where the implants should ideally be placed’.

In the following case presentation, I would like to demonstrate the advantages of block grafting in replacing the bulk of labial bone lost from extractions, and long time usage of a maxillary partial denture. The mono-cortical bone grafting places the implants back in their original position so that the emergence profile will provide better esthetics, and proper biomechanical forces on the implants. Without ‘osseo-distraction’ it is very difficult to develop any vertical bone height that has been lost. This case would have benefited from this process, but the patient opted for an ‘FP3’ prosthesis to replace the lost height of bone. They say a picture is worth a thousand words, so here is my textbook on a single case.


Without the advantage of block grafting, this case would not have turned out to be as esthetically pleasing as it did. The fact that the normal arch in the premaxilla was able to be reconstructed, allowed us to regain the lip support that was lost from extensive use of the partial denture. With the number of implants used, and being joined in a bridge, I expect this appliance to last a considerable length of time. The vertical height of bone is very difficult to regain through normal grafting procedures. A maximum of two to 3mm of bone height can be regained without losing the graft. The most predictable method for gaining bone height is now through osseous distraction. This is a new method of growing bone, and is very technique sensitive. A qualified surgeon should be chosen to do it, and it also has limitations. But that is another story.

Dr. Nicolucci is president of the Canadian Society of Oral Implantology and Oral Health’s implantology board member.

Oral Health welcomes this original article.

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