Alveolar Ridge Augmentation using the Allograft Bone Shell Technique.

BACKGROUND: The loss of teeth, whether it is from trauma or pathology, is accompanied by a concomitant loss of the surrounding alveolar bone. Khoury introduced a new method for grafting ridge defects in 2007. This technique involved using thin cortical plates harvested from the ramus, and in a 'sandwich' type manner, interposed these bone plates with cancellous bone harvested from the same site. Although this has shown success, the technique suffers from similar disadvantages of most harvesting techniques, i.e. a need for a second surgical site, and donor site morbidity. In this case presentation, we report the use of an allograft bone plate in a similar manner as was previously described by Khoury, to reconstruction lost alveolar bone in order to facilitate the correct three dimensional (3D) placement of dental implants. CASE DESCRIPTION: A 53-year-old female presented for the restoration of her missing dentition in her upper jaw. The cone bean computed tomography (CBCT) revealed a large horizontal bony defect in the region of the upper anterior teeth, with minimal remaining bone. Using bone fixation screws, the bone plates were fixed to the buccal defect and the space between the plate and the existing palatal bone wall was then filled using a combination of autograft bone scrapings and xenograft bone particles. Six months after the initial surgery, the grafted sites were surgically re-entered and showed a marked increase in ridge width. CONCLUSION: Evidence exists for the use of bone allografts for a variety of alveolar bone augmentation procedures. The case presented outlines another use for this versatile biomaterial. CLINICAL SIGNIFICANCE: Bone harvesting for large alveolar defects is invariably associated with increased morbidity and an increased risk of postoperative complications. The above technique described by the author, may be used as a suitable alternative to reconstruct these defects, without harvesting bone from a second surgical site.

Palatal ulceration as the first sign of pulmonary tuberculosis: a case report.

Tuberculosis (TB) is one of the leading casues of morbidity and death in a number of countries worldwide. A healthy 42-year-old patient presented with a chronic palatal ulcer that was not responsive to routine antibiotic treatment. A biopsy and further systemic investigation revealed a diagnosis of TB. An eight-month extended course of oral rifampin and isoniazid was instituted successfully resulting in complete resolution of symptoms. It is important that clinicians be aware that chronic oral ulcerations may be the first sign of systemic disease. A biopsy should therefore be mandatory for any chronic oral ulcer not responsive to conventional treatment.

Alveolar ridge preservation using leukocyte and platelet-rich fibrin: a report of a case.

In order for a dental implant to be restored optimally, it must be placed in an ideal anatomic position. However, this is not always possible, since physiological wound healing after tooth removal, often results in hard and soft tissue changes which ultimately compromises ideal implant placement. With the aim of minimising the need for tissue augmentation, several alveolar ridge preservation (ARP) techniques have been developed. These often require the use of grafting material and therefore increase the risk of disease transmission. Leukocyte and platelet-rich fibrin (L-PRF) is a newly developed platelet concentrate that is prepared from the patient's own blood. Clinical research has indicated that it improves wound healing and stimulates bone formation. We present a case where L-PRF was successfully used in an ARP procedure to facilitate implant placement in a compromised extraction socket.