Reconstruction of the anterior maxilla with platelet gel, autogenous bone, and titanium mesh: a case report.

Abstract

Reconstruction of defects in the anterior part of the maxilla to enable implant placement is a challenging treatment. Recent studies have suggested that the use of autogenous platelet gel may contribute to improved healing of bone grafts. A case is presented in which particulated autogenous bone, platelet gel, and a titanium mesh were used for alveolar bone reconstruction of the anterior maxilla prior to implant placement. Corticocancellous bone from the iliac crest was mixed with a preparation of autogenous platelet gel (platelet-rich plasma, thrombin, and calcium chloride) and placed against a titanium mesh fixed to the bone of the palate in a patient with severe resorption of the anterior maxilla. After 4.5 months of healing the mesh was removed and titanium implants were placed. A prolonged healing period of 8 months was allowed before healing abutments were placed and a fixed dental bridge was fabricated. Healing was uneventful, and the anterior maxilla had increased in height and width during the initial healing. All implants became integrated and have been supporting a fixed dental bridge for over 3 years with no dramatic dimensional changes of the graft. This case demonstrates that particulated autogenous bone and platelet gel may be used for reconstruction of the anterior maxilla. Autogenous growth factors in the gel possibly contributed to the positive outcome. Controlled clinical studies are needed to evaluate the effect of using platelet-rich plasma.