Atrophic Anterior Maxilla Research Articles

Digital PBL-CBL teaching method improves students' performance in learning complex implant cases in atrophic anterior maxilla.

The clinical teaching of esthetic implant-supported restoration of the atrophic maxilla is challenging due to the complexity and unpredictability of bone and soft tissue augmentation. The traditional problem-based learning and case-based learning method (PBL-CBL method) with a full digital workflow (digital PBL-CBL method) provides the students a chance to view clinical cases in a more accurate and measurable way. The aim is to evaluate the effectiveness of the new digital PBL-CBL method in teaching complex implant cases in esthetic area. A full digital workflow of dental implant therapy was established for patients with severely atrophic anterior maxilla. The digital data of cases done in the new workflow was used as teaching materials in digital PBL-CBL teaching. Fifty-four postgraduate students were randomly selected and divided into three groups, including traditional PBL-CBL group (students taught in a PBL-CBL method with no digital cases), digital PBL-CBL group (students taught in a PBL-CBL method with full digital cases) and control group (students taught in didactic teacher-centered method). After training for three months, a study of the students' opinions on the corresponding teaching method was carried out through a feedback questionnaire. A theory test was used to evaluate students' mastery of knowledge about tissue augmentation and esthetic implant restoration. A case analysis was used to determine whether students could apply the knowledge to problem solving. The digital PBL-CBL method resulted in a higher rate of satisfaction than the traditional PBL-CBL method and the didactic teacher-centered method in all items except for "This approach decreases extracurricular work". Case analysis scores of the digital PBL-CBL group were significantly higher than that of the traditional PBL-CBL group and the control group. For the theory test, the digital PBL-CBL group (61.00±6.80) but not traditional PBL-CBL group (55.22±9.86) obtained a significant higher score than the control group (45.11±12.76), although no significant difference was found between the digital PBL-CBL group and the traditional PBL-CBL group. Compared with other methods, students taught with the digital PBL-CBL method showed higher satisfaction and better performance in acquisition of academic knowledge and ability in solving practical clinical problems. The digital PBL-CBL method provided a promising alternative for teaching complex implant cases at the anterior maxilla.

The Customized Alveolar Ridge-Splitting (CARS) Technique Combined with Guided Bone Regeneration or Sinus Elevation Augmentation in Maxillary Deficient Ridges.

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are technique-sensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure-including lateral window sinus augmentation and guided bone regeneration-allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla.

Maxillary Anterior Implant-supported Restorations with Allogeneic Block-bone Graft: A Report of Two Clinical Cases

Prosthetic rehabilitation of a severely atrophic anterior maxilla is challenging. To achieve aesthetic and functional outcomes with anterior implant-supported restorations, horizontal or vertical bone augmentation should be performed prior to implant placement. Autogenous block-bone grafting is the gold standard for onlay graft techniques; however, it is associated with problems, such as patient discomfort due to additional surgery at the intra- or extra-oral donor site. Therefore, the allogeneic block-bone graft, which is relatively less traumatic and safer, is used for convenience, and the high success rate in previous studies has proven the reliability of this technique. Herein, we report two cases in which allogeneic block-bone was successfully grafted in single and long-span defects in the maxillary anterior region, with satisfactory aesthetic and functional outcomes that were stable at regular follow-ups after surgery.

Nasal Floor Elevation—An Option of Premaxilla Augmentation: A Case Report

The atrophic edentulous maxilla is demanding for dental implant placement because of extensive resorption of the alveolar ridge after teeth loss and, consequently, the proximity of the anatomical structures, nasal cavity, and maxillary sinus. Treatment options are short implants, guided bone regeneration, onlay grafts, Le Fort I osteotomy with interpositional bone grafting, distraction osteogenesis, or nasal floor elevation. Nasal floor elevation is a method of augmentation of premaxilla by raising the base of the nose. The aim of this case report is to evaluate the success of implants placed after nasal floor elevation. A 75-year-old female patient came to the Clinical Department of Oral Surgery, University Hospital Centre Zagreb, unsatisfied with her complete removable denture. Clinical and radiological examination revealed severe maxillary alveolar ridge atrophy. Nasal floor elevation was made under local anesthesia through aperture piriformis and lateral window in the distal part. After eight months, four implants were placed and, after period of osseointegration, a bar-retained implant overdenture was made. This case report shows that nasal floor augmentation can be considered among the surgical techniques to allow implant-supported rehabilitation of the atrophic anterior maxilla.

The use of 3D ceramic block graft compared with autogenous block graft for rehabilitation of the atrophic maxilla: a randomized controlled clinical trial

BackgroundDental implant placement may require a bone graft for vertical and horizontal alveolar ridge augmentation. Due to its osteoconduction, osteoinductive, and osteogenesis, autogenous bone graft characteristics are considered the standard gold treatment. However, autografts can promote postoperative morbidity and implicate difficulties concerning the graft adaptation to the recipient's bone since it can eventually avoid gaps. To overcome these issues, this trial will compare the performance of Plenum® Oss 3Dβ fit, an alloplastic graft, and a 3D-printed patient-specific graft based on β-tricalcium phosphate to the autograft procedure.MethodsThis is a split-mouth randomized clinical study designed to evaluate the performance of personalized (patient-specific) bioceramic bone grafts (Plenum® Oss 3Dβ fit) for bone augmentation of the atrophic anterior maxilla in comparison to the autogenous bone graft. We hypothesize that the gain and maintenance of the grafted area volume and the quality of the newly formed bone tissue after eight months postoperative with the synthetic patient-specific graft will be superior to the autogenous bone graft. To assess the quantity and the quality of bone neoformation, volumetric and histological analyses will be performed.DiscussionThe fabrication of medical devices by additive manufacturing presents advantages over conventional manufacturing processes, mostly related to the precision of geometry and anatomy. Additionally, the osteoconductive proprieties of β-tricalcium phosphate enable this synthetic bone substitute as an alternative solution over autogenous graft for bone defect reconstruction. Thus, patient-specific bone grafts can potentially improve patient satisfaction, reducing the need for autogenous bone grafts, consequently avoiding implications related to this type of treatment, such as patient morbidity.Trial registrationThis study is registered in REBEC (Registro Brasileiro de Ensaios Clínicos): RBR-76wmm3q; UTN: U1111-1272-7773. Registration date: 14 September 2021.

Esthetic Assessment following Ridge Augmentation, Late Implant Placement and Immediate Esthetic Reconstruction of the Atrophic Anterior Maxilla.

Purpose: Evaluate the esthetic outcome of ridge augmentation using cancellous bone-block allografts, late implant placement, and immediate loading in the atrophic anterior maxilla, by PES (pink esthetic score) and WES (white esthetic score) indexes. Materials and Methods: Retrospective cohort study. Inclusion criteria were bone loss of at least 3 mm horizontally and 3 mm vertically according to preliminary CBCT; ridge augmentation using cancellous bone-block allografts; six months later the implant insertion and immediately loaded. PES-WES index was used for esthetic assessment of soft tissues surrounding the final implant-supported prosthesis (ISP). Results: All twenty-five successive individuals were included. The mean follow-up was 12.1 ± 56 months (range, 42–90 months). The mean PES index and WES index were 7 ± 1.74 (range: 5–10) and 8.4 ± 2.12 (range: 5–10), respectively. The mean total combination of PES index and WES index (PES/WES) was 15.3 ± 2.85 (range: 12–20). All ISPs had an overall score >12 (the defined threshold of clinical acceptability). Conclusions: Ridge augmentation in the atrophic anterior maxilla using cancellous bone-block allografts and immediate loading allows a stable esthetic result of the soft and hard tissues over the years (follow-up of 42–90 months).

A fully digital workflow for prosthetically driven alveolar augmentation with intraoral bone block and implant rehabilitation in an atrophic anterior maxilla

A fully digital workflow for prosthetically driven alveolar augmentation and implant rehabilitation in the esthetic zone was planned and executed by using a bone harvest guide, trim guide, graft guide, and implant guide. A controllable procedure and predictable results can be realized by adopting this digital workflow.

The Combination Effects of Age-Related Bone Mechanical Property, Cortical Bone Thickness and Incisal Relationship on Biomechanical Performance of Narrow Diameter Implant Placed in Atrophic Anterior Maxilla: Finite Element Analysis

Atrophic anterior maxilla edentulous space could pose a significant challenge to successful osseointegrated implant due to inadequate labio-palatal dimensions. The load transferring to surrounding bone is a key factor for the long-term success of implant treatment. Thus, the aim of this study was to evaluate the influence of bone quality change in age-related bone mechanical property (AMP), cortical bone thickness (CBT) and incisal relationship (ICR) on the biomechanical performance of narrow diameter implant placed in atrophic anterior maxilla via finite element method. Three-dimensional models of a narrow diameter implant and an anterior maxillary bone were constructed. Eighteen different clinical situations including two CBTs [thin (0.5 mm) and thick (1.0 mm)], three AMPs [young, middle and old ages] under three ICRs [a low overbite (LO), a mean overbite (MO), a high overbite (HO)] were studied under the loading of 50.1 N. From the results, it is crucial to consider the critical situations of narrow diameter implant placed in atrophic anterior maxilla where the combination of the thin CBT, old age-AMP and HO-ICR clinical situation which induce surrounding bone resorption and implant damage.

The use of onlay bone grafting for implant restoration in the extremely atrophic anterior maxilla. A case series

Functional and aesthetic treatments are challenging when ensuring maintain long-term successful prosthetic rehabilitation after alveolar ridge resorption of the anterior maxilla. The goal of this case series was to evaluate implant success rate, prosthetic stability and patient satisfaction in patients treated by onlay bone grafting in atrophic premaxilla. Nineteen patients treated for severe atrophic anterior maxilla by reconstruction using onlay bone grafting and implant restoration between 2002 and 2012 were examined. The surgical procedure was designed to allow the insertion of 49 endosseous implants in the grafted anterior maxillae. Bone resorption and implant success rate were retrospectively evaluated after a follow-up period of 5 years (from 5 to 15 years) subsequent to reconstruction. A questionnaire was the medium used to evaluate patient satisfaction and highlight functional and aesthetic outcomes. The bone grafting success rate was 74%. None of the grafted bones were reported to be infected. Four implants were removed. Implant survival rate was 91.8% after 8.9 years. The permanent reconstruction was fixed in 74% of the cases and removable in 26%. The level of patient satisfaction reported was 6.5/7. In conclusion, his study suggests that onlay bone grafting can be considered a predictable technique for rehabilitation in atrophic premaxilla. The procedure has a high implant survival rate, acceptable bone resorption over time, and promotes graft stability for longterm prosthetic fixation, thereby increasing patient satisfaction.

The use of onlay bone grafting for implant restoration in the extremely atrophic anterior maxilla. A case series

Functional and aesthetic treatments are challenging when ensuring maintain long-term successful prosthetic rehabilitation after alveolar ridge resorption of the anterior maxilla. The goal of this case series was to evaluate implant success rate, prosthetic stability and patient satisfaction in patients treated by onlay bone grafting in atrophic premaxilla. Nineteen patients treated for severe atrophic anterior maxilla by reconstruction using onlay bone grafting and implant restoration between 2002 and 2012 were examined. The surgical procedure was designed to allow the insertion of 49 endosseous implants in the grafted anterior maxillae. Bone resorption and implant success rate were retrospectively evaluated after a follow-up period of 5 years (from 5 to 15 years) subsequent to reconstruction. A questionnaire was the medium used to evaluate patient satisfaction and highlight functional and aesthetic outcomes. The bone grafting success rate was 74%. None of the grafted bones were reported to be infected. Four implants were removed. Implant survival rate was 91.8% after 8.9 years. The permanent reconstruction was fixed in 74% of the cases and removable in 26%. The level of patient satisfaction reported was 6.5/7. In conclusion, his study suggests that onlay bone grafting can be considered a predictable technique for rehabilitation in atrophic premaxilla. The procedure has a high implant survival rate, acceptable bone resorption over time, and promotes graft stability for longterm prosthetic fixation, thereby increasing patient satisfaction.

Clinical Classification of Bone Augmentation Procedure Failures in the Atrophic Anterior Maxillae: Esthetic Consequences and Treatment Options.

Although the number of complications and failures in bone augmentation procedures is still relatively high, these problems remain poorly documented. Moreover, the literature concerning reconstructive techniques and the treatment of their complications in the anterior areas rarely considers the final esthetic result. The aim of this paper is to propose a new classification of bone augmentation complications in the esthetic area, providing treatment guidelines useful for the management of these cases. Failures of bony regeneration procedures can be mainly divided into partial failures and complete failures. A partial failure can be solved with a corrective surgical intervention: this second surgery can have success or may not be able to provide the desired esthetic result. When the bone reconstructive procedure fails totally, a complete failure occurs and the whole procedure has to be repeated. This new intervention can have success but also this new reconstructive surgery can fail in the same way as the first, causing important damage and a compromise solution that will hardly be acceptable from an esthetic point of view. Bone augmentation techniques are not completely predictable and are not always able to guarantee the expected result, especially in the atrophic anterior maxilla. Complications and failures can often occur and this possibility must always be clearly explained to those patients with high esthetic demands and expectations.

Implant Rehabilitation Partial Maxillary Edentulism with Onlay Autogenous Chin Bone Grafting and Prosthetic Gingival Restoration: A Case Report

Atrophic anterior maxilla rehabilitation can be a challenging procedure due to multiple factors that influence clinical decision making. After a prolonged loss of teeth, the residual bone often impedes the use of standard implant placement protocols and additional procedures are needed. The aim of this study is to describe the multidisciplinary approach for the diagnosis and treatment of a 50-year-old woman with prolonged use of a removable maxillary partial denture. This article presents a full-mouth-phased rehabilitation of an atrophic anterior maxilla with three surgical stages. First, onlay autogenous chin bone grafting was used to return the lost tissue. After the consolidation, dental implants were placed in a second stage. A few months later, a connective tissue graft was used to improve the keratinized mucosa width. In the mentioned stages, leukocyte- and platelet-rich fibrin (L-PRF) was used to improve healing and promote tissue regeneration. Finally, prosthetic gingival restoration was used in the anterior region as an alternative to overcome the limitations of hard- and soft-tissue grafting. The use of autogenous grafts obtained from the chin in combination with xenograft and then covered with an absorbable collagen membrane represents a predictable procedure for the rehabilitation of the long-term partial maxillary edentulism. Prosthetic gingival restoration is an alternative technique to overcome the limitations of hard- and soft-tissue grafting. The treatment of a patient with high and width alveolar bone loss needs a multidisciplinary approach. Autogenous grafts obtained from the chin in combination with xenograft and then covered with an absorbable collagen membrane represent an effective procedure. Also, prosthetic gingival restoration can be used as an alternative technique to overcome the limitations of hard- and soft-tissue grafting.

CLINICAL OUTCOME OF WEARING IMPLANT RETAINED OVER DENTURE IN PATIENTS WITH ATROPHIC ANTERIOR MAXILLA RECONSTRUCTED BY SUB NASAL LIFTING (CLINICAL STUDY)

INTRODUCTION: Maxillary implant overdenture has improved the quality of life for edentulous patients especially patients with atrophic maxilla. Sub-nasal lifting was introduced to solve the problem of severely atrophic anterior edentulous maxilla to allow insertion of dental implants. The type of attachment may influence the retention and stability of the prosthesis and thus, masticatory efficiency. Especially locator attachment is used with great success for improvement of implant-assisted over dentureOBJECTIVES:To evaluate clinically and radiographically the effect of wearing implant- retained over denture in patients with atrophic anterior maxilla which was reconstructed by nasal lifting. Patient satisfaction was also evaluated.MATERIALS AND METHODS: This clinical trial was conducted on seven patients with edentulous atrophic anterior maxilla rehabilitated by Sub-Nasal Lifting, restored with bilateral two implants and grafted with Platelet-Rich Fibrin. For each patient an implant- retained over denture with locator attachments was constructed. Patient assessment was done using different three method including clinical, radiographic evaluation and patient satisfaction at three intervals: at time of over denture insertion, 3months and 6 months of denture use.RESULTS: All patients showed increased bone density around dental implants with slight decrease in marginal bone height, no mobility of each implant was detected .All patient showed increased well satisfaction throughout the follow up periods.CONCLUSIONS Two implant-assisted maxillary over denture is an acceptable treatment for patients with atrophic anterior maxilla and it showed increased patient satisfaction and favorable clinical and radiographic findings.

Split crest technique: a solution for atrophic anterior maxilla – case report

Introduction: The rehabilitation of atrophic anterior maxilla can be done by different techniques. Among the procedures for bone augmentation, we can use block grafting, guided bone regeneration, and split crest technique (SCT). SCT consists in bone crest osteotomy, followed by manual/mechanical expansion up to the splitting of the buccal plate from the lingual/palatal plate through greenstick fracture. SCT advantage is the possibility of simultaneously installing a dental implant. However, SCT planning should consider the remaining bone width and the the flap type to obtain success. Objective: To report a case of implant-supported rehabilitation of an atrophic anterior maxilla using the split crest technique with insertion of 4 immediate implants, showing the effectiveness of the technique.

Split crest technique: a solution for atrophic anterior maxilla – case report

The rehabilitation of atrophic anterior maxilla can be done by different techniques. Among the procedures for bone augmentation, we can use block grafting, guided bone regeneration, and split crest technique (SCT). SCT consists in bone crest osteotomy, followed by manual/mechanical expansion up to the splitting of the buccal plate from the lingual/palatal plate through greenstick fracture. SCT advantage is the possibility of simultaneously installing a dental implant. However, SCT planning should consider the remaining bone width and the the flap type to obtain success. Objective: To report a case of implant-supported rehabilitation of an atrophic anterior maxilla using the split crest technique with insertion of 4 immediate implants, showing the effectiveness of the technique.

Three-Dimensional Reconstruction of Post-Traumatic Deficient Anterior Maxilla

Maxillary retrognathism appears in 14.3% of patients exhibiting malocclusion after trauma treatment. This report describes the application of alveolar distraction osteogenesis (ADO) for treating the severely deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes. This is a retrospective study of patients exhibiting severe vertical and anteroposterior maxillary bone deficiency after trauma injuries and treated by ADO as a first stage with additional Le Fort I advancement when required. Predictor variables included ADO for alveolar augmentation and Le Fort I advancement for anteroposterior discrepancy after ADO. Outcome variables included dental implant failure and anteroposterior maxillary relations. Twelve patients with severe atrophic anterior maxilla secondary to trauma injuries were included and treated using ADO. In accordance to the size of the horizontal deficiency, 1 or 2 distractors were used. Vertical alveolar distraction was performed and the transported segments were elongated at a rate of 0.5mm/day to a mean total of 13.9mm (12 to 15mm). In 4 of 12 cases, there was a severe anteroposterior discrepancy larger than 8mm that could not be fully corrected using an anterior inclination during the vertical elongation. Therefore, a second stage of conventional Le Fort I advancement was performed. Thirty-eight dental implants were inserted, with a survival rate of 97.37% (median follow-up, 6.2yr). This report describes treatment of the deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes, including implant-based dental rehabilitation. The main advantages include simultaneous bone and mucosa augmentation, no donor site morbidity, considerably higher vertical augmentation compared with other methods, and minimal relapse. Using an additional Le Fort I advancement in severe cases permits a useful method for proper repositioning of the maxilla, thus resulting in superior intermaxillary relations.

Histological analysis and gene expression profile following augmentation of the anterior maxilla using rhBMP-2/ACS versus autogenous bone graft.

The objective of this report was to present histological characteristics and gene expression profile of newly formed bone following horizontal augmentation of the atrophic anterior maxilla using recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier (rhBMP-2/ACS) versus an autogenous bone graft (ABG). Bone core biopsies from 24 subjects participating in a randomized clinical trial were obtained at dental implant placement, 6months following alveolar ridge augmentation using rhBMP-2/ACS (rhBMP-2 at 1.5mg/ml; total dose 4.2mg) or a particulate ABG harvested from the mandibular retro-molar region. A titanium mesh was used to provide wound stability and space for bone formation. Analysis included histological/histometric observations and gene expression profile of the newly formed bone. rhBMP-2/ACS yielded bone marrow rich in capillaries, undifferentiated cells and bone lining cells compared with the ABG (p=0.002). Whereas no significant differences were observed in total bone fraction (p=0.53), non-vital bone particles trapped in lamellar vital bone were observed in the ABG group (p<0.001). Real-time PCR showed greater BMP-2 and RUNX2 expression for rhBMP-2/ACS over the ABG (p=0.001 and 0.0021, respectively), while the ABG exhibited greater expression of RANKL:OPG, BSP and OPN over rhBMP-2/ACS (p=0.01, 0.005 and 0.0009, respectively). Our observations suggest that formative biological processes explain bone formation following implantation of rhBMP-2/ACS, whereas remodelling, resorptive/formative processes, characterizes sites receiving ABGs.

Surgical Management of Significant Maxillary Anterior Vertical Ridge Defects.

Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging scenarios in bone regeneration. Under ideal circumstances, guided bone regeneration in combination with soft tissue management has shown predictable esthetic and functional outcomes. Success largely relies on primary wound closure during and after the surgical procedure. Surgical sites present different challenges that need to be considered when designing the flap. The goal of this article is to propose a classification of flap designs that considers vestibular depth and scar formation around the periosteum when performing vertical ridge augmentation in the atrophic anterior maxilla. The four clinical conditions proposed under this classification are (1) shallow vestibule with healthy periosteum, (2) deep vestibule with healthy periosteum, (3) shallow vestibule with scarred periosteum, and (4) deep vestibule with scarred periosteum. The classification will allow clinicians to achieve tension-free closure and more predictable vertical bone gain.

Can bone marrow aspirate concentrate change the mineralization pattern of the anterior maxilla treated with xenografts? A preliminary study.

Objective:To evaluate bony reconstruction of the atrophic anterior maxilla using particulate grafts with or without autologous bone marrow aspirate concentrate (BMAC).Materials and Methods:Eight patients with atrophy of the anterior maxilla due to teeth loss were selected and split into groups according to the type of material used: Control Group (CG) (n = 4) - particulate xenograft only and Test Group (TG) (n = 4) - a combination of particulate xenograft and BMAC. Both groups received a collagen membrane to cover the xenograft. After 4 months, during implant placement, a sample of bone was removed from the graft area using a 2 mm diameter trephine bur. The specimens were fixed and preserved for histomorphometric evaluation, which included the following parameters: Mineralized tissue (MT) and non-MT (NMT). Cone beam computed tomography was performed at 3 time intervals to measure bone thickness: (1) Before grafting, (2) 4 months and (3) 8 months postgrafting, using localized bone gain (mm) as the outcome variable.Results:Tomographic analysis revealed bone gain in CG of 3.78 ± 1.35 mm and 4.34 ± 1.58 mm at 4 and 8 months, respectively. TG showed an increase of 3.79 ± 0.52 mm and 4.09 ± 1.33 mm after 4 and 8 months, respectively. Histomorphometric analysis revealed that, for CG, MT- and NMT-related values were 52.3% ± 16.78% and 47.70% ± 5.55%, respectively, whereas for TG, they were 65.04% ± 20.98% and 34.96 ± 10.38, respectively.Conclusion:Although radiographic bone gain appeared similar between the groups, the use of BMAC obtained via the BMAC® method revealed an increased mineralization trend in the anterior maxilla. It must be highlighted, however, that this is a preliminary study with a relatively small sample population and further studies with larger sample sizes are needed to verify these results.

Bone augmentation of the atrophic anterior maxilla for dental implants using rhBMP-2 and titanium mesh: histological and tomographic analysis

The loss of multiple teeth or trauma to the anterior maxilla often results in a deficient ridge width for prosthetic tooth rehabilitation. This study evaluated the use of titanium mesh and recombinant human bone morphogenetic protein 2 (rhBMP-2) for the repair of major bone defects in the alveolar bone. Five patients were enrolled in the study; these patients required implant replacements for two contiguous missing teeth in the anterior maxilla, which lacked sufficient bone. Residual ridges were augmented with rhBMP-2 and titanium mesh to direct the geometry of the newly formed bone. Seven months later, a bone biopsy specimen was removed from the implantation site before osteotomy and insertion of dental implants. Cone beam computed tomography (CBCT) scans were obtained preoperatively, postoperatively (baseline), and 48 months after implantation to evaluate implant healing. All dental implants were placed in the grafted sites without the need for further bone augmentation. The most frequent adverse effects were facial oedema and oral erythema. Biopsy specimens were used to evaluate bone quality. CBCT scans provided a prediction of alveolar restoration and long-term success. The combination of rhBMP-2 and titanium mesh provided effective augmentation of the atrophic anterior maxilla prior to implant placement.