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Onlay Grafting...the following images are very graphical
This
collection of images goes through a typical Onlay Graft procedure. This procedure is
widely used to treat resorbed bony ridges of the upper or lower jaw. This is usually
necessary prior to implant placement in order to insure proper positioning of the implant
and better esthetics of the future prosthesis.
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To the left you can see a transverse-sectional CT-Scan image of the patient’s upper
jaw. Notice how thin the ridge is on the patient’s right side (arrow). To the right
you can see a picture of the patient’s upper jaw in a stone cast copy. A Surgical Template is placed over the toothless area to
simulate where the actual replacement teeth should be, assuming proper occlusion (bite)
and esthetics. Notice the space we need to fill (arrow) in order to create enough room for
implants. |
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The left image shows the pre-surgical condition intraorally. The clinical picture actually
does not look too bad in terms of ridge width, however once we open the area up and
reflect the soft tissues somewhat, as is shown above on the right, you can appreciate how
thin the ridge actually is (arrow). In this case the thick layer of soft tissues (gums)
masked the thin bony ridge. Since looks can often be deceiving in these
situations, we often take CT-Scans to verify the actual amount of bone available. |
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The left image above shows the bony ridge exposed with the surgical template in place.
This will guide us during surgery as to how far we have to graft the area out (notice the
discrepancy as shown by the marker). The two blue double arrows also show the thickness of
the tissues in relation to that of the ridge. For this amount of bone needed, we selected
the patient’s chin as an appropriate donor site. The picture on the right shows the
chin bone exposed. |
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The image on the right shows the pieces of bone that are going to be transferred
from the chin to the upper jaw. The attachment screws are already inserted. The right
image shows the chin with the bone pieces removed. You can actually see that we removed
all the bone marrow with the graft, since we have only the cortical portion of the other
(lingual) side left.
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Above the left you can see the bone pieces ready to be transferred to the upper
jaw and to the right is a picture of the donor site being treated with a collagen-type
material (AviteneÒ), in order to achieve quick hemostasis.
After that the mentalis muscle of the chin is re-sutured and re-suspended with resorbable
sutures and then the incision is re-sutured to close the wound. |
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The left image above shows the bone pieces attached to the upper jaw, so that the
width of the ridge can be increased. Once the Onlay Graft pieces are firmly attached, the
voids are filled in with some ground autogenous bone and sometimes the whole area is
covered up with a Gore-TexÒ Membrane. After that the tissues are re-approximated and
sutured as you can see on the right. |
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The donor site is closed and sutured as described above (left). The post-operative
complications are usually minimal with this procedure. On the right you can see the upper
jaw after 8 weeks of healing. |
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Five months after the grafting procedure the patient returns for the implant placement. To
the left you can see the patient’s upper jaw five months after the grafting
procedure, with the original surgical template in place. Notice how we achieved to fill
the defect as it was shown above, prior to the grafting procedure. Once we reflect the
tissues, you can see the width of bone we gained as compare to the pre-op picture above
(right image). |
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This
allows us to place the implants in the right spot to satisfy our pre-established
functional and esthetic parameters. To the left you can see the implants placed into the
previously grafted area. |
Although this procedure is
widely used today with great success, we are constantly trying to improve and facilitate
grafting procedures for the patient as well as for the surgeon. Concepts like Distraction
Osteogenesis may eventually replace many Onlay procedures. This process, in isolated
situations, can achieve similar results as the Onlay Grafting procedure within 8 weeks
without the necessity of a donor site. Once we have enough confidence in this procedure,
it will find its way to this web site.
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