"Envelope" approach for onlay bone grafting: Preliminary surgical and prosthetic results

Minimally invasive surgery principles have been applied to preprosthetic-implant surgery, and an adequate presurgical planning reduces morbidity in both harvesting and stabilization of the bone grafts. Objective: A new "envelope" approach for onlay bone grafting at the alveolar process is presented, this avoids releasing incisions yet allowing adequate reconstruction of the defective site. Study design: To be included in the study the patient had to have an antero-posterior defect of the alveolar crest. Patient age and sex, location of the defect, type and size of graft, and complications appeared during follow up were recorded. Results: Ten consecutive patients (4 men and 6 women) have been succesfully treated with this technique between June/2006 and February/2008. Eight defects were located at the anterior maxilla (between canines), and the remaining two at the anterior mandible (between canines). Four patients received bone grafts harvested from the chin, and the remaining six patients received bone grafts from the mandibular body. Mean size of the graft was: width 11,5mm (range 8 to 17), height 14,7mm (range 9 to 18), depth 4,3mm (range 3 to 6). Conclusion: This technique improves vascularization of the mucoperiosteal flap and avoidance of releasing incisions which has an aesthetic impact in patients with gingival smile.