"Distraction" of grafted alveolar bone in cleft case using endosseous implant

Objective: Presentation of a specific surgical technique of vertical alveol ar ridge distraction performed on an alveolar bone graft 1 year after the p rimary grafting procedure designed to correct a labioalveolar cleft. The gr aft had not obtained the results desired and presented heavily scarred muco sal tissue. Technique: A dental implant placed within the graft once it has been entire ly freed by osteotomies functions as an endless screw. To avoid vascular ri sk, the alveolar bone graft is detached as a whole along its total height, Consequently, no bone remains above it to provide support for a conventiona l alveolar distracter. An osteosynthetic miniplate, fastened in a horizonta l position beneath the nasal mucosae above the graft, is used to replace th e missing bony support and to stabilize the implant, which activates the di straction process. Patient: This study is based on our first clinical case with a follow-up of 18 months at present. Result: A vertical displacement of the entire graft was achieved, including its attached mucosal layer, which repositioned both bone and mucosa on a f ar better level in the cleft area. Thus, a normal length of abutment was ob tained permitting prosthetic rehabilitation based on the same endosseous im plant, which was left in place within the graft. Conclusion: This technique may prove particularly helpful in certain cases in which a primary alveolar bone grafting procedure has produced borderline results. In such cases, on the one hand, neither the reasonably satisfacto ry volume of the bone graft itself nor the poor quality of its scarred muco sal tissue argue in favor of a secondary grafting procedure. On the other h and, it is impossible to resort to currently available alveolar distracters since our choice of techniques leaves no bone support above the graft.