Le Fort I Osteotomy with Iliac Bone Grafts and Delayed Oral Implants for the Rehabilitation of Extremely Atrophied Maxilla

Abstract

In this case report, the rehabilitation of a severely resorbed edentulous maxilla with Le Fort I osteotomy combined with interpositional autogenous bone grafts was presented. A 46-year-old woman applied to our clinic for the rehabilitation of edentulous maxilla and mandible. Her systemic history revealed diabetes type 1. It was seen that the maxilla was severe atrophic and interocclusal distance was increased due to excessive bone loss both vertically and horizontally. The patient was planned to undergo iliac bone graft with Le Fort 1 osteotomy. The maxilla was positioned 6 mm forward and 3 mm down. First, interposition grafting was performed in combination with Le Fort I surgery. Implants were placed after 4 months. Le Fort I osteotomy combined with inter-positional autogenous bone grafts gives successful results in the edentulous patient who has excessive resorption pattern with Class-III occlusal relationships and increased inter-occlusal distance.

Keywords

• Le Fort I osteotomy
• Iliac bone graft
• Dental implants
• Edentulous maxilla

References

1. 1. Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17: 232–236.
2. 2. Chiapasco M1, Brusati R, Ronchi P. Le Fort I osteotomy with interpositional bone grafts and delayed oral implants for the rehabilitation of extremely atrophied maxillae: a 1-9-year clinical follow-up study on humans. Clin Oral Implants Res. 2007 Feb;18(1):74-85.
3. 3. Isaksson S, Ekfeldt A, Alberius P, Blomqvist JE. Early results from reconstruction of severely atrophic (Class VI) maxillas by immediate endosseous implants in conjunction with bone grafting and Le Fort I osteotomy. Int J Oral Maxillofac Surg. 1993;22: 144–148.
4. 4. Cawood JI, Stoelinga PJW, Brouns JJA. Reconstruction of the severely resorbed (Class VI) maxilla. Int J Oral Maxillofac Surg. 1994;23: 219–225.
5. 5. Kahnberg KE, Nilsson P, Rasmusson L. Le Fort I osteotomy with interpositional bone grafts and implants for rehabilitation of the severely resorbed maxilla: a 2-stage procedure. Int J Oral Maxillofac Implants. 1999;14: 571–578.
6. 6. Precious DS, Morrison A, Richard D. Pterygomaxillary separation without the use of osteotome. J Oral Maxillofac Surg 1991;49:98 –9.
7. 7. Jensen OT, Leopardi A, Gallegos L. The case for bone graft reconstruction including sinus grafting and distraction osteogenesis for the atrophic edentulous maxilla. J Oral Maxillofac Surg. 2004;62: 1423–1428.
8. 8. Ferri J, Dujoncquoy J-P, Carneiro JM, Raoul G. Maxillary reconstruction to enable implant insertion: a retrospective study of 181 patients. Head Face Med. 2008;4: 31.

9. 9. Shirota T, Ohno K, Motohashi M, Michi K-I. Histologic and microradiologic comparison of block and particulate cancellous bone and marrow grafts in reconstructed mandibles being considered for dental implant placement. J Oral Maxillofac Surg. 1996;54: 15–20.
10. 10. Jones RHB. Orthognathic surgery and implants. Ann R Australas Coll Dent Surg. 2002;16: 105–108.
11. 11. Li KK, Stephens WL, Gliklich R. Reconstruction of the severely atrophic edentulous maxilla using Le Fort I osteotomy with simultaneous bone graft and implant placement. J Oral Maxillofac Surg. 1996;54: 542–546.