The Reconstruction of Extensive Bucco-palatal Defects Using Twin Block Grafts - A Clinical Report of Two Cases of the 'Sandwich' Technique

Case Presentations: Two cases are presented here with severe 3-dimensional alveolar ridge deficiency in the maxillary right lateral incisor and maxillary canine areas, respectively. Both cases had a 3-dimensional bone and contour deficiency. Restorative driven positioning of the implant necessitated augmentation of the buccal as well as the palatal aspect of the defects. The defects were grafted with autogenous cortico-cancellous bone blocks harvested from the mandibular symphysis. In both sites one block was placed on the buccal and the other on the palatal side, ‘sandwiching’ the host bone and the remainder of the gap filled with particulate autogenous bone. Implants were placed in both the cases five months after the grafting and the final restorations were placed five months subsequently. The implants and the grafts have successfully integrated at the sites with stable bone and soft tissue levels. At threeyear follow-up both implants showed stable bone and soft tissue levels. Conclusion: Autogenous cortico-cancellous block grafts used in a sandwich technique reconstruct the lost bone volume, but also facilitate implant placement and optimal restorative outcomes.