Three-dimensional reconstruction of the anterior maxilla region with autologous bone block and tunnel approach. solution to exposure with double pedicle flap using connective tissue from the palate. clinical case report

Introduction: Maxillary and mandibular bone defects are quite common. Among the different procedures which can be used to regenerate these defects, we can find Guided Bone Regeneration (GBR), the use of onlay/inlay bone blocks, the use of distraction osteogenesis or split crest technique. The most predictable material for the regeneration of the alveolar process is the autologous bone, which is considered the gold standard.
This case shows regeneration of the autologous cortical bone, as well as a solution to its exposure.
Case description: A male patient, aged 56, with no significant medical history visited the clinic for rehabilitation with implants. After performing a CBCT scan, it was decided to perform autologous block graft surgery and the tunnel approach. After 15 days, when the stitches were removed, the graft was seen to be exposed. At first, an attempt to solve this was made with chlorhexidine and chitosan rinses in search of a secondary epithelialisation. When such closure was not forthcoming, surgery was performed with a flap of bilateral pedicle connective tissue, achieving the closure desired. After 6 months, four implants were placed for implant supported rehabilitation.
Discussion: Although there has been a rise in reconstructive surgical techniques to restore an adequate bone volume, currently the autologous bone graft is still considered the best material to use. Some authors have solved the exposure of these grafts using 1% chlorhexidine gel, achieving in many cases a secondary epithelialisation. On other occasions, they found a solution to the exposed areas by covering them with a connective flap from the palate, coinciding to some extent with our case, but with the exception that we rotated a bilateral pedicle flap of connective tissue without making such waste.
Conclusion: The use of a bilateral pedicle flap of connective tissue from the palate proved to be valuable for covering large exposures of autologous bone grafts without losing them or the need to reduce them.