Bone regenerative surgery techniques arise from the need of a "prosthetically guided" implantology: implants (the roots of the incoming teeth) must be inserted in the right quantity of bone and in a useful position for the future teeth. The insertion of the implant taking into account only the available bone quantity out of an inaccurate clinical examination isn't accepted anymore.

The sinus lift is well performed since the late '80s (P.Boyne in 1987). It is the only tridimensional bone graft which doesn't suffer from "dimensional shrinking", which means that it doesn't undergo a resorption; this happens because of the unique anatomical environment in the maxillary sinus: a 3 walled cavity with the possibility of active regeneration starting from the periosteum (a thin membrane covering the bone that supportsits vascular nourishment and substitution). The grafted bone doesn't undergo the mechanical trauma, because it's situated inside a closed cavity and, therefore, it doesn't undergo the bone remodelling process which, normally, causes a partial resorption.

Small or big sinus lift: it's not a matter of the "maxillary sinus" to be "lifted"; that's an empty cavity of the upper jaw communicating with the nose and the upper airways, whose aim is to warm and filter the inspired air and that, when inflamed or infected causes sinusitis. It's the mucosa which lines its inside: the Schneiderian membrane. The "lift" can be achieved filling the newly formed space both with bone blocks and bone chips. Only one condition is mandatory to the positive outcome of the surgery: the graft material (autologous bone) has to stay still. If bone fragments are "dancing around" in the sinus, sinusitis is likely to happen. Bio-materials and frozen dried human donor bone are suitable too, however the results are less predictable.

The bone regeneration of the implant site can be realized trough different surgical techniques as membrane, bone blocks and using different materials such as biomaterials, heterologous, homologous and autologous bone. Each procedure is operator dependent: the same technique in the hands of different surgeons provides different outcomes. The onlay technique (bone blocks fixed with screws) with autologous (own) bone allows very predictable results. The bone onlays (blocks) are graftet from an intraoral (mandible) or extra-oral (iliac crest, calvaria) source, being harvestedduring the same operating session.

The iliac crest bone grafting technique performed under the microscope represents the development of a surgical technique existing since 1940. Trough a very small incision (3-4 cm) it's possible to gain access to the very big bone of the pelvis (iliac wing) and collect a great amount of cortical bone (blocks) and particulate bone (medulla full of stem cells). This allows a higher security in the reconstruction of bone defects. After the anaesthesia the patient walks immediately (avoiding weight bearing by one leg) and after 2 weeks he regains the usual gait.

The grafting procedure from the mandibular ramus allows to have just one surgical field in the oral cavity. If performed under the microscope it takes few minutes to harvest bone blocks of small dimensions (1-2 cm x 0,5-1 cm) useful for the regeneration of small defects.

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