10.59987/ads/2017.3.123-130
Background. The purpose of this study was to report the outcome of the management of both horizontal and vertical defects of alveolar crest using the bone slat technique approach in conjunction with third molar removal prior to implant placement in the aesthetic area.
Methods. We present a 20-year-old female patient who lost a maxillary lateral incisor. The objective of treatment was to replace the lateral incisor with an implant-supported crown restoration without interfering with the integrity and topography of the adjacent gingival tissues. Because the future implant site showed horizontal and vertical bone defect the Authors decided to perform bone regeneration.
The need for such bone augmentation in the younger patient often coincides with the timing for third molar removal. By combining third molar extraction with bone harvest and alveolar grafting, the patient undergoes only one surgical approach. The bone height (9.5 mm) and width (5.7 mm) were measured at the point of interest (tooth 12) both before and after implant placement in the reconstructed panoramic and parasagittal views by Cone Beam Computed Tomography (CBCT) scan.
Results. The final results demonstrated an increase in length of 5 mm after bone slat technique (from 9.5 mm to 13.5 mm) and an increase in width of 1 mm (from 5.7 mm to 6.7 mm). ISQ measurements were recorded at the time of implant placement (the mean was: 68.5) and immediately after individualized screw-retained provisional crown (the mean was: 77). Conclusions. This technique is reliable and aesthetic and functional results appear to be stable and respect this requisite: simple and fast graft harvesting and low risk of morbidity especially in conjunction with third molar removal.
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Annali di stomatologia
bone slat technique
The three-dimensional reconstruction of the jaw with “bone slat technique” in conjunction with third molar removal
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Case Report
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2017-09-01
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123-130
Ann Stomatol (Roma)
S. D'Amato
2017
10.59987/ads/2017.3.123-130
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1971-1441
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bone slat technique
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The three-dimensional reconstruction of the jaw with “bone slat technique” in conjunction with third molar removal
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                                                                                                    Case report


    The three-dimensional reconstruction of the jaw
    with “bone slat technique” in conjunction with third
    molar removal




                                                                                             li
                                                                                           na
    Mario Santagata1, MD, PhD                              Results. The final results demonstrated an in-
    Atirge Cecere1, MD                                     crease in length of 5 mm after bone slat technique
    Rosario V.E. Prisco2, MD, DDS                          (from 9.5 mm to 13.5 mm) and an increase in




                                                                                         io
    Gianpaolo Tartaro1, MD                                 width of 1 mm (from 5.7 mm to 6.7 mm). ISQ mea-
    Salvatore D’Amato1, MD, DDS                            surements were recorded at the time of implant
                                                           placement (the mean was: 68.5) and immediately




                                                                     az
      Medical Director - Multidisciplinary Department of
                                                           after individualized screw-retained provisional
    1

    Medical and Dental Specialties;
                                                           crown (the mean was: 77).

    Oral and Maxillofacial Surgery Unit, AOU University
                                                           Conclusions. This technique is reliable and aes-

    of Campania “Luigi Vanvitelli”, Naples, Italy
                                                           thetic and functional results appear to be stable

    2 CAGS Prosthodontics, Private Practice Naples,




                                                                   rn
                                                           and respect this requisite: simple and fast graft

    Italy
                                                           harvesting and low risk of morbidity especially in
                                                           conjunction with third molar removal.




                                                       te
                                                           Key words: alveolar ridge augmentation, alveolar

    Salvatore D’Amato
    Corresponding author:                                  bone grafting, esthetics, bone slat technique.

    Multidisciplinary Department of Medical and Dental
    Specialties, AOU - SUN
                                                     In
    University of Campania “Luigi Vanvitelli”
    Via B. Croce 18
                                                           Introduction

    80059 Torre del Greco (NA), Italy                      The bone available for the implant placement may be
    E-mail: saldamat@tin.it                                insufficient due to tooth extraction, trauma, periodon-
                               ni

                                                           titis, infection, or the long-term use of removable
                                                           prostheses (1, 2). This resorption of the alveolar crest
                                                           often reduces the possibility of correct three-dimen-
                                                           sional implant placement for teeth replacement.
                             io

    Summary

                                                           Severely resorbed alveolar bone requires a ridge
                                                           augmentation procedure to achieve the appropriate
    Background. The purpose of this study was to re-

                                                           width and height of bone to enable successful implant
                           iz



    port the outcome of the management of both hori-

                                                           placement.
    zontal and vertical defects of alveolar crest using

                                                           Therefore, preparation of the implant site can require
    the bone slat technique approach in conjunction

                                                           augmentation with autologous bone grafts. Different
            Ed




    with third molar removal prior to implant place-

                                                           extra- and intraoral donor sites are available (3-6).
    ment in the aesthetic area.

                                                           Other techniques used to treat bone defects and that
    Methods. We present a 20-year-old female patient

                                                           can be utilized: edentulous ridge expansion, guided
    who lost a maxillary lateral incisor. The objective

                                                           bone regeneration and sandwich bone osteotomy (7,
    of treatment was to replace the lateral incisor with

                                                           8). As well as, several Authors used connective tis-
    an implant-supported crown restoration without

                                                           sue graft to improve the aesthetic results (9, 10).
    interfering with the integrity and topography of
 IC




                                                           The purpose of this article is to present the applica-
    the adjacent gingival tissues. Because the future

                                                           tion of a new procedure for reconstruction of the at-
    implant site showed horizontal and vertical bone

                                                           rophic maxilla in conjunction with third molar removal:
    defect the Authors decided to perform bone re-

                                                           three-dimensional reconstruction with bone slats of
    generation. The need for such bone augmentation
C




                                                           about 1 mm thickness taken directly from the donor
    in the younger patient often coincides with the

                                                           site; space between the bone slats and the alveolar
    timing for third molar removal. By combining

                                                           bone was filled with bone chips harvested by bone
    third molar extraction with bone harvest and alve-

                                                           scraper.
    olar grafting, the patient undergoes only one sur-
©




                                                           This technique is reliable and aesthetic and functional
    gical approach. The bone height (9.5 mm) and

                                                           results appear to be stable and respect this requisite:
    width (5.7 mm) were measured at the point of in-

                                                           simple and fast graft harvesting and low risk of mor-
    terest (tooth 12) both before and after implant

                                                           bidity especially in conjunction with third molar re-
    placement in the reconstructed panoramic and

                                                           moval.
    parasagittal views by Cone Beam Computed To-
    mography (CBCT) scan.



    Annali di Stomatologia 2017;VIII(3):123-130                                                                123
    M. Santagata et al.


                                                                     Bietigheim-Bissingen, Germany) of region 12 (FDI
                                                                     tooth numbering system), and Cone Beam Computed
    Case description

    The requirements of the Helsinki Declaration were                Tomography (CBCT) scan (Scanora 3D - SOREDEX,
    observed and the patient gave informed consent for               Tuusula, Finland) were performed to plan the surgical
    all surgical procedures. A 20-year-old female patient            procedure.
    was referred to the Authors to save her maxillary right          The CBCT scan revealed a great vertical and hori-
    lateral incisor. The tooth was slightly mobile (grade            zontal bone dehiscence of both buccal and palatal




                                                                                                          li
    2), vital, and extremely sensitive to palpation. Radio-          plate in the maxillary right lateral area with a bone
                                                                     density of D5 using Misch’s classification (11) (mean




                                                                                                        na
    graphic examination (panoramic) revealed a marked
    bone loss. This rapid bone loss was pathognomonic                32 HU). The bone height (9.5 mm) and width (5.7
    for aggressive periodontal disease (Fig. 1). The prog-           mm) were measured at the point of interest (tooth 12)
    nosis of the tooth was hopeless, and it was destined             both before and after implant placement in the recon-
    for extraction. Moreover, the patient presented agen-            structed panoramic and parasagittal views (Fig. 2).




                                                                                                      io
    esis of 18 with inclusion of 28, 38 and 48.                      Surgical procedure was performed under local anes-
    After the diagnostic work-up was completed, a treat-             thesia (mepivacaine 2% + epinephrine 1:100.000)
    ment plan was developed using a specialist team ap-              plus oral sedation (midazolam 5 mg). The patient was




                                                                                az
    proach. The proposed treatments included orthodon-               premedicated 1 hour prior with amoxicillin plus clavu-
    tic treatment and tooth replacement by implantology.             lanic acid 2 g orally. Immediately before surgery, the
    In fact, orthodontic therapy can improve the periodon-           patient rinsed his mouth with a 0.3% chlorhexidine
    tal situation in patients with pathologic migration by           solution for one minute.
    providing good function and improved aesthetics after




                                                                              rn
    realignment.
    The maxillary right lateral incisor was extracted and            A crestal incision slightly shifted on the palatal was
                                                                     Recipient Site

    the extraction socket was carefully curetted. The                followed by a sulcular incision from the tooth 11 to




                                                            te
    crown of the extracted tooth was used as a temporary             the tooth 13, with one relieving incision that the
    tooth and was pegged to the orthodontic device dur-              mesial line angle of tooth 11 extending along the up-
    ing orthodontic alignment with arch wire technique               per labial frenulum. A full-thickness flap was elevat-
    applied to the brackets.                                         ed, and all inflammatory and granulation tissue were
                                                          In
    The objective of treatment was to replace the lateral            debrided with a curette. The incisive nerve was
    incisor with an implant-supported crown restoration              saved. To ensure tension-free wound closure, the pe-
    without interfering with the integrity and topography of         riosteum was slit basal of the flap immediately before
    the adjacent gingival tissues. Because the future im-            surgery, to prevent bleeding at the time of suture.
                              ni

    plant site showed horizontal and vertical bone defect            The bony defect was measured using a periodontal
    the Authors decided to perform bone regeneration.                probe to determine the size of the bone slat (Fig. 3).
    The need for such bone augmentation in the younger
                            io


    patient often coincides with the timing for third molar
    removal. By combining third molar extraction with
                                                                     Donor Site

    bone harvest and alveolar grafting, the patient under-
                          iz



    goes only one surgical approach.                                 Access to the ramus area for bone harvest was
                                                                     Flap design

                                                                     gained through an extension of the commonly used
                                                                     envelope flap for third molar removal: a buccal enve-
           Ed




                                                                     lope flap with a sulcular incision was performed from
                                                                     the first to the second mandibular molar with a distal
    Surgical planning

    A single X-ray (Vistascan mini view - DURR dental,               incision along the mandibular ramus.
 IC
C
©




    Figure 1. Clinical preoperative situation. Preoperative panoramic radiographic analysis.


    124                                                                                 Annali di Stomatologia 2017;VIII(3):123-130
    The three-dimensional reconstruction of the jaw with “bone slat technique” in conjunction with third molar removal




                                                                                                          li
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                                                                                                      io
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                                                                                rn
    Figure 2. Presurgical CBCT study in the area of maxillary right lateral incisor.




                                                             te                          Figure 3. The bony defect was mea-
                                                           In
                                                                                         sured using a periodontal probe to de-
                                                                                         termine the size of the bone shells.
                               ni
                             io
                           iz
            Ed




    The mucoperiosteal flap was reflected from the                     tegrity of the underlying mandibular nerve (Fig. 4).
    mandibular body, exposing the third molar area and                 After, by the use of a bone scraper (safe scraper
 IC




    buccal plate of the ramus. The flap was elevated su-               twist, Meta, Reggio Emilia, Italy), the bone particles
    periorly along the external oblique ridge to the base              were collected for later use.
    of the coronoid process and stopped in this position
    using a klemmer.
C




                                                                       The bone slats were anchored in the host bone with ti-
                                                                       Bone graft placement

                                                                       tanium microscrews (Stoma Set, Germany) (Fig. 5).
    The osteotomy was performed following the Piezo-                   Space between the bone slats and the alveolar bone
    Osteotomy

    surgery (Mectron, Genova, Italy) technique. The bone               was filled with bone chips harvested by bone scraper
©




    was harvested, to obtain the bone slat of about 1 mm               (safe scraper twist, Meta, Reggio Emilia, Italy) (Fig. 6).
    of thickness from the buccal plate. A thin chisel is               The bone graft was covered with a mucoperiosteal flap
    gently tapped along the entire length of the external              and the wound was closed with interrupted sutures.
    oblique osteotomy, taking care to parallel the lateral             The mesial and distal alveolar contours were consid-
    surface of the ramus. This technique leaves intact the             ered as reference points for adaptation of the bone
    bone medullary of the mandible preserving the in-                  slats.


    Annali di Stomatologia 2017;VIII(3):123-130                                                                              125
    M. Santagata et al.




                                                                                                           li
                                                                                                         na
                                                                                                       io
    Figure 4. A thin chisel is gently tapped along the entire length of the external oblique osteotomy, taking care to parallel the
    lateral surface of the ramus. This technique leaves intact the bone medullary of the mandible preserving the integrity of the
    underlying mandibular nerve.




                                                                                 az
                                                                               rn
                                                            te
                                                          In
                              ni
                            io
                          iz



    Figure 5. The bone slats were anchored in the host bone with titanium microscrews.
           Ed




                                                                      in width of 1 mm after bone augmentation (from 5.7
    Because the third molar tooth was completely impact-              mm to 6.7 mm) (Fig. 8).
    Third molar surgery

    ed, it was helpful to procure the graft first to visualize
    the submerged crown. After the bone harvest per-
    formed, the third molar was removed, the socket was               After a 3-month healing period, re-entry surgery was
                                                                      Implant Placement

    inspected, dental follicular tissue was curetted, the             performed for implant insertion.
 IC




    socket was irrigated copiously with normal saline, the            Following local anesthesia (mepivacaine 2% +
    flap was then repositioned and sutured (prolene 5/0,              epinephrine 1:200.000), a standard mucoperiosteal
    Ethicon).                                                         flap was elevated including sulcular incisions at both
                                                                      teeth facing the single-tooth gap via a palatally orient-
C




                                                                      ed crestal incision. The osteosynthesis titanium mi-
                                                                      croscrews were removed (Fig. 9). Thereupon, the pa-
                                                                      tient received one commercially available implants:
    Results

    CBCT scan was performed 3 months after maxillary                  MIS Seven (MIS, Barlev, Israel) 3.75 mm of diameter
    reconstruction. The CBCT scan showed reconstruc-                  and 13 mm of length. A correct 3-D positioning of the
©




    tion of both buccal and palatal plate and improvement             implant, as described by Grunder et al., was per-
    of bone density from (32 HU) to (92 HU) according to              formed (12). At the time of surgery, small-diameter
    Misch’s classification (Fig. 7) (11). The final results           healing abutments were placed (Fig. 10). The mu-
    demonstrated an increase in length of 5 mm after                  coperiosteal flap was sutured at the mesial and distal
    bone graft (from 9.5 mm to 13.5 mm) and an increase               aspect (prolene 5/0, Ethicon). Post-operative instruc-


    126                                                                                  Annali di Stomatologia 2017;VIII(3):123-130
    The three-dimensional reconstruction of the jaw with “bone slat technique” in conjunction with third molar removal


                                                                  tions included continued antibiotic treatment for 6
                                                                  days and analgesic therapy. Oral disinfection was
                                                                  recommended for 2 weeks. Sutures were removed 10
                                                                  days post-operatively.


                                                                  The implant stability coefficient, termed RFA analysis,




                                                                                                      li
                                                                  Implant stability quotient

                                                                  was measured by Osstell (Integration Diagnostics




                                                                                                    na
                                                                  AB, Goteborg, Sweden). It was necessary to screw a
                                                                  disposable magnetic attachment (Smartpeg™) to im-
                                                                  plant 4-5 Ncm. Magnetic attachment cannot have any
                                                                  contact with any metallic instrument before it is
                                                                  screwed. Smartpegs™ compatible with diameter 4.2




                                                                                                  io
                                                                  mm, 3.75 mm: seven implants (MIS, Barlev, Israel),
                                                                  system connection was used. ISQ measurements
                                                                  were recorded at the time of implant placement. Four




                                                                             az
                                                                  different measurements were taken (facial or buccal,
                                                                  lingual, mesial, distal), and then an average value of
                                                                  these 4 values was taken; ISQ was: 68.5.




                                                                           rn
    Figure 6. Space between the bone slats and the alveolar
    bone was filled with bone chips.




                                                         te
                                                                                            Figure 7. The CBCT scan sho-
                                                                                            wed reconstruction of both buc-
                                                                                            cal and palatal plate and im-
                                                                                            provement of bone density from
                                                       In
                                                                                            (32 HU) to (92 HU) according to
                                                                                            Misch’s classification.
                               ni
                             io
                           iz
            Ed




                                                                                            Figure 8. The final results
                                                                                            demonstrated an increase in
                                                                                            lenght of 5 mm after bone graft
                                                                                            (from 9.5 to 13.5 mm) and an in-
                                                                                            crease in width of 1 mm after
                                                                                            bone augmentation (from 5.7 to
                                                                                            6.7 mm).
 IC
C
©




    Annali di Stomatologia 2017;VIII(3):123-130                                                                          127
    M. Santagata et al.




                                                                                                        li
                                                                                                      na
                                                                                                    io
                                                                               az
                                                                             rn
                                                          te
                                                        In
    Figure 9. The osteosynthesis titanium microscrews were removed.
                              ni
                            io
                          iz
           Ed
 IC
C




    Figure 10. A correct 3-D positioning of the implant was performed. At the time of surgery, small-diameter healing abutments
    were placed.
©




                                                                    The CBCT scan showed reconstruction of both buc-
    After 5 months from implant surgery a CBCT scan                 cal and palatal plate and improvement of bone densi-
    Restorative Procedure

    was performed immediately after individualized screw-           ty from D5 (92 HU) to D2 (1246 HU) according to
    retained provisional crown (Fig. 11) and ISQ measure-           Misch’s classification (Fig. 12) (11). The final results
    ments were recorded with 4 different measurements.              demonstrated an increase in length of 5 mm after
    The ISQ average of these 4 values was 77.                       bone graft (from 9.5 mm to 13.5 mm) and an increase


    128                                                                               Annali di Stomatologia 2017;VIII(3):123-130
    The three-dimensional reconstruction of the jaw with “bone slat technique” in conjunction with third molar removal




                                                                                                      li
                                                                                                    na
                                                                                                  io
                                                                             az
    Figure 11. After 5 months post-op, one screw-retained pro-
    visional crown was delivered.                                 Figure 13. The final results demonstrated an increase in
                                                                  length of 5 mm after bone graft (from 9.5 mm to 13.5 mm)




                                                                           rn
                                                                  and an increase in width of 1 mm after bone augmentation
                                                                  (from 5.7 mm to 6.7 mm).


                                                                  Saw) from the retromolar region, were placed to re-



                                                          te
                                                                  shape the alveolar crest and to protect the particular
                                                                  bone (placed in the cavity between the shells), from
                                                                  resorption. Harvesting the bone shells and extraorally
                                                        In
                                                                  trimming with a cutting wheel is very technique-sensi-
                                                                  tive. Additional, harvesting of bone chips is also nec-
                                                                  essary. In particular, the harvested bone block was
                                                                  cut along its long axis into two thinner blocks with the
                                                                  same diamond disk used previously. These two
                               ni

                                                                  blocks were thinned to a thickness of 1 mm using a
                                                                  bone scraper; bone chips were collected at the same
                                                                  time.
                             io


                                                                  The major advantage of this technique, in comparison
                                                                  to a bone block augmentation placed as an onlay
                                                                  graft, is the regeneration of vital bone (15, 16). The
                           iz



    Figure 12. The CBCT scan showed reconstruction of both        bone laminae of about 1 mm thickness prevent re-
    buccal and palatal plate and improvement of bone density      sorption of the bone chips and provide the shape of
    from D5 (92 HU) to D2 (1246 HU) according to Misch’s          the graft. Blood supply from the host bone ensures
            Ed




    classification.                                               survival of the bone chips.
                                                                  Based on these biological concepts described by
                                                                  Khoury et al. (15, 16) we have made changes on the
    in width of 1 mm after bone augmentation (from 5.7            establishment of three-dimensional reconstruction of
    mm to 6.7 mm) (Fig. 13).                                      the atrophic ridge (6); in fact, the bone slat of about 1
                                                                  mm thickness was obtained directly from the donor
 IC




                                                                  site by piezosurgery Medical device with surgical tip
    Discussion                                                    MT1S-10 (Mectron®, Carasco, Genova, Italy), and
                                                                  wasn’t necessary his extraoral trimming. Further-
    The use of bone removed from the posterior                    more, the intraoral bone lamina harvested was exclu-
C




    mandible during mandibular third molar extraction al-         sive cortical bone (Fig. 4), this avoid the possibility of
    so has been described (13). The Author, in this clini-        injury the inferior alveolar nerve with paraesthesia or
    cal study, used the piezosurgery Medical device with          anesthesia; or injury of the buccal nerve with de-
    surgical tip MT1S-10 (Mectron®, Carasco, Genova,              creased sensitivity in the posterior vestibular mucosa.
©




    Italy) to remove the third (14).                              Moreover, we performed the harvesting of the bone
    Khoury et al. (15, 16) described the shell technique          lamina of about 1 mm thickness directly from the
    for three-dimensional hard tissue grafting. Their tech-       donor site avoiding the possibility of the bone con-
    nique included the harvesting technique followed the          tamination and vitality stress during the cutting along
    methodology of the MicroSaw. Thin cortical bone               its long axis into two thinner blocks with the diamond
    shells, harvested with a special cutting wheel (Micro-        disk and bone scraper.

    Annali di Stomatologia 2017;VIII(3):123-130                                                                          129
    M. Santagata et al.


    The final results of this clinical case demonstrated an                   6.    D’Amato S, Tartaro G, Itro A, Santagata M. Mandibular bone
    increase in length of 5 mm after bone graft (from 9.5                           regeneration after bone slat technique. Ann Stomatol
    to 13.5 mm) and an increase in width of 1 mm after                              (Roma). 3 Jul 2017;8(1):39-44.
    bone augmentation (from 5.7 to 6.7 mm).                                   7.    Santagata M, Sgaramella N, Ferrieri I, Corvo G, Tartaro G,
                                                                                    D’Amato S. Segmental sandwich osteotomy and tunnel tech-
    In addition, we observed an improvement of bone den-
                                                                                    nique for three-dimensional reconstruction of the jaw atro-
    sity after implant loading: from D5 (92 HU) to D2 (1246                         phy: a case report. Int J Implant Dent. Dec 2017;3(1):14.
    HU) according to Misch’s classification. We think that




                                                                                                                      li
                                                                              8.    Santagata M, Guariniello L, Tartaro G. Modified edentulous
    this improvement in bone quality is linked to the change                        ridge expansion technique and immediate implant placement:
    of the bone architecture under load so that the bone




                                                                                                                    na
                                                                                    a 3-year follow-up. J Oral Implantol. Apr 2015;41(2):184-187.
    structure will be able to support the chewing load.                       9.    Santagata M, Tartaro G, D’Amato S. Clinical and histolog-
                                                                                    ic comparative study of subepithelial connective tissue
                                                                                    graft and extracellular matrix membrane. A preliminary split-
                                                                                    mouth study in humans. Int J Periodontics Restorative Dent.




                                                                                                                  io
                                                                                    Jan-Feb 2015;35(1):85-91.
    Conflict of interest
                                                                              10.   Santagata M, Guariniello L, Prisco RV, Tartaro G, D’Ama-
    No potential conflict of interest relevant to this article
                                                                                    to S. Use of subepithelial connective tissue graft as a bio-
    was reported.                                                                   logical barrier: a human clinical and histologic case report.




                                                                                          az
                                                                                    J Oral Implantol. Aug 2014;40(4):465-448.
                                                                              11.   Misch CE. Density of bone: effect on treatment plans, sur-
                                                                                    gical approach, healing, and progressive bone loading. Int
                                                                                    J Oral Implantol. 1990;6(2):23-31.
    References
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          P, Nedic M, Orsini M. A bone regenerative approach to alve-               to-implant relationship on esthetics. Int J Periodontics Res-
          olar ridge maintenance following tooth extraction. Report of              torative Dent. 2005;25:113-119.
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    2.    Ong CT, Ivanovski S, Needleman IG, Retzepi M, Moles DR,                   third molar removal for onlay grafting before placement of




                                                                      te
          Tonetti MS, Donos N. Systematic review of implant outcomes                dental implants. J Oral Maxillofac Surg. 1999;57:1376-1379.
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          35(5):438-462.                                                            D’Amato S. The piezoelectric osteotomy technique compared
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    3.    Lundgren AK, Lundgren D, Hämmerle CH, Nyman S, Sen-                       to the one with rotary instruments in the surgery of includ-
          nerby L. Influence of decortication of the donor bone on guid-            ed third molars. A clinical study. Minerva Stomatol. Jun
          ed bone augmentation. An experimental study in the rabbit                 2012;61(6):247-253.
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    4.    Misch CM. Comparison of intraoral donor sites for onlay graft-            the retromolar region: a 10-year prospective clinical
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          ing prior to implant placement. Int J Oral Maxillofac Implants.           study. Int J Oral Maxillofac Implants. May-Jun 2015;30
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    5.    D’Amato S, Tartaro G, Itro A, Nastri L, Santagata M. Block          16.   Khoury F, Khoury CH. Mandibular bone block grafts: diag-
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          mandibular lateral incisor defects: clinical and histologic anal-         procedures. In: Khoury F, Antoun, H, Missika P, eds. Bone
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          (1):e1-8.                                                                 2007.
                               iz
             Ed
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    130                                                                                            Annali di Stomatologia 2017;VIII(3):123-130
