Augmentation of the atrophic edentulous maxilla with hydroxylapatite

A technique for augmentation of the severely atrophic edentulous maxilla is presented. This technique combines the mobilization of the available soft tissue of the labial vestibule with a subperiosteal reflection and "filleting" of the redundant crestal soft tissue to create ample space to accommodate the insertion of the desired amount of hydroxylapatite. The surgical development of a distinct labial periosteal flap by both a subperiosteal and supraperiosteal dissection allows a two-layered lapped closure of the mucosal and periosteal flaps. Fourteen patients were treated with this technique and have been observed for period of 8 to 40 months. Arch form was dramatically improved in all cases. Observation of panoramic radiographs disclosed an average initial increase in ridge height of 11.8 mm in the midline and 7.6 mm in the first premolar regions. During the first 6 months, consolidation of the ridge occurred, but the diminution in ridge height never exceeded 15%.