The Guided Bone Regeneration of a Large, Noncontained Maxillary Anterior Perforation Defect: A Case Report

The reconstruction of alveolar ridge defects can be challenging, especially when the lesion is large, noncontained, and located in the esthetic region. The present report describes the guided bone regeneration (GBR) procedure and prosthetic rehabilitation of a severe perforation defect in the anterior maxilla. Clinical and radiographic evaluations of the lesion indicated an endodonticperiodontal origin, and biopsy results confirmed the absence of malignancy. GBR was performed with the use of cortical mineralized freeze-dried bone allograft (FDBA) combined with recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and a resorbable collagen membrane without the use of tenting or fixation screws. Six months after GBR, CBCT revealed adequate bone fill for the placement of 4.1 × 10-mm or 4.1 × 12-mm dental implants. The implant surgery was fully guided with a two-stage approach. After 10 months of healing, the implants were loaded with a screw-retained porcelain partial denture. The staged GBR approach, using a combination of FDBA, rhPDGF-BB, and a resorbable membrane without the use of tenting or fixation screws, resulted in significant bone fill, successful implant placement, and a functional and esthetic implant-supported prosthesis.