Periimplant soft tissues management in case of deficiency of thickness and width of keratinized tissue at the stage of dental implants uncovering. Clinical case

Introduction. Mucogingival surgery in the case of keratinized soft tissue deficiency is indicated to optimize the volume of the peri-implant soft tissue to reduce the risk of further complications (peri-implantitis, mucositis, peri-implant recession). A number of surgical methods for peri-implant soft tissue management are proposed, which makes it difficult to choose the optimal one for specific clinical situations. Aim of the study. Evaluation of surgical methods for peri-implant soft tissue management. Methods and materials. Clinical case presentation, patient F / 39 year old was rehabilitated with an implant-prosthetic in the dental clinic "Omni Dent" in the period 2021-2022. The patient had a deficiency of width of the keratinized soft tissue (LGK) as well as the thickness of the keratinized soft tissue (GGK). The stage of mucogingival surgery was decided to be performed after implant osseointegration. At the stage of uncovering the implants 14, 15, 24, 36, 3 mucogingival surgical methods were used: 1) at the level of the implants 14, 15 the apical positioned flap technique; 2) at the level of the implant 25 the pouch roll technique; 3) at the level of the implant 36, the free gingival graft from the palate. Study criteria: keratinized soft tissue width, thickness, trauma morbidity, complications. Dynamic monitoring 2-14 days, one month and 3 months - postoperatively. Results. The patient was monitored postoperatively in dynamics to evaluate 3 methods performed simultaneously comparing them according to the proposed criteria. Method 1: preoperative LGK - 3 mm, postoperative LGK - 6 mm; GGK pre- 1.5 mm, GGK post- 3 mm; moderate edema; moderate pain; difficult and long time to perform. Method 2 LGK pre- 4 mm, LGK post- 7 mm; GGK pre-2 mm, GGK post-4 mm; edema, insignificant pain; simple and short time to perform. Method 3 LGK pre- 3 mm, LGK post- 8 mm; GGK pre-2 mm, GGK post-4 mm; moderate edema; moderate pain in the donor and recipient area; difficult and long time to perform. Postoperative complications were not present. The choice of methods used in the study should be based on the analysis of several criteria and individualized to the clinical case despite the advantages and disadvantages. Conclusion. The technique of rotating flap (method 2) proved to be the method with the best results according to the established criteria, being followed by the technique of free gingival grafting from the palate (method 3), a good result but with more sacrifice. The last method with the apical positioned flap (method 1) did not show high efficiency obtaining minimum thickness difficult work and long time to perform, it is a method that requires a higher training and precision to perform

Angle malocclusion Class II / 1

Department of Maxillo-Facial Surgery, Pedodontics and Orthodontics, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Class II / 1 malocclusion is a quantitative and directional growth disorder, produced at the jaw or dental level, whose essential characteristics are: insufficient development in the transverse plane (mono or bimaxillary, symmetric or asymmetric), distalized occlusion type, sagittal inocclusion with a normo, hyper or hypodivergent facial pattern, associated with functional and aesthetic disorders. Aim of the study. Studying and evaluating etiology aspects, diagnostic methods such as photostatic exam, digital cephalometrics and biometric study of models in dento-maxillary abnormalities Class II / 1 Angle. Materials and methods. The basic material for the research performance is the result of the biometric analysis and model study according to the methods proposed by Pont, Korkhaus, Nance, Linder Hart, Bolton, where eight patients with class II / 1 Angle malocclusion were analyzed. Results. The analysis of Pont's modeling models, Linder Hart, determined that in the class II / 1 Angle abnormalities, both jaws suffered transversal shortage. At the premolar (at the maxillary: Pont -100% Linder Hart -80%, mandible: Pont -80% Linder Hart -33.33%), at the molar level (at the maxilla: Pont and Linder Hart -93.33% at the jaw: Pont -60% Linder Hart -33.33%) Nance lists both excess space in 60% and 40% deficit which demonstrates the variety of class II / 1 Angle malocclusion. The Korkhaus analysis found elongation of the anterior maxillary sector in 66.67%. Conclusions. Class II malocclusion Angle is one of the most common and difficult to treat anomaly compared to others because of a wide variety, and the interaction between different etiological factor

Tratamentul chirurgical al recesiunii paradontale. Caz clinic

Introducere. Recesiunea gingivală reprezintă expunerea suprafeței radiculare rezultate prin migrarea marginii gingivale apical de joncțiunea smalț-cement. Deoarece apare treptat de multe ori este ignorată până la apariția stadiilor avansate, astfel necesită diagnostic precoce și tratament pentru preîntâmpinarea complicațiilor. Scopul lucrării. Analiza metodei de tratament chirurgical a recesiunii gingivale prin grefarea cu țesut conjunctiv subepitelial autogen prin prisma unui caz clinic. Materiale și metode. Pacienta T.I, f.36 de ani, s-a adresat la clinica stomatologică „Omni Dent” pentru tratament stomatologic prezentând acuze estetico-funcționale, hipersensibilitate, defecte cuneiforme. S-a depistat prezența biotipului gingival subțire, recesiunie gingivală cu resorbție osoasă la nivelul apofizei alveolare cl.II Miller. Plan de tratament: asanarea cavității bucale; operația de grefare cu țesut conjunctiv subepitelial palatin. Rezultate. S-a efectuat intervenția chirurgicală de recoltare a grefei cu țesut conjunctiv subepitelial autogen de la nivelul palatului dur pe dreapta prin incizii liniare cu grosime parțială, extinse de la suprafața distală a caninului pană la suprafața mezială a molarului II. Defectul a fost închis cu Colapol KP-3LM urmat de suturare. Grefele obținute au fost poziționate deasupra suprafețelor radiculare la nivelul dinților 3.3-3.6 și fixate prin suturare, după pregătirea zonei recipiente. Ca rezultat s-a obținut închiderea recesiunii prin creșterea volumului orizontal și vertical de gingie. Concluzii: Intervenția chirurgicală cu grefă autogenă de țesut conjunctiv subepitelial din palat a rezolvat defectul determinat de recesiunea gingivală îmbunătățind aspectul morfofuncțional și estetic

Tratamentul chirurgical al recesiunii paradontale. Caz clinic

Introduction. Gingival recession is the exposure of root surfaces because of apical migration of the gingival tissue margins; gingival margin migrates apical to the cemento- enamel junction. As it occurs gradually, it is often ignored up to advanced stages; therefore, it requires early diagnosis and treatment to prevent complications. Purpose of the paper. Analysis of the method of surgical treatment of gingival recession by autogenous subepithelial connective tissue grafting from the viewpoint of a case report. Materials and methods. The patient T.I, f., 36 years old, came to the „Omni Dent” dental clinic for dental treatment with aesthetic-functional charges, hypersensitivity and wedge- shaped defects. The presence of the thin gingival biotype was detected, as well as the gingival recession with bone resorption in alveolar process, Miller class II. Treatment plan: oral hygiene; subepithelial gingival connective tissue grafting. Results. Autogenous subepithelial connective tissue grafting was carried out at the level of the hard palate on the right side, through linear partial-thickness incisions, extended from the distal surface of the canine to the mesial surface of the second molar. The defect was closed using Colapol KP-3LM followed by suturing. The obtained grafts were positioned above the root surfaces of teeth 3.3-3.6, and were attached by suturing, after the recipient area was prepared. As a result, the recession was closed by horizontal and vertical gingival enlargement. Conclusions: The autogenous subepithelial connective tissue grafting fixed the defect caused by the gingival recession, improving thus the morpho-functional and aesthetical appearance.Introducere. Recesiunea gingivală reprezintă expunerea suprafeței radiculare rezultate prin migrarea marginii gingivale apical de joncțiunea smalț-cement. Deoarece apare treptat de multe ori este ignorată până la apariția stadiilor avansate, astfel necesită diagnostic precoce și tratament pentru preîntâmpinarea complicațiilor. Scopul lucrării. Analiza metodei de tratament chirurgical a recesiunii gingivale prin grefarea cu țesut conjunctiv subepitelial autogen prin prisma unui caz clinic. Materiale și metode. Pacienta T.I, f.36 de ani, s-a adresat la clinica stomatologică „Omni Dent” pentru tratament stomatologic prezentând acuze estetico- funcționale, hipersensibilitate, defecte cuneiforme. S-a depistat prezența biotipului gingival subțire, recesiunie gingivală cu resorbție osoasă la nivelul apofizei alveolare cl.II Miller. Plan de tratament: asanarea cavității bucale; operația de grefare cu țesut conjunctiv subepitelial palatin. Rezultate. S-a efectuat intervenția chirurgicală de recoltare a grefei cu țesut conjunctiv subepitelial autogen de la nivelul palatului dur pe dreapta prin incizii liniare cu grosime parțială, extinse de la suprafața distală a caninului pană la suprafața mezială a molarului II. Defectul a fost închis cu Colapol KP-3LM urmat de suturare. Grefele obținute au fost poziționate deasupra suprafețelor radiculare la nivelul dinților 3.3-3.6 și fixate prin suturare, după pregătirea zonei recipiente. Ca rezultat s-a obținut închiderea recesiunii prin creșterea volumului orizontal și vertical de gingie. Concluzii: Intervenția chirurgicală cu grefă autogenă de țesut conjunctiv subepitelial din palat a rezolvat defectul determinat de recesiunea gingivală îmbunătățind aspectul morfofuncțional și estetic

SURGICAL TREATMENT OF GINGIVAL RECESSION. CLINICAL CASE.

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Recesiunea gingivală reprezintă expunerea suprafeței radiculare rezultate prin migrarea marginii gingivale apical de joncțiunea smalț-cement. Deoarece apare treptat de multe ori este ignorată până la apariția stadiilor avansate, astfel necesită diagnostic precoce și tratament pentru preîntâmpinarea complicațiilor. Scopul lucrării. Analiza metodei de tratament chirurgical a recesiunii gingivale prin grefarea cu țesut conjunctiv subepitelial autogen prin prisma unui caz clinic. Materiale și metode. Pacienta T.I, f.36 de ani, s-a adresat la clinica stomatologică „Omni Dent” pentru tratament stomatologic prezentând acuze estetico-funcționale, hipersensibilitate, defecte cuneiforme. S-a depistat prezența biotipului gingival subțire, recesiunie gingivală cu resorbție osoasă la nivelul apofizei alveolare cl.II Miller. Plan de tratament: asanarea cavității bucale; operația de grefare cu țesut conjunctiv subepitelial palatin. Rezultate. S-a efectuat intervenția chirurgicală de recoltare a grefei cu țesut conjunctiv subepitelial autogen de la nivelul palatului dur pe dreapta prin incizii liniare cu grosime parțială, extinse de la suprafața distală a caninului pană la suprafața mezială a molarului II. Defectul a fost închis cu Colapol KP-3LM urmat de suturare. Grefele obținute au fost poziționate deasupra suprafețelor radiculare la nivelul dinților 3.3-3.6 și fixate prin suturare, după pregătirea zonei recipiente. Ca rezultat s-a obținut închiderea recesiunii prin creșterea volumului orizontal și vertical de gingie. Concluzii: Intervenția chirurgicală cu grefă autogenă de țesut conjunctiv subepitelial din palat a rezolvat defectul determinat de recesiunea gingivală îmbunătățind aspectul morfofuncțional și estetic.Introduction. Gingival recession is the exposure of root surfaces because of apical migration of the gingival tissue margins; gingival margin migrates apical to the cemento-enamel junction. As it occurs gradually, it is often ignored up to advanced stages; therefore, it requires early diagnosis and treatment to prevent complications. Purpose of the paper. Analysis of the method of surgical treatment of gingival recession by autogenous subepithelial connective tissue grafting from the viewpoint of a case report. Materials and methods. The patient T.I, f., 36 years old, came to the „Omni Dent” dental clinic for dental treatment with aesthetic-functional charges, hypersensitivity and wedge-shaped defects. The presence of the thin gingival biotype was detected, as well as the gingival recession with bone resorption in alveolar process, Miller class II. Treatment plan: oral hygiene; subepithelial gingival connective tissue grafting. Results. Autogenous subepithelial connective tissue grafting was carried out at the level of the hard palate on the right side, through linear partial-thickness incisions, extended from the distal surface of the canine to the mesial surface of the second molar. The defect was closed using Colapol KP-3LM followed by suturing. The obtained grafts were positioned above the root surfaces of teeth 3.3-3.6, and were attached by suturing, after the recipient area was prepared. As a result, the recession was closed by horizontal and vertical gingival enlargement. Conclusions: The autogenous subepithelial connective tissue grafting fixed the defect caused by the gingival recession, improving thus the morpho-functional and aesthetical appearance

Ameloblastoma. Diagnostics. Differential diagnosis. Clinical case

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Ameloblastomul este o tumoare benignă de origine odontogenă, structura cărei se aseamănă cu cea a organului smalțului, care provine din țesutul epitelial și se caracterizează printr-o creștere invazivă, local distructivă. Depistarea precoce precum și tratamentul chirurgical minimal invaziv sunt preocupările specialiștilor în domeniu pentru a reduce consecințele invalidizante a patologiei. Scopul lucrării. Identificarea patologiei prin prisma diagnosticului diferențial pentru abordarea planului optimal de tratament. Material și metode. Pacienta O. T., F/ 30 de ani s-a adresat la clinica stomatologică: ,,Omni Dent’’ prezentând acuze estetice și funcționale. Manifestările clinice și radiologice prezentau distrucție osoasă la nivelul corpului și unghiul mandibulei pe stânga cu prezența mobilității dinților și tulburări de inervație. Diagnosticul stabilit a fost: „Osteoblastoclastom a mandibulei in regiunea corpului pe stânga”. Rezultate. S-a efectuat operația de exereză segmentară a mandibulei, restabilirea cu placă reconstructivă din titan cu augmentarea transplantului autogen din creasta iliaca și reabilitarea implantoprotetică ulterioară cu patru implante la osul nou-format. La examenul histologic s-a identificat Ameloblastom Pleomorf, acestea doi patologii au manifestări clinice și radiologice asemănători, și de aceea numai după examen histologic putem să facem diagnostic diferențial. Supravegherea în dinamică la un an a demonstrat eficacitatea metodelor aplicate, lipsa complicațiilor și rezultat acceptabil. Concluzii. Depistarea clinică fără manifestări accentuate, diversitatea structurii histologice a ameloblastoamelor stă la baza apariției erorilor de diagnostic, respectiv, la etapa de planificare finală a intervenției chirurgicale este o condiție prealabilă - utilizarea nu numai a tomografiei computerizate, ci și a studiului histologic.Introduction. Ameloblastoma is a benign odontogenic tumor, whose structure resembles that of enamel organ, originating from epithelial tissue and characterized by invasive and locally destructive growth. Early detection and minimally invasive surgical treatment are the concerns of specialists in the field to reduce the disabling consequences of this pathology. Objective of the study. Identifying the pathology through the prism of differential diagnosis to establish an optimal treatment plan. Material and methods. Patient O.T., female, 30 years old, presented at the Omni Dent dental clinic with aesthetic and functional complaints. The clinical and radiological manifestations showed bone destruction in the body and angle of the left mandible, accompanied by tooth mobility and nerve disturbances. The established diagnosis was „Osteoblastoclastoma of the mandible in the region of the left body.” Results. Segmental mandibular resection was performed, followed by reconstruction using a titanium reconstructive plate with autogenous bone grafting from the iliac crest, and subsequent implant-supported rehabilitation with four implants in the newly formed bone. Histological examination identified Pleomorphic Ameloblastoma. These two pathologies have similar clinical and radiological manifestations, and therefore, only through histological examination can a differential diagnosis be made. Dynamic follow-up at one year demonstrated the effectiveness of the applied methods, absence of complications, and an acceptable outcome. Conclusions. The clinical detection of ameloblastoma without pronounced manifestations and the diversity of its histological structure contribute to diagnostic errors, emphasizing the importance of not only using computed tomography but also histological studies in the final surgical planning stage

Peri-implantitis: explantation versus peri-implant regeneration

Rezumat. Periimplantita este o complicaţie în reabilitarea implanto-protetică care provoacă dereglări morfo-funcţonale, masticatorii şi estetice. În funcţie de gravitate poate fi abordată prin tratament conservativ chirurgical sau radical. Scopul lucrării este analiza comparativă a metodelor conservativ chirurgicale (păstrarea implantului) versus radicale (explantarea).S-au studiat 2 pacienţi care s-au adresat la clinica SRL “Omni Dent” cu periimplantita. S-au comparat manifestarea, tratamentul, evoluţiala ambiipacienţi. Criterii de analiză: extinderea defectului osos, aspectul ţesuturilor moi, regenerarea tisulară, timpul de reabilitare implanto-protetică. La pacientul RI au fost modificări de culoare şi aspect al ţesuturilor moi periimplantare (hiperemie, edem, eliminări purulente), radiotransparenţa periimplantară pe toată suprafaţa implantului; la pacientul TM au fost aceleaşi semne clinice însă limitate la ½ lungime implant. La pacientul RI s-a efectuat explantarea cu reimplantarea în regiunea invecinată 2.4 peste 4 luni cu protezare peste alte 4 luni. Regenerarea tisulară fără complicaţii. La pacientul TM s-a recurs la păstrarea implantului cu chiuretaj, implantoplastie, adiţie osoasă. Reabilitarea protetică urmată ulterior fără complicaţii. Adresarea la timp ar preîntâmpina dezvoltarea complicaţiilor cu pierderea implantelor. Pierderea neînsemnată a ţesuturilor periimplantare poate fi recuperată cu păstrarea implantului, în defectele extinse soluţia optimală este explantarea cu reabilitarea implanto-protetică ulterioară.Summary. Peri-implantitis is a complication in implant-prosthetic rehabilitation that causes morpho-functional, masticatory and aesthetic disorders. Depending on the severity it can be approached by conservative surgical or radical treatment. The aim of the paper is the comparative analysis of conservative surgical methods (implant preservation) versus radical (explantation). We studied 2 patients who came to the SRL “Omni Dent” clinic with peri-implantitis. Manifestation, treatment and evolution in both patients were compared. Analysis criteria: bone defect extension, soft tissue appearance, tissue regeneration, implant-prosthetic rehabilitation time. In RI patient there were changes in color and appearance of the peri-implant soft tissues (hyperemia, edema, purulent discharge), peri-implant radiolucency on the entire implant surface; in the TM patient there were the same clinical signs but limited to ½ implant length. RI patient underwent explantation with re-implantation in the neighboring region 2.4 after 4 months with prosthesis fixing after another 4 months. Tissue regeneration evolved without complications. In TM patient was decided to keep the implant through curettage, implantoplasty and bone addition. Prosthetic rehabilitation followed later without complications. Timely addressing would prevent the development of complications with implant loss. The insignificant loss of peri-implant tissues can be recovered with the preservation of the implant, in the extended defects the optimal solution is the explantation with the subsequent implantprosthetic rehabilitation

The rotated pedicle palatal connective tissue flap technique (RPPCTF) in management of soft tissue defects

Department of Oral and Maxillofacial Surgery Arsenie Gutan, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Esthetic and functional reconstruction of soft tissue in maxilla have driven the evolution of plenty of techniques for rehabilitation. Selection of a proper surgical technique often causes difficulties. The closer the flap donor site is to the defect; the less morbidity is associated with the reconstructive surgery. The RPPCTF technique present a multilateral application. It can be used in closure of the alveolus after immediate implant placement, complete socket closure, increasing soft-tissue volume, papilla reconstruction, defects and dehiscence repair, closure of oro- antral communication (OAC). Aim of the study. Evaluation of the soft tissue reconstruction technique for covering defects associated with maxillary region. Materials and methods.. This study was axed on 7 patients which represent the different types of soft and bone tissue defects in maxillary aesthetic zone. In 3 cases this technique was performed to complete socket closure and postponed implant placement. Closure of oro-antral communication was performed at 1 patient, closure of the alveolus after immediate implant placement was performed in 3 cases. After local anesthesia and a minimally invasive extraction of tooth, the socket was curetted and inspected. The dimensions of the socket were measured and considered for RPPCTF technique preparation. A single palatal incision (Hurzeler MB, Weng D.) design was placed, pedicle graft was prepared leaving the mesial side attached, then is checked for freedom of movement, rotation and placement. The pedicle graft is rotated and positioned over the edentulous area and onto the buccal surface. After that the flap are sutured using horizontal mattress and simple interrupted sutures. The donor site remains primarily covered. Results. During treatment with this method partial flap necrosis did not occur. All patients showed a significant improvement over the preoperative condition. In all cases we got a large volume of soft tissue, excellent esthetic results, primary socket closure. RPPCTF can help to preserve or restore the natural ridge contours. In addition to providing graft containment, the RPPCTF can also serve as a barrier membrane during bone regeneration. Conclusions. The rotated pedicle palatal connective tissue flap is a relatively simple technique for soft tissue coverage without excessive tension. It is an excellent technique that can be used to improve the vertical and horizontal thickness of soft tissue. It can be employed to improve aesthetic soft-tissue structure around the tooth, implants and intraoral defects

Orthopantomography and computed tomography with conical beam as auxiliary tools in the diagnosis of osteoporosis in women

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra de chirurgie OMF şi implantologie orală „Arsenie Guţan”, Chișinău, Republica Moldova, Departamentul Pediatrie, Centrul pentru Politici și Analize în Sănătate (Centrul PAS), Catedra de odontologie, paradontologie și patologie orală, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Osteoporosis is a systemic disease of the skeleton, characterized by a decrease in bone density, impaired bone tissue microarchitecture, which leads to increased bone fragility and consequently increases the risk of fractures (WHO) [1]. Currently, with the increase in the number of elderly people globally, the incidence of osteopenia/osteoporosis also increases. This condition is prevalent in older people and sometimes may be detected only if fractures occur. However, it is known that this condition can be prevented when detected early, using various diagnostic techniques and methods. The assessment of bone mineral density (BMD) by DXA is considered the gold standard for the identification of osteoporosis, as it is an easy method to perform and provides high accuracy in detecting BMD. But there are other radiological methods (OPG,CBCT), which allow the detection of BMD disorders. The obtained results provide us with data that can be used for a treatment course in the implant-prosthetic rehabilitation of patients with presumed osteopenia/osteoporosis [2]. Purpose. Assessment of radiological methods used in the dentist's activity for early detection of osteopenia/osteoporosis. Material and methods. The study included 49 patients (50-84 years, mean = 60.38) with edentulousness, who addressed for prosthetic implant rehabilitation in dental clinic “Omni Dent”. Radiological examination (OPG, CBCT) was performed in all patients (figure 1 and figure 2). The diagnosis of osteopenia / osteoporosis was made according to Klemetti classification (figure 1). The results were correlated with those obtained from the osteodensitometric radiological examination. Results. Osteodensitometry result: 11 patients with normal BMD, 20 with low bone density corresponding to osteopenia and 18 patients with osteoporosis (figure 3). OPG and CBCT radiological examination results: C1-13 patients; C2-19 patient; C3- 17 patient. Correlating the OPG, CBCT data with the osteodensitometric, we established that the method according to Klemetti has a statistical truthfulness rate of 85.3%. Of the group of patients over 60 years of age, 12 (48%) were diagnosed with osteoporosis, 9 (36%) with osteopenia and 4 (16%) with normal BMD. In the group of patients up to 60, 6 (25%) patients with osteoporosis, 11 (45.83%) with osteopenia and 7 (29.16%) with normal BMD were detected. Conclusions The obtained result allows us to state that OPG and CBCT can be considered auxiliary methods for the early diagnosis of osteopenia / osteoporosis. In case of advanced forms detection, the patient needs to be directed to specialized physicians for further examination

Alveolar bone reconstruction with autogenous intraoral grafts in the context of posttraumatic rehabilitation

Department of Oral and Maxillofacial Surgery and Oral Implantology Arsenie Gutan, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. The rehabilitation in conditions of bone loss supposes a bone augmentation surgery.The optimal choice for this kind of performance is the autogenous grafts harvested from the patients own body especially intraoral sites. Khoury introduced a new method for grafting ridge defects in 2007, using thin cortical plates harvested from the ramus, and in a 'sandwich' type manner, interposed these bone plates with cancellous bone harvested from the same site. The principles involved in successful bone grafts include osteoconduction, osteoinduction, and osteogenesis .Osteogenesis only occurs with autograft tissue and cellular bone matrices therefore. Case report. 21-year-old female presented for the restoration of her missing dentition in her upper jaw due to an early childhood trauma. CBCT revealed a large horizontal and vertical bony deficiency in the region of the upper anterior teeth , The Khoury technique was decided to aply ,using bone fixation screws, the bone plates that were harvested from the ramus were fixed to the buccal defect ,the space between the plate and the existing palatal bone wall was then filled using a combination of autograft bone scrapings and xenograft bone particles. Six months after the initial surgery, the grafted sites were surgically re-entered and showed a marked increase in ridge dimensions from 4,2 to 9,5 mm. The regeneration of the alveolar crests took place in conventional terms without complications , donor site was fully restored without signs of morbidity. The radiological and clinical examinations 6 moths postoperative showed up a good result of bone formation nearly 5.3 mm. The advantages of using mostly intraoral autografts in GBR tehnique comparatively to others is that they provide a good bone regeneration , stimulate local resources of the bone, serve as the source of BMP, serves as a scaffold for new bone growth that is perpetuated by the native bone, actually autografts integrate all basic peculiarities that the bone needs to regenerate its structure and reestablish all the physiological functions. Conclusions. The usage of autogenous intraoral grafts as a method of augmentation appeared to give a stable and relatively quick result . If good surgical skills are performed, the graft seems to facilitate tissue healing and promote bone formation that is most important for the subsequent posttraumatic rehabilitation of the patient