Maxillary post-traumatic outcome correction. Literature review and personal experience. Part II: loss of maxillary substance (free grafts of autologous bone).

Loss of maxillary substance following trauma varies significantly in relation to the dimensions, site and type of tissue involved. Anatomical maxillary interruptions, loss of dental elements and consequent bone re-absorption give rise to altered chewing, swallowing and speech functions. Treatment of pathological conditions over the years has seen the development of surgical protocols designed to achieve simultaneous aesthetic and functional restoration of the stomatognatic apparatus. The advent of osteointegrated implantology and continual progress in pre-prosthesis surgical techniques have undoubtedly revolutionised established approaches to prosthetic rehabilitation by introducing the concept of supported implant prostheses. The implantation protocols used are a safe and reproducible treatment method suitable for adequate anchorage of such prosthetic implants; the application of such protocols in any case is subordinated to the presence of adequate morpho-volumetric bone at the skeletal bases. Depending on the entity of maxillary loss of substance, the reconstruction methods we propose, in agreement with numerous other authors, are based on the use of free and free-revascularised autologous bone grafts or, even more recently, the application of osteogenetic distraction techniques. The purpose of this article is to evaluate treatment of loss of maxillary substance following trauma by means of non-revascularised free flaps. The use of free grafts of autologous bone is elective in patients presenting bone deficits less than 6 cm with and/or without upkeep of maxillary and mandibular cortical bone continuity but without compromise to the integrity and trophism of the soft tissues.