When there is a bone defect in the upper maxilla or mandible we have to select the most appropriate procedure for reconstruction, depending on size, soft-tissue involvement and patient characteristics. We must always seek to ensure that the technique with less morbidity achieves better aesthetic and functional results, aimed at early prosthetic restoration.
Below we present a case where there is a defect of more than 50% of the upper maxillary bone with central oronasal communication. We opted to use a microvascular fibula flap for bone support and to seal the fistula. A year later, we placed six titanium implants on which we subsequently implanted a tooth-supported prosthesis. Different types of materials can be used for the reconstruction of bone defects of the upper or lower jaw and subsequent dental restoration, from membranes (closely linked to the concept of guided tissue regeneration) to stabilisers (elements capable of binding and/or converting particulate fillers into a non-dispersible mouldable mass) and fillers (autologous bone, homologous bone, heterologous bone and nonosseous synthetic and organic materials).
The reconstruction of extensive upper maxilla bone defects requires careful surgical planning, designed to provide the patient with good aesthetic and functional results. Currently, microvascular flaps represent the best option and if there is also a significant soft tissue defect, the type of graft to be used must be carefully selected. In our experience, microvascular fibular grafting can provide, apart from soft tissue, bone extension, which, if not of the best quality, is still sufficient for the subsequent placement of implants and prosthetic restoration.