• Crestal pyramidal flap will be done with 2 releasing incisions for adequate exposure.
• Buccal& palatal full reflection for adequate exposure and to avoid the interference between the onlay graft and the residual bone.
• Decortication of the bone bed to increase the blood supply to the onlay graft.
• The block graft harvested from the chin is placed crestal to the residual ridge and stabilized in place using dental implant immediately.
• Periosteal incisions are usually needed to allow tension free sutures.
• Vicryl 3/0 sutures for closer.
• augmentin 1g twice daily for 5 days.
• catflam 50g twice daily for 3 days

• Crestal incision with labial flap reflected leaving the palatal tissues without elevation.
• Marking of the 3 bony cuts ( 2 vertical cuts & 1 horizontal cut ) using fine fissure bur in the form of perforations along the cuts position.
• Drilling of pilot drill and first drill only.
• 3 full thickness cuts will be performed (2 vertical stop cuts will be made by using the tungsten carbide disc at the distal ends of the horizontal bony cut on the facial surface of alveolar ridge.
• splitting osteotomes are used and mallet to complete the splitting of the bony segment.
• After bony separation the rectangular bony segment (transport segment) will be mobilized occlusally and pedicled on the palatal mucoperiosteum.
• The autogenous block graft harvested from the chin area is placed in the space gained under the mobile bony segment.
• Drilling through the bony segment and the block graft.
• Immediate implant placement

chin graft block dental implants

* Local anesthesia with vasoconstrictor(V.C) used for hemostasis.

chin block graft

• Scrubbing and draping of the patient will be carried out in a standard fashion using betadine surgical scrub.
• The donor site is usually the chin area, its approached using local anesthesia with VC at symphysis region.
• Low vestibular incision exposing the symphysis area to the inferior border of the mandible.
• Using fissure bur to harvest the graft for the defect.
• Closure using vicryl 3-O sutures.

• The nasal floor will be used as a fixed reference by adjusting the cross sectional long axis in the center of the area of interest and bisecting it (showing the buccolingual dimension).
• All the patients will wear the radiographic dentures with radiopaque material (barium sulphate mixed with acrylic powder) filling the teeth at the area of interest to ensure that the calculations were taken at the same region.
• On the cross sectional view of CBCT and at each proposed implant site, a line will be drawn starting from the crest of the ridge till the nasal floor. The height will be recorded preoperatively, immediately (1 week) and 6 months postoperatively.the difference between them in millimeters will be recorded.

crestal bone loss around the implant will be measured in millimeter after 6 months