Pericranium graft in preprosthetic maxillary reconstruction.

Cases presentation: The necessary requirements for bone graft reconstruction success are: appropriate vascular support in the recipient site, adequate rigid fixation and graft protection from external infecting agents. The senior author has developed a new technique consisting in the positioning of a pericranium layer, harvested from the parietal area of the cranium, over the rigidly fixed bone grafts. The advantages are: prevention from bone exposure and resorption due to the presence of a layer physically interposed between graft and mucosa and with osteogenic potential; thickening of the alveolar mucosa which is helpful in soft tissue conditioning during the prosthodontic phase. In this study, we enrolled 18 patients affected by maxillary and mandibular bone atrophy and treated using the above-mentioned technique. Twelve cases underwent calvarial graft, 6 iliac bone graft; All patients underwent pericranium graft overlapping. After a healing period of 6 months for calvaria and 4 months for iliac crest, implants were positioned. Results: No donor site complications were reported. Bone graft survival and maintenance of morphology was observed in all cases. Two patients, during the second postoperative week, presented vascular damage of the mucosal flap with exposure of the underlying periosteum, which appeared still vital at that time protecting the underlying bone. The damage healed spontaneously by second intention, and the presence of the periosteal tissue prevented from bone contamination. Conclusion: Because of protective capability towards bone grafts and lack of donor site morbidity, the pericranium graft could become a standard procedure in preprosthetic reconstructive surgery.