1. IntroductionDimensional changes in bone following tooth extraction are a natural occurrence and can be attributed to both biological and mechanical factors. Following Wolff’s law, the structure and mass of bone are influenced by mechanical stress and strain. Consequently, in the absence of teeth and the associated forces, there is a potential for bone resorption to take place.1 The remodeling of the alveolar bone ridge following tooth extraction results in noteworthy dimensional changes in both the horizontal and vertical planes.2-7 Research indicates that the resorption rate is more pronounced in the horizontal dimension compared to the vertical dimension.4, 7 However, it is essential to recognize that reconstruction and management of complications associated with vertical bone defects present greater challenges post-surgery.8, 9Over the past decades, various techniques have been developed for the vertical reconstruction of each defect, tailored to the specific type and severity of the defect. Notable methods in this field include distraction osteogenesis, block grafting (onlays or inlays, inter-positional grafts), guided bone regeneration (GBR) utilizing non-absorbable membranes, the application of titanium mesh, and the implementation of tent screws.9-18 While there remains a lack of consensus regarding the most suitable method for vertical reconstruction, it is crucial to consider two fundamental factors when implementing any vertical reconstruction technique. Firstly, the presence of supportive bony walls (bone peaks) and the second is the availability of appropriate soft tissue for achieving a tension-free closure.19-21The characteristics of the bone peaks within the edentulous area play a crucial role in determining the regeneration potential of the defect, particularly in relation to the chosen reconstruction technique. In cases with wide vertical defects, where a considerable distance exists between the bone peaks, inadequate angiogenesis often hinders the regenerative potential.19, 20, 22 In circumstances where the potential for bone regeneration is diminished, utilizing autogenous bone, whether as particles or blocks, may be the preferred option to enhance osteogenic properties and promote osteoinductivity.23 In the context of vertical reconstructions, achieving primary closure presents greater challenges than horizontal reconstructions. Utilizing autogenous blocks may offer a reduced risk of early wound exposure compared to non-absorbable membranes or titanium meshes.12, 24, 25 Furthermore, autogenous blocks demonstrate superior space preservation and diminished late resorption relative to autogenous bone particles, highlighting their advantages in vertical reconstruction procedures.26In certain cases, a segment of alveolar bone may be removed along with the tooth root during tooth extraction. When this fragment can be securely repositioned at the defect site, it can serve as an autogenous block, providing a gold-standard option for horizontal and vertical bone reconstruction.This study presents a simple and minimally invasive approach known as the socket wall autogenous bone block approach for vertical reconstruction in conjunction with tooth extraction. This method has the potential to yield significant results in clinical practice.

1. IntroductionAfter extracting the posterior teeth in the upper jaw, there may be insufficient bone height available for implant installation. Ongoing maxillary sinus pneumatization and crestal bone loss are factors that can have a significant impact on the RBH. According to several studies, the reduction of RBH around dental implants may be attributed more significantly to crestal resorption than to sinus pneumatization.1 In situations where it is necessary to enhance bone height, one of the viable approaches is to elevate the sinus floor through the lateral or crestal method. In general, the RBH value is the decisive factor in selecting between the lateral and crestal techniques. When the RBH is less than 5 mm, it is recommended to employ a lateral approach utilizing grafting material.2The technique of the crestal approach, which was originally introduced by Tatum in 1986, underwent a significant modification by Summers in 1994.3, 4 This technique involves the utilization of an osteotome, which may induce complications for the patient as a result of enduring multiple blows.5, 6 Subsequently, this approach has been gradually replaced by other methods that offer a safer alternative. In 2020, a modified technique known as VEST (Vertically Expander Screw Technique) was proposed to gradually separate the sinus membrane from the sinus floor bone. This innovative technique employs screws from bone expander kits to elevate the membrane upwards.7 It should be noted that the crestal method, despite its efficacy, still presents certain concerns, particularly the potential sinus membrane perforation due to its inherent blind nature.8According to research conducted using endoscopic techniques to evaluate the risk of sinus membrane perforation, it has been demonstrated that sinus floor elevation with a crestal approach between 3 and 5 mm is associated with the lowest risk of perforation.9, 10Based on the findings of a recent systematic review, it has been suggested that dental implants with a shorter length (less than 8 mm) may present a viable alternative to the standard implants of 10 mm or more in cases of residual bone height deficiency in the posterior maxilla.11 In situations where RBH falls within the range of 4-6 mm, it is advisable to use an implant that is around 6-8 mm long, with a suitable diameter to ensure the safe elevation of the sinus floor from the crestal bone.When performing sinus floor elevation via the crestal approach, it is essential to consider the risk of membrane perforation due to direct contact with the schneiderian membrane. In this regard, three factors may increase the possibility of membrane perforation. The first is the direct contact of the sinus floor elevation instrument with the membrane, which may occur if the force applied is not carefully controlled. For instance, the use of an osteotome may increase the likelihood of such an outcome. Second, direct contact of the bone graft material with the sinus membrane and the associated risk of perforation, which stems from the irregularity of graft particles. Third, direct contact between the implant apex and the sinus membrane during implant insertion. Therefore, the implant’s geometry plays a pivotal role in the prevention of sinus membrane perforation.In the context of the sinus floor elevation procedure, the utilization of flexible graft materials such as PRF prior to device or implant insertion may potentially mitigate the incidence of membrane perforation.This article presents a modified technique of VES, using the bone Tap drill available in the Straumann surgical kit, combined with PRF to safeguard the sinus membrane while simultaneously placing 8 mm implants.

1. IntroductionAfter a tooth extraction, the dental socket experiences a natural process of physiological remodeling. Currently, there are no known methods to prevent these changes.1 Several factors, including the thickness of the buccal plate and the condition of the proximal bone influence the degree of changes observed in the socket.2Numerous techniques for bone regeneration have been developed and proposed. These techniques can be classified based on the type of barrier membrane used, the type of bone graft employed, or the method used to create a space for the graft material. Barrier membranes can be categorized as either resorbable or non-resorbable; however, their application falls under the broader term of guided bone regeneration (GBR).3 The distinction between types of bone grafts primarily relates to their source, which can be categorized as autogenous or non-autogenous.4 The creation of a conducive environment for osteogenic cell activity can be achieved by applying graft particles that possess adequate durability, serving as scaffolds. Alternatively, the implementation of new walls may be utilized to prevent the soft tissue collapse at the defect site.5According to the PASS principles, employing methods that facilitate the maintenance or creation of space for osteogenic cell growth can enhance the predictability of graft success.6 The application of graft particles in conjunction with flexible, resorbable membranes raises concerns regarding potential soft tissue collapse. Conversely, the use of rigid barriers, such as titanium mesh, necessitates the incorporation of bone particles to adequately fill the space beneath these structures.7The utilization of autogenous blocks effectively addresses both concerns associated with bone grafting. These blocks contain viable cellular components and osteogenic signals, while also providing the structural strength necessary to prevent soft tissue collapse. Consequently, the application of autogenous blocks remains the gold standard in the treatment of severe atrophy.8-10. Autogenous bone can be utilized in two main forms: as blocks9 or as plates11, which contribute to the formation of a structural box. Additionally, the gap beneath the plates or the spaces surrounding the blocks can be filled with autogenous chips or bone substitute particles, such as allograft particles. The regenerative capacity of the defect in question primarily influences the choice of technique for reconstructing bone defects. Bone defects can be categorized as critical or non-critical; as the nature of the defect progresses toward non-contained, the application of autogenous grafts becomes increasingly advantageous.12In cases of contained defects, the presence of additional bone walls enhances the support for the graft components and facilitates blood supply.13 This characteristic contributes to a more predictable success rate for the treatment. By incorporating autogenous bone blocks into severely atrophic ridges, we can create new bone walls, effectively transforming non-contained defects into contained defects.Autogenous block can be sourced both intraorally or extraorally, with the chin and posterior mandible representing the most prevalent intraoral sources.14, 15 Several techniques exist for harvesting autogenous blocks, including the use of surgical burs, piezosurgery and surgical saws, which are some of the most widely recognized methods.11 However, there is currently no consensus regarding the impact of the size and shape of the autogenous block, nor on the extent to which the block should cover the defect. This article describes a different method for harvesting a specific type of autogenous block using a trephine bur to implement the innovative osteogenic wall concept for reconstructing severely atrophic ridges. Additionally, the study examines the regenerative potential of bone defects in the context of discontinuous autogenous block fragments.