Severely resorbed mandible: predictable reconstruction with soft tissue matrix expansion (tent pole) grafts.
OBJECTIVE
Attempts to reconstruct the severely resorbed mandible (<or=6 mm) have historically been unsuccessful and often been complicated by fracture, fistulas, and neurosensory loss. In the past, bone grafts to these severely resorbed mandibles have rapidly resorbed due to a soft tissue volume deficiency that contracts about the graft.


METHODS
A novel surgical approach using dental implants as "tent poles," along with bone grafting, is described, and the long-term follow-up of 64 cases is presented.


RESULTS
The results revealed that all 64 grafts maintained 15 mm of bone height, with a follow-up ranging from 3 to 10 years and a mean follow-up of 4.9 years. The starting bone heights ranged from 3 to 6 mm, with a mean height of 4.8 mm. The mean bone height gain was 10.2 mm, with a range of 9 to 13 mm. All patients progressed to a functional denture that remained in function at the time of their follow-up. Short-term paresthesia (<or=3 weeks) was noted in 17.1% of patients, but no permanent neurosensory disturbance was noted. In these 64 cases, 356 dental implants were placed and 354 were osseointegrated (99.5%) and functioning at the time of follow-up (>or=3 years).


CONCLUSIONS
The novel strategy of this surgery whereby bone grafts consolidate and maintain their volume by dental implants that creates a tenting effect offers predictable long-term reconstruction of the severely resorbed mandible without the complications observed with other approaches.
Marx
Robert E
RE
Division of Oral and Maxillofacial Surgery, University of Miami School of Medicine, Miami, FL 33157, USA.
Shellenberger
Thomas
T
Wimsatt
James
J
Correa
Pedro
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016723:Bone Remodeling / Q000502:physiology; D001862:Bone Resorption / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods* / Q000473:pathology; D002508:Cephalometry; D002680:Chin / Q000294:innervation; D003758:Dental Implantation, Endosseous / Q000379:methods; D015921:Dental Implants; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008334:Mandible / Q000473:pathology / Q000601:surgery; D008336:Mandibular Diseases / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016348:Osseointegration; D010292:Paresthesia / Q000209:etiology; D011183:Postoperative Complications; D015626:Tissue Expansion / Q000379:methods*; D014727:Vestibuloplasty
D015921:Dental Implants