title: Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.
abstract: The objective of this study was to evaluate the outcomes of mandibular vertical defect reconstruction with autologous bone and the use of a sub-periosteal tunnel approach in preparation for dental implant insertion. Forty-three consecutive patients with an atrophic posterior mandible were reconstructed using this method. Two thin laminae of cortical bone, obtained by splitting blocks harvested from the retromolar area, were fixed in a box-like framework containing cancellous and particulate bone. The goal was to achieve an alveolar ridge width of ≥5.5mm and an effective bone height (EBH) of ≥10.5mm for dental implant insertion (≥3.4mm diameter, ≥9.5mm length). Fifty reconstruction procedures were performed. The mean EBH was 7.1±1.3mm pre-treatment and 12.3±1.1mm post-treatment (mean increase 5.2±1.4mm). Complete graft loss was recorded in two cases; the remaining complications were minor. After a mean consolidation period of 3.5 months, 96 dental implants were placed. No failure of osseointegration was observed at follow-up (mean 32.9 months). The average bone height reduction was 0.9mm (graft vertical resorption 17.4%). Reconstruction of posterior mandibular vertical defects using two autogenous cortical bone blocks with particulate bone between them, combined with a tunnelling technique, provided good healing with no wound dehiscence and minimum resorption of the grafted bone, favouring a substantial vertical bone gain.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Principe de Asturias University Hospital, University of Alcala, Madrid, Spain. Electronic address: andres.restoy@salud.madrid.org.
authors.forename: A
authors.initials: A
authors.lastname: Restoy-Lozano
authors.affiliation: Department of Oral and Maxillofacial Surgery, Principe de Asturias University Hospital, University of Alcala, Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Dominguez-Mompell
authors.affiliation: Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, University of Seville, Seville, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Infante-Cossio
authors.affiliation: Department of Oral and Maxillofacial Surgery, Principe de Asturias University Hospital, University of Alcala, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Lara-Chao
authors.affiliation: Department of Oral and Maxillofacial Surgery, Torrecardenas Hospital, Almeria, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Espin-Galvez
authors.affiliation: Department of Oral and Maxillofacial Surgery, Principe de Asturias University Hospital, University of Alcala, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Lopez-Pizarro
mesh_terms: D000328:Adult; D000368:Aged; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001284:Atrophy; D016025:Bone Transplantation / Q000379:methods*; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011862:Radiography, Panoramic; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants
keywords: atrophic mandible; bone augmentation; dental implants; onlay bone grafting; pre-prosthetic surgery; tunnel technique