Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants |
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| Authors: | S. Pelo R. Boniello A. Moro G. Gasparini P.F. Amoroso |
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| Affiliation: | 1. Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor, Departments of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor, Department of Orthodontics, University of Maryland School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC;2. Chief Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC;1. VI Division of General Surgery, AOU San Giovanni Battista, University of Torino, Italy;2. Division of Hematology and Cell Therapy, AO Ordine Mauriziano, University of Torino, Italy;3. Molecular Biotechnology Center (M.B.C.), University of Torino, Italy;4. Division of Nuclear Medicine, University of Torino, Italy;5. Division of Hematology, AOU San Giovanni Battista, University of Torino, Italy;1. Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, University of Bern, Bern, Switzerland;2. Advanced Research Center, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan;3. Department of Histology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan;1. Divisione Clinicizzata di Malattie Infettive, Dipartimento di Scienze Biomediche e Cliniche “Luigi Sacco”, Universita’ degli Studi di Milano, Milano;2. ITB-CNR, Segrate, MI;3. Laboratorio di Igiene Ospedale S. Martino, Genova;4. Istituto di Clinica Malattie Infettive, Universita’ Cattolica del Sacro Cuore, Roma;5. Laboratorio Microbiologia, Ospedale L. Sacco, Milano;6. Seconda Divisione Malattie Infettive, Ospedale L. Sacco, Milano;7. Ambulatorio Clinica Malattie Infettive, Fondazione Policlinico S. Matteo, Pavia;8. Malattie Infettive, Ospedale SM Annunziata, Antella, FI;9. Laboratorio Virologia, Ospedale Careggi, Firenze;10. Malattie Infettive, Ospedali Galliera, Genova;11. Clinica Malattie Infettive, Ospedale S. Martino, Universita’ degli Studi di Genova, Genova;12. Laboratorio Virologia, Policlinico Universitario, Bari;13. Clinica Malattie Infettive, Universita’ degli Studi di Bari, Bari;14. University of Siena, Siena, Italy;1. Piracicaba Dental School, Oral and Maxillofacial Surgery (Department of Oral Diagnosis), (Head: Jose Ricardo de Albergaria-Barbosa), State University of Campinas e UNICAMP, P.O. Box 52, Piracicaba, Sao Paulo, 13414-903, Brazil;2. Centro de Investigaciones del Colegio Odontológico (CICO), Institución Universitaria Colegios de Colombia, Bogotá, Colombia;3. Department of Prosthodontics and Periodontology, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil;4. University of Porto, FEUP, Faculty of Engineering, Portugal;5. Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Brazil;6. Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile |
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| Abstract: | Extensive resorption of the mandible increases the interarch space and rehabilitation with traditional dentures is often unsatisfactory due to the superficialization of intraoral muscles. A study of 19 patients who underwent augmentation of an atrophic mandible using a bilateral two-step osteotomy and interpositional bone graft technique is presented. Three horizontal bone cuts (one in the intraforamina and two in the molar region) were made and jointed together by two short vertical bone cuts mesialy to the mental nerve. The cranial fragment was lifted and the iliac bone graft was interposed recreating the correct intermaxillary relationship. A broad vascular pedicle was maintained during surgery, ensuring nutrition from the lingual side, essential to reduce resorption of the bone graft and cranial fragment. 141 Biomet 3i Osseotite® implants were placed. Patients were rehabilitated with a full-arch implant-supported fixed prosthesis or an implant-supported overdenture. This clinical study describes the resorption process over a 4 year follow-up. 3 of 19 suffered from persistent neurosensitive disturbances. In conclusion, bilateral two-step osteotomy in association with interpositional bone graft is a reliable surgical means to recreate the anatomical morphology of the mandible. |
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