Full-arch vertical reconstruction of an extremely atrophic mandible with "box technique". A novel surgical procedure: a clinical and histologic case report

Guided "sandwich" technique: a novel surgical approach for safe osteotomies in the treatment of vertical bone defects in the posterior atrophic mandible: a case report

PURPOSE

A novel technique to perform safe osteotomies during inlay block regenerative procedures in the posterior atrophic mandible is described.

MATERIAL AND METHODS

A 52-year-old male patient with vertical atrophy of the left posterior mandible was treated adopting an inlay block "sandwich" technique using an allogenic cancelous block and a mixture of mineralized and demineralized human bone allograft in putty form as graft. The horizontal osteotomy for the lifting of the osteotomized bone segment was performed using a template prepared from a virtual anatomical replica of the patient's mandible obtained from cone beam computed tomography data. In the second surgical phase, 3 months after the augmentation, 2 implants were easily placed.

RESULTS

The horizontal osteotomy was carried out, with no risk, very close to the nerve structures after the precise osteotomy line established preoperatively on the three-dimensional computed tomography (3D-CT) virtual reconstruction. No neurological complications were observed in the first days after the procedure, and no subsequent problems were recorded during the 3-month healing period.

CONCLUSION

Radiographic evaluations and complication-free clinical healing demonstrate the effectiveness of this technique to obtain safe and precise osteotomies.

Long-term outcome of transosteotomy bone augmentation of the inferior border of the severely resorbed mandible

We report a case of severe mandibular atrophy with residual crest height as short as 4.3 mm anterior to the mental foramens. The patient was reluctant to accept bone augmentation surgery and that was the motivation to perform transosteotomy bone augmentation of the inferior border of the mandible and the insertion of 4 short implants anterior to the mental foramens. The insertion torque of the 4 implants was about 65 N·cm, which allowed for the application of immediate loading protocol. Detailed follow-up during 8 years showed uneventful healing and successful prosthetic rehabilitation with screw-retained prostheses.