Reconstruction of the extremely resorbed mandible with interposed bone grafts and placement of endosseous implants

Use of the sandwich osteotomy plus an interpositional allograft for vertical augmentation of the alveolar ridge

“…Onlay augmentation methods using autogenous free bone grafts to restore the vertical dimension of the alveolar ridge have shown high resorption rates of up to 50% (Von Arx et al, 1996). Augmentation procedures using interposed bone have been evaluated over many years and appear to be reliable (Stoelinga et al, 1978;Stellingsma et al, 1998). The data in the present study verify that the interpositional graft method reduces the amount of bone loss.…”

“…Panoramic radiographs were used to assess the level of bone loss in previous follow-up studies evaluating the postoperative healing after vertical augmentation of the deficient alveolar ridge (Stoelinga et al, 1978;Stellingsma et al, 1998), even though it may be impossible to measure the level of bone loss with panoramic radiographs due to its lack of sharpness and image distortion (Geertman et al, 1996). In this study, cephalometric radiographs were used to assess the amount of postoperative bone loss at the augmentation sites.…”

“…Horizontal osteotomy with the interposition of bone in the form of a 'sandwich' to augment the alveolar ridge has been described before (Schettler, 1976;Stoelinga et al, 1978;Stellingsma et al, 1998). This offers the advantage of guaranteeing a greater vascular supply to the inlay graft.…”

“…This offers the advantage of guaranteeing a greater vascular supply to the inlay graft. It allows optimum use of the basal bone, which is less prone to resorption (Zins et al, 1984;Stellingsma et al, 1998). However, this technique involves donor site morbidity (Misch and Misch, 1995;Misch, 1996), as autogenous bone is used as the interpositional material.…”

The combined use of two endosteal implants and iliac crest onlay grafts in the severely atrophic mandible by a modified surgical approach

“…The use of endosteal implants in severely atrophic mandibles can be successful 24 , but, without bone-grafting, esthetic problems because of lack of soft tissue support, denture-stability problems and problems related to overloading may occur. Therefore, the combined use of iliac crest onlay grafts in combination with implant placement has been advocated by several authors 1, 11,14,21,23 .…”