Sandwich osteotomy of the atrophic posterior mandible prior to implant placement

Abstract

Key Clinical MessageThe continuing resorption of the alveolar ridge will eventually result in insufficient bone height superior to the IAN, making dental implant placement impossible. The augmentation procedure above the IAN in terms of height provides sufficient bone for implant placement and allows long-term successful restoration of missing teeth with implant-supported prosthesis.

Segmental sandwich osteotomy of the posterior mandible in pre-implant surgery - A systematic review

“…There were five case reports including just one patient (8,9,16,19,22), and four case series including three to eighteen patients each (10,17,18,24). On the other side, the randomized clinical trials included six to thirty patients each (11-15,20,21,23).…”

“…Xenografts were most often used (12-15,19,20,22) followed by autografts (10,11,16,17,20-24), usually harvested from the iliac crest or the retromolar triangle. In the vast majority of the studies, block grafts were chosen along with granules for filling the gaps of the osteotomy (9-13,14-17,19-24). As for the stabilization of the segmented fragment, the majority of the studies chose osteosynthesis with titanium plates and screws (8,11-24), while rarely no further stabilization was used, apart from the rigidity of the bone graft (9,10,15,18,24).…”

“…In the vast majority of the studies, block grafts were chosen along with granules for filling the gaps of the osteotomy (9-13,14-17,19-24). As for the stabilization of the segmented fragment, the majority of the studies chose osteosynthesis with titanium plates and screws (8,11-24), while rarely no further stabilization was used, apart from the rigidity of the bone graft (9,10,15,18,24). The augmented area was usually covered with a membrane, especially in combination with xenografts (12-15,18-21).…”

“…Intraoperative graft fracture is also associated with increased risk of failure (14). Mean bone gain was usually 4 to 6mm (9,10,17-24), and the mean bone resorption was usually estimated between 0.2mm and 1.1mm (18,20,21,23,24). The implant survival during the follow-up period ranged between 90.9% and 100% (8-24).…”

A retrospective study of an alternative technique for implant repositioning in the maxillary esthetic region

“…Bone grafts for horizontal bone atrophy have high rates of success, with survival rates ranging from 90.2% to 100% after 3 years of evaluation when autologous bone grafts were used . In cases of vertical bone atrophy, different techniques may be used including guided bone regeneration (GBR) with titanium mesh or membranes reinforced with titanium, intraoral distractors, the bilaminar cortical tenting grafting technique, the tent‐pole technique using screws or implants, the sandwich osteotomy, and so forth. In all of the previously cited techniques, bone regeneration is usually realized before the installation of the dental implant, which requires longer treatment durations and high financial costs …”