10.59987/ads/2017.1.39-44
Background. The reconstruction of alveolar ridges for implant placement is still a challenging surgical procedure, especially in the case of extensive vertical and horizontal bone atrophy.
Objective. The objective of the present study was to evaluate the quantity and quality of newly regenerated bone; clinically by means of direct clinical measuring, ridges augmented by autogenous cortical bone associated with autogenous particulate bone graft in the posterior lower jaw defect.
Methods. For the preliminary study, a bone defects in partially edentulous in patient aged 52 years were selected to receive horizontal ridge augumentation prior autolougous bone block and particulate graft. The donor site was the ramus of the same side. Prior the clinical evaluation, periapical X-ray and the cone beam computerized tomography (CBCT) was observed the quality, quantity and the stability the soft and hard tissue healing process, final result and the outcome.
Result. The bone augmentation achieved with this technique created the ideal bone volume of hard and soft tissue, in quantity and quality, for placement of implants.
Conclusion. The surgical technique was found to be easy in terms of technique and surgical trauma.
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Annali di stomatologia
autologous bone block graft
Mandibular bone regeneration after bone slat technique
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Mandibular bone regeneration after bone slat technique
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                                                                                                   Case report


    Mandibular bone regeneration after bone slat
    technique




                                                                                                          i
                                                                                                        al
    Salvatore D’Amato MD, DDS1                              and soft tissue, in quantity and quality, for place-




                                                                                             n
    Gianpaolo Tartaro MD1                                   ment of implants.
    Angelo Itro MD2                                         Conclusion. The surgical technique was found to




                                                                                          io
    Mario Santagata MD, DDS3                                be easy in terms of technique and surgical trau-
                                                            ma.

    1 Multidisciplinary Department of Medical and Dental




                                                                az
    Specialties, AOU - SUN, University of Campania “Lui-
                                                            Key words: bone slat technique, mandible recon-

    gi Vanvitelli”, Naples, Italy
                                                            struction, implant dentistry, autologous bone

    2 Director of Multidisciplinary Department of Medical
                                                            block graft.

    and Dental Specialties, University of Campania




                                                              rn
     “Luigi Vanvitelli”, Naples, Italy
    3 Division of Oral and Maxillofacial Surgery,
                                                            Introduction

    Multidisciplinary Department of Medical and Dental      The reconstruction of alveolar ridges for implant
    Specialties, AOU, University of Campania                placement is still a challenging surgical procedure,




                                                            te
    “Luigi Vanvitelli”, Naples, Italy                       especially in the case of extensive vertical and hori-
                                                            zontal bone atrophy. A number of surgical procedures
                                                            have been utilized to reconstruct the alveolar crest.
                                                     In     These procedures include “split-ridge” (osteotomy for
    Salvatore D’Amato                                       lateral expansion), osteodistraction, bone grafting
    Corresponding author:

    Multidisciplinary Department of Medical and Dental      with various grafting materials (autogenous bone, al-
    Specialties, AOU - SUN                                  lograft, xenograft and alloplastic materials), guided
    University of Campania “Luigi Vanvitelli”               bone regeneration (GBR) alone or in combination
                                                 ni

    Via B. Croce 18                                         with grafting materials and other techniques (1-18).
    80059 Torre del Greco, (NA), Italy                      Therefore, the purpose of the present study was to
    E-mail: saldamat@tin.it                                 clinically and cone beam computerized tomography
                                        io


                                                            (CBCT) evaluate the quantity and quality of newly re-
                                                            generated bone for mandibular posterior lateral de-
                                                            fect utilizing autogenous cortical as a membrane with
                              iz



                                                            autogenous particulate bone to facilitate placement of
                                                            implants.
    Summary
               Ed




    Background. The reconstruction of alveolar
    ridges for implant placement is still a challenging
    surgical procedure, especially in the case of ex-       Case report

                                                            A 52-year-old female non-smoker, good general con-
    tensive vertical and horizontal bone atrophy.

                                                            ditions, edentulous in the posterior mandible, pre-
    Objective. The objective of the present study was

                                                            sented for implant rehabilitation. Clinical and radio-
    to evaluate the quantity and quality of newly re-
 IC




                                                            graphic examinations (cone beam computerized to-
    generated bone; clinically by means of direct clin-

                                                            mography: panorex and cross section view) showed
    ical measuring, ridges augmented by autogenous

                                                            severe vertical mandibular atrophy [7 mm of bone
    cortical bone associated with autogenous particu-

                                                            height from the ridge to the mandibular canal and 3
    late bone graft in the posterior lower jaw defect.
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                                                            mm of bone width Occlusal Vertical Dimension (OVD)
    Methods. For the preliminary study, a bone de-

                                                            was increased because of bone atrophy] (Figs. 1, 2).
    fects in partially edentulous in patient aged 52

                                                            Posterior mandibular vertical ridge augmentation was
    years were selected to receive horizontal ridge

                                                            planned to allow for future placement of implants.
    augumentation prior autolougous bone block and
@




                                                            The exclusion criteria were:
    particulate graft. The donor site was the ramus of

                                                            • local infection
    the same side. Prior the clinical evaluation, peri-

                                                            • smoking(more than 10 cigarettes/day)
    apical X-ray and the cone beam computerized to-

                                                            • uncontrolled diabetes (HbA1c >53 mmol/mol)
    mography (CBCT) was observed the quality,

                                                            • previous radiotherapy in head and neck region
    quantity and the stability the soft and hard tissue

                                                            • chemotherapy in progress
    healing process, final result and the outcome.

                                                            • liver, kidney or hematological diseases
    Result. The bone augmentation achieved with this
    technique created the ideal bone volume of hard

    Annali di Stomatologia 2017;VIII (1):39-44                                                                 39
    S. D’Amato et al.




                                                                                                                               i
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    Figure 1. a, b Clinical view: horizontal defect; clinical evaluation of the soft tissue and intermaxillary relationship; c. clinical
    view of the bone defect.




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    Figure 2. CBCT evaluation the horizontal bone defect and the donor site choosing.
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    •   immunosuppression                                               the space created between the bone slat and the native
    •   corticosteroid therapy in progress                              lingual bone (Fig. 3b-d); finally, a resorbable collagen
    •   pregnancy                                                       membrane (Bioguide, Geistlich AG, Wolhusen, Switzer-
    •   inflammatory or autoimmune diseases of the oral                 land) was placed to protect the augmented site (Fig.
        cavity                                                          3e). The flap was completely release and closed with
    • poor oral hygiene and lack of motivation.                         nonabsorbable monofilament sutures 5/0 (Fig. 3f).
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    Surgery was carried out under local anesthesia (2%                  Amoxicillin plus clavulanic acid (825/125 mg 2 times a
    mepivacaine and adrenalin 1:100 000). A supracrestal                day for 6 days) and ibuprofen (600 mg 3 times a day for
    incision was made in the edentulous ridges and on the               3 days) were administered. Patients were instructed not
    mucogingival line in the anterior region, and a full mu-            to brush the surgical site and to continue rinsing with
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    coperiosteal flap was raised. The emergence of right in-            0.20% chlorexidine twice a day till suture removal, 15
    ferior dental nerves at the mentonian foramina was ex-              days later.
    posed. A bone slat graft from the mandibular ramus of
    the same side was harvested using piezoelectric equip-
@




    ment (Piezosurgery, Mectron, Garlasco, Italy) (Fig. 3a).
    The bone slat graft was fixed on the top of the ridge
                                                                        Clinical measurements

    with osteosynthesis screws (Stoma Storz am Mark ®                   Bone height and width were measured by a periodontal
    Emmingen-Liptingen GmbH). A particulate autologous                  probe (Hu-Friedy Unc/cp 15) and recorded, by the
    bone graft was harvested from the mandibular ramus                  same operator approximating to 0.5 mm, at baseline
    by cortical bone collector “safescraper twist” (Meta,               surgical procedure and at time of implant placement
    Reggio Emilia, Italy) of the same side placed inside of             (re-entry). Two horizontal measurements were taken:


    40                                                                                        Annali di Stomatologia 2017;VIII (1):39-44
    Mandibular bone regeneration after bone slat technique




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    Figure 3. a, b. The ramus as donor site, block and particulate. Clinical view the bone harvested using piezosurgery. Note
                              iz



    very slim the osteotomy thickness; c, d. The block was fixed prior two mini screws and the space making was filled with au-
    tologous particulate bone; e. The surgical site of the bone augmentation was been covered with a resorbable collagen mem-
    brane in a double layer; f. The flap, after periosteum incision, was relaxed to obtain a correct suturing.
               Ed




    one at the point of greatest coronal convexity of the ad-       augmentation (Fig. 5b, c) and were loaded 2 months af-
    jacent teeth and one at the greatest concavity of the           ter placement. No implant failures were recorded 36
    defects. For this second measurement the distance to            months after loading (Figs. 5d-7a, b).
    the adjacent teeth cement-enamel junction was record-
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    ed to standardize the height of measurement. Vertical
    measurements were taken at the maximum bone defi-
    ciency, and compared to adjacent bone peaks.
                                                                    Discussion

    Two MIS V3 implants (MIS) 5.0 mm diameter and 10                In cases of a three-dimensional ridge defect, a non-
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    mm length in correspondence of the tooth 46 and 3.9             absorbable membrane with a supporting titanium
    mm diameter and 11.5 mm length in tooth 44 were in-             frame is required (19). The possibility of grafting-ma-
    serted as prosthetically planned.                               terial collapse or premature membrane exposure is
                                                                    greatly increased (20). As an alternative to the single
@




                                                                    block onlay graft, a method using a thinner cortical
                                                                    blocks (laminae) was introduced. These can be fixed
                                                                    into the defect area to create the occlusal bone plate
    Results

    The postoperative clinical and radiographic examina-            and the vestibular plate or the buccal and lingual
    tion (periapical x ray and CBCT scan) showed an in-             walls (21) and Khoury first used thin mandibular corti-
    crease in the height and the width of the alveolar ridge        cal bone blocks (laminae) to reconstruct the buccal
    (Figs. 4a, b, 5a). Implants were placed 3 months after          and palatal (lingual) walls or the occlusal wall of verti-


    Annali di Stomatologia 2017;VIII (1):39-44                                                                              41
    S. D’Amato et al.




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     a                                                                b
    Figure 4. a, b Clinical and radiographic (CBCT Scan) view after 3 months.




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    Figure 5. a. Bone healing after 3 months; b. Implants placement; c. Healing abutment and connective tissue graft; d. soft tis-
    sue healing around implants after 12 months.
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    Figure 6. a, b. Clinical view immediate delivery of the prosthesis in 2013; c. Periapical X-Ray.

    cal defects, filling the intervening space with autoge-            and good fit between the graft and the recipient site
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    nous bone (21). We modified this technique because                 had been obtained during the first surgery.
    we prefer to harvest the laminae autologous bone di-               In the present study no exposure of the bone slat
    rectly from the donor site in single slats differently             graft was observed. This phenomenon, which is
    from that described by Khoury (21) that harvests the               rather commonly reported (22), was carefully avoided
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    block and than perform the splitting of the block in               by a complete release of the flaps during the first
    several laminae.                                                   surgery.
    According to our study, the bone augmentation tech-                Moreover, several Authors, have described neurologi-
    niques generated a sufficient amount of bone to in-                cal problems due to bone harvesting from the
    sert an implant properly. At reentry, the autologous               mandibular ramus and symphysis, characterized by
    bone slat grafting appeared clinically well-incorporat-            paraesthesia, anaesthesia, hyperalgesia of the chin
    ed into the native bone, suggesting that good contact              area (23, 24).

    42                                                                                      Annali di Stomatologia 2017;VIII (1):39-44
    Mandibular bone regeneration after bone slat technique




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    Figure 7. a. Clinical view after 3 years; b. Periapical X-Ray after 3 years.

    This technique involves the removal only of the corti-                          grafts and implants: a 3-year report of a prospective clinical




                                                                                  az
    cal bone by way of slats thus avoiding the possibility                          study. Clinical Implant Dentistry and Related Research.
    of damaging neurovascular underlying structures                                 2007;9:46-59.
    making it safe and effective.                                             10.   Hammerle CH, Jung RE, Yaman D, Lang NP. Ridge aug-
                                                                                    mentation by applying bioresorbable membranes and de-
    Further studies are needed to increase the sample
                                                                                    proteinized bovine bone mineral: a report of twelve con-




                                                                                rn
    size, to verify augmentation stability over time, suc-
                                                                                    secutive cases. Clinical Oral Implants Research. 2008;19:19-
    cess of implant therapy in the medium and long term                             25.
    and eventual differences in the incidence of biological                   11.   Jensen SS, Terheyden H. Bone augmentation procedures
    or aesthetic complications using this technique. The




                                                                              te
                                                                                    in localized defects in the alveolar ridge: clinical results with
    bone slat technique was found to be easy, effective                             different bone grafts and bone-substitute materials. Inter-
    and surgically atraumatic.                                                      national Journal of Oral and Maxillofacial Implants.
                                                                                    2009;24(Suppl):218-236.
                                                                      In      12.   Gonzalez-Garcia R, Monje F, Moreno C. Alveolar split os-
                                                                                    teotomy for the treatment of the severe narrow ridge max-
                                                                                    illary atrophy: a modified technique. International Journal of
    References

    1.   D’Amato S, Tartaro G, Itro A, Nastri L, Santagata M. Block                 Oral and Maxillofacial Surgery. 2011;40:57-64.
         versus particulate/titanium mesh for ridge augmentation for          13.   Simion M, Baldoni M, Zaffe D. Jawbone enlargement using
                                                      ni

         mandibular lateral incisor defects: clinical and histologic anal-          immediate implant placement associated with a split-crest
         ysis. Int J Periodontics Restorative Dent. 2015;35(1):e1-8.                technique and guided tissue regeneration. Int J Periodontics
    2.   Santagata M, Tartaro G, D’Amato S. Clinical and histolog-                  Restorative Dent. 1992;12:462-473.
                                           io


         ic comparative study of subepithelial connective tissue              14.   Scipioni A, Bruschi GB, Calesini G. The edentulous ridge ex-
         graft and extracellular matrix membrane. A preliminary split-              pansion technique: a five year study. Int J Periodontics
         mouth study in humans. Int J Periodontics Restorative Dent.                Restorative Dent. 1994;14:451-459.
                                                                              15.   Schwartz-Arad D, Levin L. Multitier technique for bone aug-
                                 iz



         2015;35(1):85-91.
    3.   Moura LB, Carvalho PH, Xavier CB, Post LK, Torriani MA,                    mentation using intraoral autogenous bone blocks. Implant
         Santagata M, Chagas Júnior OL. (2016) Autogenous non-                      Dent. 2007;16(1):5-12.
         vascularized bone graft in segmental mandibular recon-               16.   Boyne PJ, Cole MD, Stringer D, Shafqat JP. A technique for
               Ed




         struction: a systematic review. Int J Oral Maxillofac Surg                 osseous restoration of deficient edentulous maxillary ridges.
         45(11):1388-1394.                                                          J Oral Maxillofac Surg. 1985;43(2):87-91.
    4.   Santagata M, Guariniello L, Tartaro G. Modified edentulous           17.   Marchetti C, Corinaldesi G, Pieri F, Degidi M, Piattelli A.
         ridge expansion technique and immediate implant placement:                 Alveolar distraction osteogenesis for bone augmentation
         a 3-year follow-up. J Oral Implantol. 2015;41(2):184-187.                  of severely atrophic ridges in 10 consecutive cases: a his-
    5.   Santagata M, Guariniello L, Prisco RV, Tartaro G, D’Ama-                   tologic and histomorphometric study. J Periodontol. 2007;
 IC




         to S. Use of subepithelial connective tissue graft as a bio-               78(2):360-366.
         logical barrier: a human clinical and histologic case report.        18.   Buser D, Bornstein MM, Weber HP, Grütter L, Schmid B,
         J Oral Implantol. 2014;40(4):465-468.                                      Belser UC. Early implant placement with simultaneous
    6.   Santagata M, Guariniello L, Tartaro G. A modified edentu-                  guided bone regeneration following single-tooth extraction
         lous ridge expansion technique for immediate placement of                  in the esthetic zone: a cross-sectional, retrospective study
C




         implants: a case report. J Oral Implantol. 2011;37SpecNo:114-              in 45 subjects with a 2- to 4-year follow-up. J Periodontol.
         119.                                                                       2008;79(9):1773-1781.
    7.   Santagata M, Guariniello L, D’Andrea A, Tartaro G. A mod-            19.   Funato A, Ishikawa T, Kitajima H, Yamada M, Moroi H. A nov-
         ified crestal ridge expansion technique for immediate place-               el combined surgical approach to vertical alveolar ridge aug-
@




         ment of implants: a report of three cases. J Oral Implantol.               mentation with titanium mesh, resorbable membrane, and
         2008;34(6):319-324.                                                        rhPDGF-BB: a retrospective consecutive case series. Int J
    8.   Widmark G, Andersson B, Ivanoff CJ. Mandibular bone graft                  Periodontics Restorative Dent. 2013;33:437-445.
         in the anterior maxilla for single-tooth implants. Presentation      20.   Misch CM, Jensen OT, Pikos MA, Malmquist JP. Vertical bone
         of surgical method. International Journal of Oral and Max-                 augmentation using recombinant bone morphogenetic pro-
         illofacial Surgery. 1997;26:106-109.                                       tein, mineralized bone allograft, and titanium mesh: a ret-
    9.   Sjostrom M, Sennerby L, Nilson H, Lundgren S. Recon-                       rospective cone beam computed tomography study. Int J Oral
         struction of the atrophic edentulous maxilla with free iliac crest         Maxillofac Surg. 2015;30:202-207.


    Annali di Stomatologia 2017;VIII (1):39-44                                                                                                   43
    S. D’Amato et al.


    21. Khoury F, Khoury CH. Mandibular bone block grafts: diag-               1996;11(3):387-394.
        nosis, instrumentation, harvesting techniques and surgical         23. Nkenke E, Schultze-Mosgau S, Radespiel-Tröger M, Kloss
        procedures. In: Khoury F, Antoun, H, Missika P, eds. Bone              F, Neukam FW. Morbidity of harvesting of chin grafts: a
        Augmentation in Oral Implantology. Berlin: Quintessence.               prospective study. Clin Oral Implants Res. 2001;12(5):495-
        2007.                                                                  502.
    22. Von Arx T, Hardt N, Wallkamm B. The TIME technique: a              24. Raghoebar GM, Louwerse C, Kalk WW, Vissink A. Morbid-
        new method for localized alveolar ridge augmentation prior             ity of chin bone harvesting. Clin Oral Implants Res.




                                                                                                                                 i
        to placement of dental implants. Int J Oral Maxillofac Implants.       2001;12(5):503-307.




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