Computed Tomography-Guided Bone Block Harvesting From the Mandibular Ramus

Abstract

PARRA, M.; JARA, J.; NAVARRO, P.; VÁSQUEZ, B. & OLATE, S. Computed tomography-guided bone block harvesting from the mandibular ramus. Int. J. Morphol., 36(1):362-366, 2018. SUMMARY:The aim of this study was to ascertain the distance from the mandibular canal to the lateral, medial and upper zones of the mandibular ramus in order to identify safety margins that reduce the risk of nerve injuries in the process of removing a bone graft. A descriptive study was conducted, analyzing bilaterally 20 CBCT exams from different patients, taking measurements at 4 points in the central, lateral and medial areas of the corresponding mandibular ramus, which was located at a distance of 5 mm between each line, starting at the distal point of the second molar. Forty hemimandibles were included in this study, estimating a vertical distance for the 4 points of analysis, from between 16 and 17 mm, a distance laterally of 5 mm approximately and medially approximately from 3 to 3.9 mm; the lateral zone was significantly larger than the medial zone. It is estimated that the maximum achievement of a bone block from the area posterior to the second molar must be 13 mm deep and 3 mm laterally to minimize the risks of injuries to the inferior alveolar neurovascular bundle.

Horizontal Ridge Augmentation of a Single Atrophic Site in the Anterior Maxilla Using Hydroxyapatite and rhBMP-2

“…Using an autogenous block graft for augmenting the width, Buser et al observed an increase in bone of 3.5 mm (ranges of 1 to 7.5 mm) whilst Schwartz-Arad et al reported a mean bone augmentation of 3.8 mm with a success rate close to 88 %, using the same reconstruction technique. With autogenous bone, the width of graft is around 3.5 mm because the intraoral donor site cannot provide a thickness greater than 4mm (to avoid neurological or morphological alterations) (Velásquez et al, 2017;Parra et al, 2018). Taking this into consideration, obtaining a 4 mm bone increase with the technique described in this investigation, would appear appropriate and efficient for the insertion and retention of implants.…”

Aumento Óseo Horizontal Utilizando Técnica “Tent Pole” en Mandíbula Posterior

“…Al emplear el injerto con bloque autógeno, Buser et al, presentaron ganancias óseas de 3,5 mm (rangos de 1 a 7,5 mm), mientras que Schwartz-Arad et al presentaron un promedio de aumento óseo de 3,8 mm con un éxito cercano al 88 % utilizando la misma técnica reconstructiva. Con hueso autógeno, las ganancias óseas son cercanas a los 3,5 mm debido a que el sitio donante intraoral no puede entregar espesores mayores de 4mm (para evitar alteraciones neurológicas o morfológicas), determinando que el máximo de ganancia sea relativo al tamaño del injerto instalado (Velásquez et al, 2017;Parra et al, 2018). Considerando estos patrones, la obtención de 4 mm de ganancia ósea con la técnica descrita en esta investigación parece adecuada y eficiente para la instalación y mantención de implantes.…”