Evaluation of the Mandible as an Alternative Autogenous Bone Source for Oral and Maxillofacial Reconstruction

Abstract

The objective of this study was to quantify the amount of bone graft material present in the different regions of the mandible while avoiding the inferior alveolar neurovascular bundle, mental foramen and tooth injury. The study was carried out on 16 samples of dry, cadaverous skull. The dimensions of the anterior part of ascending ramus, mandibular symphysis and mandibular body in these samples were evaluated. The osteotomy lines in the anterior part of the ascending ramus were made in front of the mandibular canal from the mandibular notch to 3 mm posterior of the root of the third molar. The osteotomy line in the mandibular body was made just medial to the external oblique ridge from the ascending ramus to approximately 3 mm posterior to the mental foramen. Vertical osteotomy lines were then made from the cut ends of the first osteotomy down to the lower border of the mandible. The osteotomy lines in the mandibular symphysis were performed on the mandible with 5-mm safety margins caudal to the expected position of the mandibular dentition, anterior to the position of the mental foramen, and cephalad to the inferior border of the mandible. It was determined that the dimensions of the anterior part of the ascending ramus were 37.60 mm x 33.17 mm x 22.48 mm x 9.15 mm, and the thickest part of the graft material was 12.23 mm. The average horizontal length of the mandibular body bone was 35.10 mm, and the average vertical length was 19.13 mm. The dimensions of the bone graft obtained from the mandibular symphysis were 45.36 mm x 10.31 mm, and the average thickness was 9.63 mm. Based on the results of this study, it is apparent that the different regions of the mandible can reliably be selected as the harvest site in a variety of oral and maxillofacial reconstructive procedures.

Simulation of sinus floor augmentation with symphysis bone graft using three-dimensional computerized tomography

“…They also used calipers to measure the dimensions of the graft materials. The authors of the present study believe that their technique offers a more reliable evaluation of the graft volume for patients in clinical practice than that used in previous studies; it also avoids mental nerve or tooth injury, and simultaneously preserves the preoperative facial contour 6,15 .…”

“…They harvested the symphysis bone graft as two roughly equivalent blocks and measured the average volume of the corticocancellous block as 4.71 ml in dentate human cadavers. GÜ NGÖ RMÜ S et al 6 conducted a study on a cadaverous skull, and although they reported the average vertical-horizontal lengths and thickness of the bone graft obtained from the mandibular symphysis, bone volume was not evaluated. They also used calipers to measure the dimensions of the graft materials.…”

“…Although allogenic, xenogenic and alloplastic materials can be used in sinus lift surgery, autogenous bone grafts are preferred due to their osteoinductive and osteoconductive properties 5,6,8 . ZERBO et al 20 determined that osteogenesis occurred at a higher rate on an autogenous bone graft than on the b-TCP used for sinus floor augmentation; they suggested that the difference in bone volume between the two graft sides was because the process of osteoconduction was slower on the b-TCP side.…”

“…As an autogenous bone graft, the mandibular symphysis has been used for sinus augmentation, reconstruction of the orbital floor, as an interpositional graft in the treatment of nonunion or malunion of maxillary and mandibular fractures, in conjunction with Le Fort I maxillary advancement, in the reconstruction of alveolar clefts, and most popularly, in the reconstruction of alveolar defects and ridge augmentation 6,15 . Compared with other intraoral sites, the symphyseal region can provide higher quantities of bone 1 .…”

Special Design of Removable Partial Denture Restoration Following Surgical Resection of Mouth Floor Neoplasm

“…To sum up, this untraditional denture design helps patient avoid occlusal pressing pain and get better denture retention [1][2][3].…”