Harvesting Mandibular Ramus Bone Grafts Using Ultrasonic Surgical Device: Report of 20 Cases

Abstract

Successful osseointegration of the dental implants requires sufficient bone volume surrounding implant site. The mandibular ramus is considered reliable donor site for reconstructing alveolar ridge defects prior to dental implant placement. The aim of this study was to present the clinical efficiency of using ultrasound surgery for harvesting mandibular ramus bone graft. 20 patients (10 male, 10 female; mean age 47.5 ± 11.4years) with insufficient bone volume, who underwent autogenous bone grafting prior to implant placement, were presented. The grafts were harvested from the ascending ramus along with the external oblique ridge using an ultrasound surgical device (Piezosurgery, Mectron, Italy) from 20 donor sites and used to augment alveolar ridge atrophies. After waiting 4 to 5 months for healing grafted sites, 48 dental implants were inserted. Clinical parameters such as inferior alveolar nerve (IAN) damage, complications at donor and recipient site, the size of the graft and implant placement at the proper site were evaluated retrospectively. Mean graft length was 20.1mm (SD=2.73), and mean graft width was 12mm (SD=2.47). Of 20 recipient sites, 20 healed uneventfully, and of 20 donor sites 18 healed uneventfully. Only one patient had transient altered sensitivity of the lower lip.Ultrasound surgery allowed precise and smooth bone cutting with better intraoperative visibility. Specially angulated tip of the devise made inferior horizontal cut easier and safer. The results of this study suggest that the use of ultrasound surgery is an effective method for harvesting bone grafts from mandibular ramus with avoidance of any major complication.

Multidisciplinary treatment for a young patient with severe bone loss from a trauma: A case report

“…Harvesting ramus block graft is a well-established surgical technique in the literature. 9,10,16,18,19,24 In the literature various surgical devices has been used with success for harvesting ramus graft such as motor driven rotary or oscillating tools, special electric handpiece with cutting disk or ultrasonic surgery device to date. 9,10,16,23,24 However, animal and clinical studies showed that the ultrasonic surgery yielded faster bone healing and remodeling.…”

“…9,10,16,18,19,24 In the literature various surgical devices has been used with success for harvesting ramus graft such as motor driven rotary or oscillating tools, special electric handpiece with cutting disk or ultrasonic surgery device to date. 9,10,16,23,24 However, animal and clinical studies showed that the ultrasonic surgery yielded faster bone healing and remodeling. 25,26 In the presented study, the authors utilized the ultrasonic surgery device to harvest ramus bone.…”

“…Restoration driven implant procedures usually dictate insertion of a dental implant in certain localization that often involves bone augmentation procedures to obtain sufficient bone volume prior to implant surgery. 8,9 Even though different kinds of homogeneic, xenogeneic or synthetic bone graft materials have been instituted, autogenous bone still considered the gold standard. 10 As a result, the use of autogenous bone is relatively common in reconstruction bone defects in maxillofacial region.…”

“…15 To date, intraoral donor sites such as mandibular symphysis, body, ascending ramus and tuberosity for alveolar ridge reconstruction has been extensively documented. 9,[16][17][18][19] Among them ascending ramus area is the most preferred donor site with certain advantages.16 This case report describes the utilizing of ascending ramus graft in the reconstruction of atrophied alveolar ridge for the implant site development. This article also tries to address a multidisciplinary approach to implant rehabilitation.…”