Bone grafting mandible in implant-prosthetic rehabilitation

Abstract

Introduction: The goal of modern dentistry is to restore the patient to normal contour, function, comfort, speech, esthetics, and health. One of the most important prerequisites for achieving and maintaining successful osseointegration is the presence of a sufficient volume of healthy bone and soft tissue, at the recipient site. Bone crest atrophy represents an important obstacle in implant-prosthetic rehabilitation patients with different types of edentulism. Purpose and Objectives: The aim of this study was to evaluate and describe surgical techniques and to create an algorithm of conduct in different degrees of mandible atrophies (type Bw, C and D by Misch). Material and Methods: The study was axed on 33 patients, treated in ambulatory and inpatient unit by using the following methods: autogenous bone grafting from extra- and intra- oral sites, osseo-splitting, lateral synthetic bone grafting and implant placement, autogenous and synthetic bone grafting with delayed implant placement, synthetic bone grafting and implant placement, transposition of the inferior alveolar nerve, alveolar distraction osteogenesis. Results: The mean age of the patient was 41,58±2,17 years. Six patients who had type B (Misch) atrophy, with the mean age 38,8±5,09 years, were rehabilitated using synthetic bone grafts and immediate implant placement. This is a simple method which provides a good outcome. Three patients with the mean age 43,3±6,38 years, were treated using autogenous and synthetic bone grafts with delayed implant placement, this method can provide a better understanding of patients force factors, but this procedure requires additional surgical interventions. The average age of 5 patients with available bone type B+, B-w by Misch, was 46±4,08 years, the mean width of the alveolar crest before procedure was 3, 56±0, 44mm, they were treated using osseo-splitting method, after the procedure the width of the alveolar crest was approximately 5 mm. This method is useful when a wider implant is needed to be placed to ensure a better stability with a predictable result. Two patients who suffered from type D atrophy were rehabilitated using alveolar distraction osteogenesis. Since its introduction in 1996, this procedure has been considered a viable technique for reconstruction of alveolar bone before implant placement. At the end of this procedure we increased the height of alveolar crest by 10 mm. Conclusion: One should take in consideration the individual clinical situation, professional skills, the ratio between the risk, complications and expected results, and the psychological status of patient before choosing one of the modern methods of oral rehabilitation.