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A ramus cortical bone harvesting technique without bone marrow invasion

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초록

Autogenous bone grafts from the mandibular ramus are a known source of inadequate bone volume scenarios of the residual alveolar ridge. However, the conventional block-type harvesting technique cannot prevent bone marrow invasion, which can cause postoperative complications such as pain, swelling, and inferior alveolar nerve injury. This study aims to suggest a complication-free harvesting technique and present the results of bone grafting and donor sites. One patient received two dental implants with a complication-free harvesting technique that involves creation of ditching holes with a 1 mm round bur. Sagittal, coronal, and axial osteotomies produced grid-type cortical squares using a micro-saw and a round bur to confirm the cortical thickness. The grid-type cortical bone was harvested from the occlusal aspect, and the harvesting was extended through an additional osteotomy on the exposed and remaining cortical bone to prevent bone marrow invasion. The patient did not suffer postoperative severe pain, swelling, or numbness. After 15 months, the harvested site exhibited new cortical bone lining, and the grafted area had healed to a cortico-cancellous complex with functional loading of the implants. Our technique, grid-type cortical bone harvesting without bone marrow invasion, allowed application of autogenous bone without bone marrow invasion to achieve acceptable bone healing of the dental implants and to regenerate the harvested cortical bone.

Abstract

Autogenous bone grafts from the mandibular ramus are a known source of inadequate bone volume scenarios of the residual alveolar ridge. However, the conventional block-type harvesting technique cannot prevent bone marrow invasion, which can cause postoperative complications such as pain, swelling, and inferior alveolar nerve injury. This study aims to suggest a complication-free harvesting technique and present the results of bone grafting and donor sites. One patient received two dental implants with a complication-free harvesting technique that involves creation of ditching holes with a 1 mm round bur. Sagittal, coronal, and axial osteotomies produced grid-type cortical squares using a micro-saw and a round bur to confirm the cortical thickness. The grid-type cortical bone was harvested from the occlusal aspect, and the harvesting was extended through an additional osteotomy on the exposed and remaining cortical bone to prevent bone marrow invasion. The patient did not suffer postoperative severe pain, swelling, or numbness. After 15 months, the harvested site exhibited new cortical bone lining, and the grafted area had healed to a cortico-cancellous complex with functional loading of the implants. Our technique, grid-type cortical bone harvesting without bone marrow invasion, allowed application of autogenous bone without bone marrow invasion to achieve acceptable bone healing of the dental implants and to regenerate the harvested cortical bone.

참고문헌 (15)

  1. 김영균, "Ridge augmentation in implant dentistry", 대한구강악안면외과학회지, 46(3), pp.211~217 (2020), 대한구강악안면외과학회[DOI]
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  6. Hyeong-Geun Lee, "Volumetric stability of autogenous bone graft with mandibular body bone: cone-beam computed tomography and three-dimensional reconstruction analysis", 대한구강악안면외과학회지, 41(5), pp.232~239 (2015), 대한구강악안면외과학회
  7. Hyun-Suk Cha, "Frequency of bone graft in implant surgery", Maxillofacial Plastic Reconstructive Surgery, 38(3), pp.1~4 (2016), 대한악안면성형재건외과학회[DOI]
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  9. Reininger D, "Complications in the use of the mandibular body, ramus and symphysis as donor sites in bone graft surgery. A systematic review", Med Oral Patol Oral Cir Bucal, 21, pp.e241~e249 (2016)[DOI]
  10. Hwang KG, "Partial-thickness cortical bone graft from the mandibular ramus : a non-invasive harvesting technique", J Periodontol, 79, pp.941~944 (2008)[DOI]
  11. Mohamed Bayome, "New three-dimensional cephalometric analyses among adults with a skeletal Class I pattern and normal occlusion", 대한치과교정학회지, 43(2), pp.62~73 (2013), 대한치과교정학회
  12. Clavero J, "Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation : comparison of donor site morbidity and complications", Clin Implant Dent Relat Res, 5, pp.154~160 (2003)[DOI]
  13. Kim SG, "Modified veneer bone graft with the concomitant installation of a dental implant : technical note", Oral Maxillofac Surg, 15, pp.189~192 (2011)[DOI]
  14. Leong DJ, "Distance between external cortical bone and mandibular canal for harvesting ramus graft : a human cadaver study", J Periodontol, 81, pp.239~243 (2010)[DOI]
  15. 도레미, "Delayed paresthesia of inferior alveolar nerve after dental surgery: case report and related pathophysiology", Journal of Dental Anesthesia and Pain Medicine, 18(3), pp.177~182 (2018), 대한치과마취과학회[DOI]

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