J Korean Assoc Oral Maxillofac Surg.  2023 Apr;49(2):100-104. 10.5125/jkaoms.2023.49.2.100.

A ramus cortical bone harvesting technique without bone marrow invasion

• Ku JK
• Ghim MS
• Park JH
• Leem DH

• KMID: 2542217
• DOI: http://doi.org/10.5125/jkaoms.2023.49.2.100

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.

Keyword

Autograft; Bone grafting; Dental implant; Mandible; Osteotomy

Figure

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  Fig. 1 Schematics of the ramus harvesting technique without bone marrow invasion. A. Ditching holes created with a 1 mm round bur on the ascending branch of the ramus. B-D. Regarding the cortical thickness confirmed by a round bur, the following procedures were completed with sagittal (B), coronal (C), and axial osteotomies (D) using a micro-saw. E. Harvesting grid-shaped cortical squares.

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  Fig. 2 Intraoperative images of the ramus harvesting technique without bone marrow invasion. A. Formation of ditching holes with a 1 mm round bur was followed by osteotomies was made using the micro-jigsaw and sagittal and oscillating micro-saws. B. After harvesting on the most occlusal aspect, osteotomies were created on the cortical bone. C. Additional harvesting was performed without bone marrow exposure. D. Harvesting of only cortical bone was confirmed by postoperative computed tomography.

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  Fig. 3 Preoperative radiograph. Severe bone defect and sinus pneumatization were observed on the right maxilla. A. Panoramic X-ray. B. Panoramic section on computed tomography.

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  Fig. 4 Bone graft surgery. A. The harvested grid-type cortical bone. B. The crushed cortical bone. C. The grafted cortical bone with titanium mesh.

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  Fig. 5 Bone healing 5 months after grafting. A. Removal of the titanium mesh. B. The bone healing was enough to obtain primary stability of the dental implants. C. The dental implants were placed with a 1-stage protocol.

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  Fig. 6 Images at 15 months after grafting. A. The dental implants were well-maintained during 10 months after prosthetic loading. B. Well-functioning dental implants and healthy gingiva. C. The grafted cortical bone exhibited a cortico-cancellous pattern with remodeling. D. The harvested cortical bone was regenerated.

Reference

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