L- Shape Symphyseal Autogenous Bone Block for Alveolar Ridge Augmentation in Anterior Maxilla and Mandible
Condition: Atrophic Anterior Alveolar Ridge
MeSH terms: Atrophy
Study type: Interventional

Summary: 
      the aim of this study was to assess both horizontal and vertical alveolar bone augmentation
      for sever atrophied anterior maxilla and mandible, using L- shape autogenous bone block
      harvested from the symphysis. eleven partially edentulous patients seeking horizontal and
      vertical alveolar bone augmentation in the anterior maxilla or mandible were included in this
      study. For each patient, autogenous bone block was harvested from the symphysis, trimmed to
      L-shape and used to augment the anterior maxilla or mandible horizontally and vertically.
      Horizontal and vertical bone gain was measured by CBCT immediate postoperative and at 6months
      after grafting.
    

Detailed description: 
      A total of 11 partially edentulous patients needing extensive horizontal and vertical bone
      augmentation in the anterior maxilla or mandible were included in this study. The patients
      were recruited from the Outpatient Clinic of Oral and Maxillofacial Department, Faculty of
      Dentistry, Mansoura University.

      Before the surgical operation, all patients were informed about the treatment options, the
      nature of the operation, and the probable postoperative sequelae. An informed consent was
      signed from each patient.

      Preoperative assessment

        -  Patients' medical status were carefully evaluated.

        -  A thorough intraoral examination was done to evaluate oral hygiene, occlusion, and
           mucosa that covers the recipient and donor sites.

        -  Preoperative CBCT was done for each patient to evaluate bone width and height in both
           the recipient and donor sites.

      Surgical procedures Prophylactic antibiotic 600 mg Clindamycin (Clindam, Sigma, Egypt) was
      administered 1 hour before surgery. A thorough mouth rinsing using Chlorhexidine mouth wash
      (Hexitol, Adco, Egypt) for about 1 min was done immediately before surgery.

      Harvesting procedure of the symphysis bone block:

      Under local anesthesia, a sulcular incision was performed between lower right and left second
      premolars with an oblique incision distal to each one. After that, a full thickness
      mucoperiosteal flap was elevated to expose the anterior mandible including the entire
      symphysis and both mental nerves. By using piezo-surgery unit, a rectangular bone block was
      harvested from the symphysis about 8mm in depth and 2mm wider than the recipient site to
      allow for contouring. The bone cuts were performed 5mm far from the apices of the anterior
      teeth, mental foramina, and inferior border of the mandible. Finally, thin curved osteotomes
      was used to detach the bone blocks. The harvested bone block was trimmed to form L-shape
      block and kept in normal saline. After hemostasis, the flap was closed with 4/0 vicryl
      interrupted sutures.

      Recipient site preparation:

      At the maxillary recipient site, after induction of local anesthesia, a mid-crestal incision
      that continued in the sulcus for two teeth on either side of the defect with bilateral
      oblique incisions were performed. After that, the full thickness mucoperiosteal flap was
      elevated. While for mandibular recipient site, it was the same flap used for harvesting
      symphyseal bone block. For both upper or lower recipient sites, perforations (bone marrow
      penetration) were done to the recipient site by using a fissure surgical bur. The L-shape
      block graft was trimmed to obtain optimal adaptation to the recipient site, then it was fixed
      to the residual ridge with two 1.5mm self-tapping titanium screws. After attaining graft
      stability, any sharp edges were smoothed and any gap between the graft and underlying
      alveolar bone was filled with particulate bone curetted from the donner site. Finally, the
      flap was relaxed by periosteal incisions and blunt muscle dissection from the anterior
      maxilla or mandible to obtain a primary tension free closure using 4/0 vicryl interrupted and
      horizontal mattress sutures.

      Postsurgical instructions:

      Patients were instructed to avoid any wound trauma, and apply ice packs on the host and
      recipient surgical sites 20min/ hour for the first day after surgery. Proper oral hygiene
      should be maintained by mouth rinsing with chlorhexidine mouth wash 3times/ day for 1 week.
      Diclofenac potassium 50mg (Cataflam, Novartis, Switzerland) anti-inflammatory analgesic was
      prescribed as needed. Clindamycin 300mg twice daily was prescribed for 7days.

      Implant insertion:

      After 6months, the surgical site was opened to remove fixation screws and insert dental
      implants, and the final restoration was done 4months after implant insertion.

      Evaluation: the patients were scheduled at 3days, 14days, 3months, and 6months
      postoperatively to evaluate:
    

Intervention name(s): harvesting bone block; Recipient site preparation; implant insertion
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Under local anesthesia, a sulcular incision was performed between lower right and left second premolars with an oblique incision distal to each one. After that, a full thickness mucoperiosteal flap was elevated to expose the anterior mandible including the entire symphysis and both mental nerves. By using piezo-surgery unit (Surgic Touch, Woodpecker, China), a rectangular bone block was harvested from the symphysis about 8mm in depth and 2mm wider than the recipient site to allow for contouring. The bone cuts were performed 5mm far from the apices of the anterior teeth, mental foramina, and inferior border of the mandible. Finally, thin curved osteotomes was used to detach the bone blocks. The harvested bone block was trimmed to form L-shape block and kept in normal saline. After hemostasis, the flap was closed with 4/0 vicryl interrupted sutures.; At the maxillary recipient site, after induction of local anesthesia, a mid-crestal incision that continued in the sulcus for two teeth on either side of the defect with bilateral oblique incisions were performed. After that, the full thickness mucoperiosteal flap was elevated. While for mandibular recipient site, it was the same flap used for harvesting symphyseal bone block. For both upper or lower recipient sites, perforations (bone marrow penetration) were done to the recipient site by using a fissure surgical bur. The L-shape block graft was trimmed to obtain optimal adaptation to the recipient site, then it was fixed to the residual ridge with two 1.5mm self-tapping titanium screws. After attaining graft stability, any sharp edges were smoothed and any gap between the graft and underlying alveolar bone was filled with particulate bone curetted from the donner site.; Implant insertion:
After 6months, the surgical site was opened to remove fixation screws and insert dental implants, and the final restoration was done 4months after implant insertion.
Other intervention name(s): piezo-surgery block harvesting
Intervention model: Single Group Assignment
Intervention model description: eleven partially edentulous patients seeking horizontal and vertical alveolar bone augmentation in the anterior maxilla or mandible were included in this study. For each patient, autogenous bone block was harvested from the symphysis, trimmed to L-shape and used to augment the anterior maxilla or mandible.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: L- Shape autogenous bone block; symphysis; alveolar ridge augmentation; anterior maxilla and mandible