Dynamic Navigated "Sandwich" Technique: A Novel Surgical Approach for Safe Osteotomies in the Rehabilitation of an Atrophic Posterior Mandible: A Case Report.

Pietro Felice,Carlo Barausse,Lorenzo Bonifazi,Cesare Berti,Gerardo Pellegrino,Maryia Karaban

doi:10.3390/mps4020034

Pietro Felice, Carlo Barausse + Show 4 more

Open Access

https://doi.org/10.3390/mps4020034

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Abstract

A 56-year-old female patient with vertical atrophy of the right posterior mandible was treated adopting an interpositional bone block approach using a cancellous heterologous bone block. Osteotomies of the patient’s mandible were performed with the help of dynamic computer-assisted surgery using virtual anatomical patient information obtained from a cone beam computed tomography (CBCT). The use of the dynamic computer-assisted surgery allowed authors to perform the horizontal osteotomy line as planned preoperatively on the CBCT virtual reconstruction, trying to minimize the risks of the inlay technique. No neurological complications were observed after surgery. The inlay technique could benefit from the aid of dynamic navigation technologies in posterior atrophic mandibles, increasing the reproducibility of the technique. A likely safer method for performing osteotomies with the “sandwich” technique in the posterior atrophic mandible is reported.

Highlights

The posterior mandible area is probably the most complex area to rehabilitate with a fixed implant solution due to the proximity of the inferior alveolar nerve
Bone complex treatments with several possible complications, but it is the only option to get an complex treatments with several possible complications, but it is the only option to get an complex treatments with several possible complications, but it is the only option to get an aesthetic prosthesis of adequate crown length in patients with high aesthetic needs aesthetic prosthesis of adequate crown length in patients with high aesthetic needs aesthetic prosthesis of adequate crown length in patients with high aesthetic needs [2]
Given the growing number of studies showing the accuracy of dynamic navigation systems in dental implants, which appears to be similar to that of static ones but with greater versatility, in this case report, the authors chose to combine this digital dentistry technology with the inlay technique [20,21,22,23,24,25]

Summary

Introduction

The posterior mandible area is probably the most complex area to rehabilitate with a fixed implant solution due to the proximity of the inferior alveolar nerve. First proposed by Schettler in 1976, the inlay technique allows for the obtaining of positive outcomes in vertical bone augmentations thanks to favorable vascular supply, and to reduce bone resorption [3,4,5]. The “sandwich” technique, described in the literature for the mandible and for the maxilla, involves the interposition of a bone block in a new space obtained by lifting a bone segment after a horizontal and two vertical osteotomies. In this procedure, it is possible to use different kinds of grafts: autogenous, allogenic, or xenogenic [6]. Xenografts are more preferable for both the patient and the clinician [7]

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