Guided "sandwich" technique: a novel surgical approach for safe osteotomies in the treatment of vertical bone defects in the posterior atrophic mandible: a case report.

Abstract

A novel technique to perform safe osteotomies during inlay block regenerative procedures in the posterior atrophic mandible is described. A 52-year-old male patient with vertical atrophy of the left posterior mandible was treated adopting an inlay block "sandwich" technique using an allogenic cancelous block and a mixture of mineralized and demineralized human bone allograft in putty form as graft. The horizontal osteotomy for the lifting of the osteotomized bone segment was performed using a template prepared from a virtual anatomical replica of the patient's mandible obtained from cone beam computed tomography data. In the second surgical phase, 3 months after the augmentation, 2 implants were easily placed. The horizontal osteotomy was carried out, with no risk, very close to the nerve structures after the precise osteotomy line established preoperatively on the three-dimensional computed tomography (3D-CT) virtual reconstruction. No neurological complications were observed in the first days after the procedure, and no subsequent problems were recorded during the 3-month healing period. Radiographic evaluations and complication-free clinical healing demonstrate the effectiveness of this technique to obtain safe and precise osteotomies.