Mandibular Discontinuity Reconstruction with Composite Grafts

Abstract

SUMMARY Composite bone grafts (free autogenous cor- ticocancellous iliac bone and titanium endos- seous implants) have been successful in the treatment of mandibular discontinuity of various etiologies with follow-up for as long as 7 years in 18 patients. This surgical treatment has allowed final oral prosthetic rehabilitation with a bone-anchored fixed rather than a soft tissue- supported removable prosthesis. This treatment advance has provided superior functional and aesthetic improvement over our previous mandibular discontinuity reconstructive efforts. A careful, meticulous surgical technique is required for bone graft harvesting, donor site preparation, and endosseous implant insertion. Specific soft-tissue procedures are selectively required prior to bone grafting or before or after endosseous implant placement, particularly in patients who exhibit postradiation or postsurgical deficits in soft-tissue quality or quantity. Donor and recipient site cell (osteo- cyte) viability is preserved by controlling heat production during osseous surgery. A two-stage procedure (bone grafting followed 6 months later by implant placement) is physiologically and practically sound and has given predictable results to date. Long-term dental prosthesis function will theoretically occur if undisturbed implant healing and proper biomechanical implant loading are provided. Long-term composite graft stability, predictability, and retention will become clearer with further basic and clinical research.