Reconstruction pré-implantaire du secteur mandibulaire postérieur

Abstract

We present a literature reviewed of pre-implant posterior mandible reconstruction, and report our experience with 107 patients exclusively reconstructed with cranial bone grafts. Over a period of 15 years, 167 patients presenting with sometimes extremely severe bone resorption were grafted using various techniques depending on the type of resorption. The mean bone augmentation was 7.83 mm vertically and 7.16 mm horizontally respectively for patients with vertical and horizontal resorption. It was 6.66 mm vertically and 8.11 mm horizontally for patients with combined horizontal and vertical resorption. The postoperative complications were: mental nerve dysesthesia in 6.5% of patients, graft exposure in 1.8%, and ± complete graft resorption in 4.2%. Implant placement was possible 3 months after reconstruction and bridge placement 6 months after reconstruction. The posterior mandible is the most difficult area to reconstruct, according to our experience. The vertical expansion technique, called "sandwich" osteotomy, frequently cannot be used. Alveolar distraction has a lot of drawbacks: patient constraints, uncertain outcome, and high risk of complications. Guided bone regeneration is restricted to small deficits. The onlay graft technique is poorly documented although it has many assets as demonstrated by our study. It may be used in any situation, even the most severe cases, except for rare cases of reduced occlusal space.