Bifunctional Sculpturing of the Bone Graft for 3-Dimensional Augmentation of the Atrophic Posterior Mandible

Short implant procedures may suffer from fixture instability, if incorrectly planned and performed, and from an esthetically compromised rehabilitation, due to increased interarch distance and increased crown-implant ratio. Several procedures have been proposed to achieve alveolar ridge augmentation with different success and complication rates: onlay grafts, alveolar sandwich osteotomies, titanium micromesh, alveolar distraction, and alveolar nerve transposition. The edentulous posterior mandible suffers from the presence of a compact cortical layer, which tends to limit graft osteogenesis, because of a low permeability to the osteogenic elements (microvessels and cells). This report introduces a variant to the endochondral onlay bone graft, in which an external cortical layer is placed above a biologically active core of cancellous bone and platelet-rich plasma. This solution provides easy 3-dimensional conformation of the graft, enhancing its mechanical stability. The presence of the biologically active core provides better vascular support and a valid interface between graft and the osteogenetic cell lines.