Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.727
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 8, August, p. 1159–1168

doi: 10.17219/acem/74054

Publication type: review article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Mandibular ridge reconstruction: A review of contemporary methods

Natalia Dorosz1,A,C, Marzena Dominiak1,E,F

1 Department of Oral Surgery, Wroclaw Medical University, Poland


Reconstruction can be very problematic in the case of mandibular alveolar bone loss, which can also hinder the implant restorative treatment. The aim of the study was to present current views on reconstructing the alveolar part of mandibular bone, which allows the insertion of implants and then the placement of denture. Based on the available literature, the efficacy of various techniques of filling of mandibular bone losses was described and compared. Reconstruction with autogenous bone block graft had been used as a gold standard. Recently, other techniques have appeared that offer better functional and esthetics results. They include reconstruction with allogeneic bone block graft, osteotomy allowing immediate insertion of implants, bone distraction, guided bone regeneration using titanium mesh (Ti-mesh), new techniques using scaffolds (biphasic calcium phosphate, poly-lactide-co-glycolide/tricalcium phosphate, bioresorbable polycaprolactone), Sonic Weld Technique® (Tuttlingen, Germany) using resorbable membrane and pins with polymer lactide acid (PLA), and the tent technique. These abovementioned techniques allow solving the problem of insufficient amount of bone for prosthetic treatment.

Key words

allogeneic bone, titanium mesh, scaffold, resorbable pins, tent technique

References (61)

  1. Perdijk FBT, Meijer GJ, van Strijen PJ, Koole R. Complications in alveolar distraction osteogenesis of the atrophic mandible. Int J Oral Maxillofac Surg. 2007;36(10):916–921.
  2. Mangano F, Macchi A, Caprioglio A, Sammons L, Piattelli A, Mangano C. Survival and complication rates of fixed restorations supported by locking-taper implants: A prospective study with 1 to 10 years of follow-up. J Prosthodont. 2014;23(6):434–444.
  3. Mangano F, Shibli JA, Sammons RL, Veronesi G, Piattelli A, Mangano C. Clinical outcome of narrow-diameter (3.3-mm) locking-taper implants: A prospective study with 1 to 10 years of follow-up. Int J Oral Maxillofac Implants. 2014;29(2):448–455.
  4. Poli PP, Beretta M, Ciccu M, Maiorana C. Alveolar ridge augmentation with titanium mesh. A retrospective clinical study. Open Dent J. 2014;8:148–158.
  5. Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant placement. Int J Oral Maxillofac Implants. 1997;12(6):767–776.
  6. Mehta RKP, Deschler DG. Mandibular reconstruction in 2004: An analysis of different techniques. Curr Opin Otolaryngol Head Neck Surg. 2004;12(4):288–293.
  7. Keith JD, Salama MA. Ochrona i augmentacja wyrostka zębodołowego zwiększa przewidywalność i poprawia efekt estetyczny leczenia implantologicznego. Implants. 2010;5(2):20–26.
  8. Szadowski M, Popowski W, Frank S, Nieckula P, Kamiński A, Wojtowicz A. Odbudowa ubytku kostnego w przednim odcinku szczęki allogennym blokiem kostnym wzbogaconym PRP. Implants. 2015;10(2):18–24.
  9. Dudek D, Żaba M, Barć-Czarnecka M, et al. Augmentacja kości szczękowych z zastosowaniem kości ludzkiej świeżo mrożonej – kliniczne doświadczenia własne. Implants. 2015;10(2):30–37.
  10. Yun KI, Choi H, Wright RF, Ahn HS, Chang BM, Kim HJ. Efficacy of alveolar vertical distraction osteogenesis and autogenous bone grafting for dental implants: Systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2016;31(1):26–36.
  11. Teng F, Zhang Q, Wu M, Rachana S, Ou G. Clinical use of ridge-splitting combined with ridge expansion osteotomy, sandwich bone augmentation, and simultaneous implantation. Br J Oral Maxillofac Surg. 2014;52(8):703–708.
  12. Engelke WG, Diederichs CG, Jacobs HG, Deckwer I. Alveolar reconstruction with splitting osteotomy and microfixation of implants. Int J Oral Maxillofac Implants. 1997;12(3):310–318.
  13. Kao DW, Fiorellini JP. Comparison of ridge expansion and ridge splitting techniques for narrow alveolar ridge in a Swine cadaver model. Int J Periodontics Restorative Dent. 2015;35(3):e44–49.
  14. Simion M, Fontana F, Rasperini G, Maiorana C. Vertical ridge augmentation by expanded-polytetrafluoroethylene membrane and a combination of intraoral autogenous bone graft and deproteinized anorganic bovine bone (Bio Oss). Clin Oral Implants Res. 2007;18(5):620–629.
  15. Cordaro L, Amadé DS, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clin Oral Implants Res. 2002;13(1):103–111.
  16. Mangano FG, Zecca PA, van Noort R, et al. Custom-made computer-aided-design/computer-aided-manufacturing biphasic calcium-phosphate. Case Rep Dent. 2015;2015:941265.
  17. Moldovan I, Juncar M, Dinu C, et al. Mandibular reconstruction using free vascularized iliac crest grafts and dental implants. Clujul Med. 2015;88(3):391–394.
  18. Rasperini G, Pilipchuk SP, Flanagan CL, et al. 3D printed bioresorbable scaffold for periodontal repair. J Dent Res. 2015;94(Suppl 9):153S–157S.
  19. Rong D, Chen P, Yang Y, et al. Fabrication of gelatin/PCL electrospun fiber mat with bone powder and the study of its biocompatibility. J Funct Biomater. 2016;7(1):6.
  20. Pilling E, Mai R, Theissig F, Stadlinger B, Loukota R, Eckelt U. An experimental in vivo analysis of the resorption to ultrasound activated pins (Sonic weld) and standard biodegradable screws (ResorbX) in sheep. Br J Oral Maxillofac Surg. 2007;45(6):447–450.
  21. Le B, Rohrer MD, Prasad HS. Screw “tent-pole” grafting technique for reconstruction of large vertical alveolar ridge defects using human mineralized allograft for implant site preparation. J Oral Maxillofac Surg. 2010;68(2):428–435.
  22. Nocini PF, De Santis D, Fracasso E, Zanette G. Clinical and electrophysiological assessment of inferior alveolar nerve function after lateral nerve transposition. Clin Oral Implants Res. 1999;10(2):120–130.
  23. Kan JY, Lozada JL, Goodacre CJ, Davis WH, Hanisch O. Endosseous implant placement in conjunction with inferior alveolar nerve transposition: An evaluation of neurosensory disturbance. Int J Oral Maxillofac Implants. 1997;12(4):463–471.
  24. Sharma R. Trigeminal Nerve Injuries. Medical Journal, Armed Forces India. 2015;71(1):42.
  25. Hoffman GR, Islam S, Eisenberg RL. Microvascular reconstruction of the mouth, face and jaws. Oromandibular reconstruction – free fibula flap. Aust Dent J. 2012;57(3):379–387.
  26. Goh BT, Lee S, Tideman H, Stoelinga PJ. Mandibular reconstruction in adults: A review. Int J Oral Maxillofac Surg. 2008;37(7):597–605.
  27. Hidalgo DA. Fibula free flap: A new method of mandible reconstruction. Plast Reconstr Surg. 1989;84(1):71–79.
  28. Marchetti C, Bianchi A, Mazzoni S, Cipriani R, Campobassi A. Oromandibular reconstruction using a fibula osteocutaneous free flap: Four different “preplating” techniques. Plast Reconstr Surg. 2006;118(3):643–651.
  29. Kokosis G, Schmitz R, Powers DB, Erdmann D. Mandibular reconstruction using the free vascularized fibula graft: An overview of different modifications. Arch Plast Surg. 2016;43(1):3–9.
  30. Chim H, Salgado CJ, Mardini S, Chen HC. Reconstruction of mandibular defects. Semin Plast Surg. 2010;24(2):188–197.
  31. Boyd JB, Caton AM, Mulholland RS, Tong L, Granzow JW. The sensate fibula osteocutaneous flap: Neurosomal anatomy. J Plast Reconstr Aesthet Surg. 2013;66(12):1688–1694.
  32. Maiorana C, Santoro F, Rabagliati M, Salina S. Evaluation of the use of iliac cancellous bone and anorganic bovine bone in the reconstruction of the atrophic maxilla with titanium mesh: A clinical and histologic investigation. Int J Oral Maxillofac Implants. 2001;16(3):427–432.
  33. Navarro Cuellar C, Caicoya SJ, Acero Sanz JJ, Navarro Cuellar I, Muela CM, Navarro Vila C. Mandibular reconstruction with iliac crest free flap, nasolabial flap, and osseointegrated implants. J Oral Maxillofac Surg. 2014;72(6):1226.e1-15.
  34. Thoma A, Khadaroo R, Grigenas O, et al. Oromandibular reconstruction with the radial-forearm osteocutaneous flap: Experience with 60 consecutive cases. Plast Reconstr Surg. 1999;104(2):368–378.
  35. Kumar KAJ, Masrom AK, Patil K, Kunusoth R, Begum F, Venkatesh V. Evaluation of vertical bone gain following alveolar distraction osteogenesis in the anterior edentulous mandible: A clinical study. J Maxillofac Oral Surg. 2014;13(4):539–545.
  36. Gerber-Leszczyszyn H, Pawlak W, Łuczak K. Wykorzystanie wewnątrzustnych dystraktorów kostnych w leczeniu ubytków pourazowych wyrostka zębodołowego żuchwy – opis przypadku. Dent Med Probl. 2003;40(1):155–157.
  37. Perdijk FB, Meijer GJ, Strijen PJ, Koole R. Complications in alveolar distraction osteogenesis of the atrophic mandible. Int J Oral Maxillofac Surg. 2007;36(10):916–921.
  38. Mampilly MO, Rao LP, Sequiera J, Sripathi Rao BH, Chandra J, Rai G. Rehabilitation of edentulous atrophic anterior mandible – The role of vertical alveolar distraction osteogenesis. J Clin Diagn Res. 2014;8(11):ZR01–ZR03.
  39. Li J, Zhang L, Lv S, Li S, Wang N, Zhang Z. Fabrication of individual scaffolds based on a patient-specific alveolar bone defect model. J Biotechnol. 2011;151(1):87–93.
  40. Ciocca L, De Crescenzio F, Fantini M, Scotti R. CAD/CAM and rapid prototyped scaffold construction for bone regenerative medicine and surgical transfer of virtual planning: A pilot study. Comput Med Imaging Graph. 2009;33(1):58–62.
  41. Liu YF, Zhu FD, Dong XT, Peng W. Digital design of scaffold for mandibular defect repair based on tissue engineering. J Zhejiang Univ Sci B. 2011;12(9):769–779.
  42. Yamada H, Nakaoka K, Horiuchi T, et al. Mandibular reconstruction using custom-made titanium mesh tray and particulate cancellous bone and marrow harvested from bilateral posterior ilia. J Plast Surg Hand Surg. 2014;48(3):183–190.
  43. Roccuzzo M, Ramieri G, Spada MC, Bianchi SD, Berrone S. Vertical alveolar ridge augmentation by means of a titanium mesh and autogenous bone grafts. Clin Oral Implants Res. 2004;15(1):73–81.
  44. Roccuzzo M, Ramieri G, Bunino M, Berrone S. Autogenous bone graft alone or associated with titanium mesh for vertical alveolar ridge augmentation: A controlled clinical trial. Clin Oral Implants Res. 2007;18(3):286–294.
  45. Lizio G, Corinaldesi G, Marchetti C. Alveolar ridge reconstruction with titanium mesh: A three-dimensional evaluation of factors affecting bone augmentation. Int J Oral Maxillofac Implants. 2014;29(6):1354–1363.
  46. Miyamoto I, Funaki K, Yamauchi K, Kodama T, Takahashi T. Alveolar ridge reconstruction with titanium mesh and autogenous particulate bone graft: Computed tomography-based evaluations of augmented bone quality and quantity. Clin Implant Dent Relat Res. 2012;14(2):304–311.
  47. Proussaefs P, Lozada J. Use of titanium mesh for staged localized alveolar ridge augmentation: Clinical and histologic-histomorphometric evaluation. J Oral Implantol. 2006;32(5):237–247.
  48. Zaffe D, D’Avenia F. A novel bone scraper for intraoral harvesting: A device for filling small bone defects. Clin Oral Implants Res. 2007;18(4):525–533.
  49. Yildirim M, Spiekermann H, Handt S, Edelhoff D. Maxillary sinus augmentation with the xenograft Bio-Oss and autogenous intraoral bone for qualitative improvement of the implant site: A histologic and histomorphometric clinical study in humans. Int J Oral Maxillofac Implants. 2001;16(1):23–33.
  50. Poli PP, Beretta M, Cicciù M, Maiorana C. Alveolar ridge augmentation with titanium mesh. A retrospective clinical study. Open Dent J. 2014;8:148–158.
  51. Shikinami Y, Matsusue Y, Nakamura T. The complete process of bioresorption and bone replacement using devices made of forged composites of raw hydroxyapatite particles/poly l-lactide (F-u-HA/PLLA). Biomaterials. 2005;26(27):5542–5551.
  52. Matsuo A, Chiba H, Takahashi H, Toyoda J, Abukawa H. Clinical application of a custom-made bioresorbable raw particulate hydroxyapatite/poly-L-lactide mesh tray for mandibular reconstruction. Odontology. 2010;98(1):85–88.
  53. Louis P, Holmes J, Fernandes R. Resorbable mesh as a containment system in reconstruction of the atrophic mandible fracture. J Oral Maxillofac Surg. 2004;62(6):719–723.
  54. Lan Levengood SK, Polak SJ, Poellmann MJ, et al. The effect of BMP-2 on micro- and macroscale osteointegration of biphasic calcium phosphate scaffolds with multiscale porosity. Acta Biomater. 2010;6(8):3283–3291.
  55. Dominiak M, Gedrange T. New ways of reconstructing complex bone defects in the alveolar ridge. In: Dominiak M, Gedrange T, eds. Esthetics in Implantology. Wrocław: BF Remigiusz Dyńka; 2013;193–214.
  56. Mangano F, Macchi A, Shibli JA, et al. Maxillary ridge augmentation with custom-made CAD/CAM scaffolds. A 1-year prospective study on 10 patients. J Oral Implantol. 2014;40(5):561–569.
  57. Chen D, Zhao M, Mundy GR. Bone morphogenetic proteins. Growth Factors. 2004;22(4):233–241.
  58. Spath S, Drescher P, Seitz H. Impact of particle size of ceramic granule blends on mechanical strength and porosity of 3D printed scaffolds. Materials (Basel). 2015;8(8):4720–4732.
  59. Jansen JA, Vehof JW, Ruhe PQ, et al. Growth factor-loaded scaffolds for bone engineering. J Control Release. 2005;101(1–3):127–136.
  60. Ruhe PQ, Hedberg EL, Padron NT, Spauwen PH, Jansen JA, Mikos AG. rhBMP-2 release from injectable poly(DL-lactic-co-glycolic acid)/calcium-phosphate cement composites. J Bone Joint Surg Am. 2003;85-A(Suppl 3):75–81.
  61. Kramer FJ, Dempf R, Bremer B. Clin Oral Implants Res. 2005;16(1):80–88.