Atrophic Anterior Mandible Treated With Sandwich Osteotomy Without Mini-Screws and Mini-Plates: A Case Report With 7 Years of Follow-Up.

Abstract

Restoring the anterior mandible may be challenging due to both insufficient height and width of the edentulous alveolar ridge; thus, this case report aimed to treat anterior mandibular atrophy by using the inlay technique without the use of mini-screws or mini-plates to stabilize the augmented bone fragments. A 19-year-old patient who lost his anterior teeth in an accident was treated with a horizontal osteotomy performed 4 mm from the alveolar ridge, with two oblique cuts made using an ultrasonic instrument, and the final phase of the osteotomy was performed with a lever for dental extraction. One mini-block of equine bone was inserted between the coronal osteotomized segment and the mandibular basal bone, with cancellous equine bone particles filling the residual space. A resorbable collagen membrane was used to cover the biomaterials and mini-block. Seven days after the augmentation procedure, there were no signs of dehiscence, lesions, infection, or segment movement. Four months after surgery, a CBCT radiograph was obtained for implant placement, revealing a 5-7 mm vertical increase without bone resorption or height loss. The radiographic assessment showed a mineralized zone between basal bone and coronal portion of osteotomized segments, whereas the histological analysis showed new bone and osteoid matrix around and inside the block material. As a result, this case report indicated that using an equine collagenated block in alveolar bone augmentation resulted in high stability while eliminating the need for mini-screws and mini-plates, resulting in a simplified sandwich technique.