Dr Alireza Modarresi , OMFS , Assistant professor , Department of oral and maxillofacial surgery,Sschool of dental medicine , Azad university of medical sciences
Introduction :
A three-dimensionally favourable mandibular bone crest is desirable to be able to successfully implant placement to meet the aesthetic and functional criteria in the implant-prosthetic rehabilitation[1]. The rehabilitation of posterior mandible with dental implants represents today a hard challenge for clinicians due to the lack of supporting bone[2]. In cases of vertical atrophic mandible, the distance to the mandibular canal is an anatomic limitation for rehabilitation with dental implants[1]. Patients can be treated with vertical ridge augmentation, inferior alveolar nerve displacement and the placement of short implants (6mm or less)[2,3]. Several surgical procedures have been advocated for vertical bone augmentation of the atrophic mandible : guided bone regeneration (GBR) , alveolar distraction osteogenesis , onlay bone grafting and interpositional bone graft (sandwich osteotomy).unpredictable resorption of grafted materials are considered in these techniques [1,4]. Vascularity is main factor in determining whether such a graft can be maintained in situ [2]. Harle was the first surgeon to report osteotomy of anterior mandibular ridge sagittaly in order to augmentation of bone[5]. Schetteler split the atrophic alveolar ridge and grafted it [6]. Peterson and Slade modified Harle’s technique [7]. The sandwich osteotomy technique vitalised superior bone segment by preservation of lingual periosteum . Segmented bone vascularized by lingual and crestal attached soft tissue. Piezoelectric surgery is the preferred technique for sandwich osteotomy since it is kind to surrounding tissues such as the lingual periosteum , mentalnerves , and buccal mucosa during surgery . Piezoelectric osteotomy cuts bone with precision and minimizes the bleeding from the site [8,9]. Piezoelectric osteotomy was first described by Jacques and Pierre Curie (1880) [10]. The advantages of piezoelectric surgery are desired shape bone cutting , minimal vital structure damage such as nerve and vessel , reduced heat in surgical site by cavitation and reduced surgical noise [11,12]. The aim of this report is to investigate the efficacy of the sandwich technique for vertical bone augmentation in the atrophic posterior mandible.