implants - international magazine of oral implantology International Edition

I research Fig.1_NanoBoneblockfixationat ridgeaugmentationprocedures. Fig.2_Bonegainedsixmonthsafter ridgeaugmentation. _Introduction Reconstruction of the posterior mandible is chal- lengingbecausethedeformityinvolvesdeficienciesin both bone and mucosa,1 and unlike the maxillary si- nuses, the alveolar ridge does not provide a natural cavitytocontainparticulategraftingmaterial.2 There- fore,thegraftmusthavesufficientstrengthandrigid- ity to be fixated at the recipient site. It must also be three-dimensionally stable to withstand muscular forces.3 Constraints in autogenous bone block graft availabilityfromintra-oralsitesoftenlimittreatment possibilities.4 Among the possible alternatives to au- togenous bone block grafting is the use of synthetic NanoBoneblock(ARTOSSGmbH).Thisarticlewilldis- cuss the potential complications during atrophied posterior mandible augmentation using NanoBone block, practically focusing on outcome of complica- tionstreatment(Figs.1&2). Complicationfromridgeaugmentationmaybere- lated to problems in bone management such as bone block fracture or improper block fixation or problems in soft tissue management. The volume added by in- sertionofboneblockgraftoftenrequiresreleasecuts anddissectionoftheperiosteum.Dissectionofthepe- riosteumisacommontechniqueforelongationofthe flap. However, excessive periosteum releasing inci- sions can also result in overthinned or overstretched soft tissue which when placed over the bone block graftmayleadtoperforationorflapnecrosis.Tension- free wound closure is a key factor for success in bone block grafting procedures. So, full-thickness flaps should be prepared in the area of the grafted site and split-thickness flaps beyond the site to provide ten- sion-free wound closure. Sharp edges of the bone block should be carefully avoided to prevent flap in- juries.5 _Complications during block grafting Complicationsrelatedtoproblemsinboneblockman- agement Shaping of the bone block for a perfect fit into the surgical site using rotating instruments may pose a risk of injury to the surgeon and fracture of the bone block. Complicationsrelatedtoproblemsinsofttissueman- agement Soft-tissue related problems are even more diffi- culttohandleandareoftenunderestimated.Delicate mucosa, scar tissue and lesions may complicate cov- eragewithsufficientsofttissue.Thevolumeaddedby theinsertionofboneblockoftenrequiresreleasecuts and dissection of the periosteum. Opening of the woundduetoflapretractionorflapnecrosiswithsub- sequent graft infection is one of the major complica- tionsinbonegraftingprocedures.However,thisprob- lem is predominantly one of soft tissue. Tension-free Ridge augmentation for an atrophied posterior mandible using NanoBone block Part I:Treatment outcome of complications Authors_Dr Omar Soliman & Prof. Dr Dr Mohamed Nassar, Egypt 10 I implants1_2014 Fig. 1 Fig. 2