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      Segmental sandwich osteotomy of the posterior mandible in pre-implant surgery - A systematic review

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          Abstract

          Background

          The rehabilitation of the atrophic posterior mandible with dental implants often requires bone augmentation procedures. The aim of the present study is the systematic review of the literature concerning the success rate of Segmental Sandwich Osteotomy (SSO) of the posterior mandible in pre-implant surgery.

          Material and Methods

          Systematic review of all clinical cases and clinical studies of SSO of the posterior mandible in pre-implant surgery with a minimum follow-up of 6 months after implant loading was performed, based on specific inclusion and exclusion criteria. The search strategy involved searching the electronic databases of MEDLINE, EMBASE, COCHRANE LIBRARY, Clinical Trials (www.clinicaltrials.gov) and National Research Register (www.controlled-trials.com), supplemented by a manual search, in August 2015. In every study, the intervention characteristics and the outcome were recorded.

          Results

          Out of the 756 initial results, only 17 articles fulfilled the predetermined inclusion and exclusion criteria. They consisted of 9 retrospective case reports or series and 8 prospective randomized clinical trials. Overall, the studies included 174 patients. In these patients, 214 SSO augmentation procedures were performed in the posterior mandible and 444 implants were placed. The follow-up period after implant loading ranged between 8 months and 5.5 years. The success rate of SSO ranged between 90% and 100%. The implant survival during the follow-up period ranged between 90.9% and 100%.

          Conclusions

          Segmental Sandwich Osteotomy should be considered as a well documented technique for the rehabilitation of the atrophic posterior mandible, with long-term postsurgical follow-up. The success rates are very high, as well as the survival of the dental implants placed in the augmented area.

          Key words:Segmental osteotomy, dental implant, mandible, inlay graft.

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          Most cited references25

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          Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment.

          Marco Esposito, Maria Grusovin, Pietro Felice … (2009)
          Dental implants require sufficient bone to be adequately stabilised. For some patients implant treatment would not be an option without horizontal or vertical bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. To test whether and when augmentation procedures are necessary and which is the most effective technique for horizontal and vertical bone augmentation. The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. Last electronic search was conducted on 11 June 2009. Randomised controlled trials (RCTs) of different techniques and materials for augmenting bone horizontally or vertically or both for implant treatment reporting the outcome of implant therapy at least to abutment connection. Trials were divided into two broad categories: horizontal augmentation and vertical augmentation techniques. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and odd ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient. Thirteen RCTs out of 18 potentially eligible trials were suitable for inclusion. Three RCTs (106 patients) dealt with horizontal and 10 trials (218 patients) with vertical augmentation. Since different techniques were evaluated in different trials, only one meta-analysis could be performed. When comparing whether vertical augmentation procedures are advantageous over short implants, a meta-analysis of two trials resulted in more implant failures odds ratio (OR) = 5.74 (95% confidence interval (CI) 0.92 to 35.82; borderline significance, P = 0.06) and statistically more complications OR = 4.97 (95% CI 1.10 to 22.40) in the vertically augmented group. When comparing various horizontal augmentation techniques (three trials) no statistically significant differences were observed. When comparing various vertical bone augmentation techniques (eight trials) no statistically significant differences were observed with the exception of three trials which showed that more vertical bone gain could be obtained with osteodistraction than with inlay autogenous grafts (mean difference 3.25 mm; 95% CI 1.66 to 4.84), and with a bone substitute rather than autogenous bone in guided bone regeneration (mean difference 0.60 mm; 95% CI 0.21 to 0.99) in posterior atrophic mandibles, and that patients preferred a bone substitute block than a block of autogenous bone taken from the iliac crest (OR = 0.03; 95% CI 0.00 to 0.64; P = 0.02). These conclusions are based on few trials including few patients, sometimes having short follow-up, and often being judged to be at high risk of bias. Various techniques can augment bone horizontally and vertically, but it is unclear which are the most efficient. Short implants appear to be a better alternative to vertical bone grafting of resorbed mandibles. Complications, especially for vertical augmentation, are common. Some bone substitutes could be a preferable alternative to autogenous bone. Osteodistraction osteogenesis allows for more vertical bone augmentation than other techniques which on the other hand can allow for horizontal augmentation at the same time. Titanium screws may be preferable to resorbable screws to fixate onlay bone grafts.
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            Three-year results from a randomised controlled trial comparing prostheses supported by 5-mm long implants or by longer implants in augmented bone in posterior atrophic edentulous jaws.

            Marco Esposito, Roberto Pistilli, Carlo Barausse … (2014)
            To evaluate whether 5-mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10-mm long implants in posterior atrophic jaws. Fifteen patients with bilateral atrophic mandibles (5 mm to 7 mm bone height above the mandibular canal) and 15 patients with bilateral atrophic maxillae (4 mm to 6 mm bone height below the maxillary sinus), and bone thickness of at least 8 mm, were randomised according to a split-mouth design to receive one to three 5-mm short implants or at least 10-mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after another 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures; any complication and peri-implant marginal bone level changes. In five augmented mandibles, the planned 10-mm long implants could not be placed and shorter implants (7 mm and 8.5 mm) had to be used instead. Three years after loading, two patients, one treated in the mandible and one in the maxilla, dropped out. Three prostheses (1 mandibular and 2 maxillary) failed in the short implant group versus none in the long implant group. In mandibles, one long implant failed versus two short implants in 1 patient. In maxillae, one long implant failed versus three short implants in 2 patients. There were no statistically significant differences in the failures. Eight patients had 13 complications at short implants (1 patient accounted for 6 complications) and 11 patients had 13 complications at long implants. There were no statistically significant differences in complications (P = 0.63, difference = 0.10, 95% CI from -0.22 to 0.42). Three years after loading, patients with mandibular implants lost on average 1.44 mm at short implants and 1.63 mm at long implants of peri-implant marginal bone. This difference was not statistically significant (difference = 0.24 mm; 95% CI -0.01, 0.49 P = 0.059). In maxillae, patients lost on average 1.02 mm at short implants and 1.54 mm at long implants. This difference was statistically significant (difference = 0.41 mm; 95% CI 0.21, 0.60, P = 0.001). Three years after loading, 5-mm short implants achieved similar results as longer implants in augmented bone. Short implants might be a preferable choice to vertical bone augmentation, especially in mandibles, since the treatment is faster and cheaper, however there are still insufficient data on the long-term prognosis of short implants.
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              Vertical ridge augmentation of atrophic posterior mandible using an inlay technique with a xenograft without miniscrews and miniplates: case series.

              Bartolomeo Assenza, Maurizio Piattelli, Giovanna Murmura … (2011)
              Rehabilitation of partially or totally edentulous posterior mandible with implant-supported prosthesis has become a common practice in the last few decades, with reliable long-term results. The use of miniscrews and miniplates have been reported to increase the risk of fracture of the osteotomy segments. The purpose of this case series was to use an inlay technique, without the use of miniscrews and miniplates for stabilization of the transported bone fragments.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Oral Patol Oral Cir Bucal
                Journal ID (iso-abbrev): Med Oral Patol Oral Cir Bucal
                Journal ID (publisher-id): Medicina Oral S.L.
                Title: Medicina Oral, Patología Oral y Cirugía Bucal
                Publisher: Medicina Oral S.L.
                ISSN (Print): 1698-4447
                ISSN (Electronic): 1698-6946
                Publication date (Print): January 2017
                Publication date (Electronic): 6 December 2016
                Volume: 22
                Issue: 1
                Pages: e132-e141
                Affiliations
                [1 ]DDS, MSc, MSc, Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece
                [2 ]DDS, PhD, Assistant Professor. Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece
                [3 ]MD, DDS, PhD, Associate Professor. Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece
                [4 ]MD, DDS, PhD, Professor and Head. Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece
                Author notes
                2-4, Alkmaionidon St 16121, Athens, Greece , E-mail: gkamperos@ 123456yahoo.gr

                Conflict of interest statement: The authors have declared that no conflict of interest exist.

                Article
                Publisher ID: 21633
                DOI: 10.4317/medoral.21633
                PMC ID: 5217491
                PubMed ID: 27918747
                SO-VID: 54d3d7e9-3aec-4b44-94a2-439b285069be
                Copyright © Copyright: © 2017 Medicina Oral S.L.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date accepted : 18 November 2016
                Date received : 11 September 2016
                Categories
                Subject: Review
                Subject: Oral Surgery

                ScienceOpen disciplines: Surgery
                Data availability:
                ScienceOpen disciplines: Surgery

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