Background: When considering implant rehabilitation for missing teeth both bone volume and quantity needs to be considered for placement. With natural atrophy of the alveolar ridge at sites of missing teeth bone augmentation can be required prior to implant placement. The use of iliac crest, mandibular ramus and chin as donor sites are well documented in the literature but are not without potential morbidities. We present a case report where mandibular tori (benign bone exostosis) are used as an onlay autograft for localised alveolar ridge augmentation in the posterior maxilla.
Methods: Thirty-nine-year old male presenting with hypodontia, mandibular tori and an atrophic region in the maxilla and mandible in the premolar region. The multidisciplinary team consisting of Orthodontics, Restorative and Oral and Maxillofacial surgery (OMFS) carried out full management.
Results: Orthodontics for initial deciduous extractions, alignment of the arches and optimisation of the recipient sites with removable retainers prior to operation. OMFS provided a single procedure of bilateral mandibular tori harvesting, onlay graft with titanium screw fixation along with bone scrapings and a particulate graft cover Bio Oss prior to a resorbable non cross-linked membrane Bio Gide. Restoratively a 2 stage implant placement with final restorative construct.
Conclusions: Although extra oral sites can be used they produce a second donor site which can give rise to complications. Common intra-oral sites include the maxillary tuberosity mandibular symphysis, and ascending ramus of the mandible which have been shown to have low associated morbidity. From the literature success of intraoral endosseous implant placement into autogenous bone grafted from intra-oral donor sites has been shown to be up to 98.3%. With the occurrence of mandibular tori reported between 6 and 32% this case has shown that they are a viable source for autogenous bone in alveolar bone augmentation.
Disclosure: The authors declared no competing interests.