Augmentation Techniques – the Basis of Aesthetic

Bone harvesting from the symphysis The symphyseal region is readily accessible, thus being an apparent candidate for bone harvesting. On the other hand, the rate of postoperative complica- tions has been shown to be particularly high with this approach. These eventualities need to be dis- cussed with the patient in detail. Frequent complica- tions include: • Desensitization of the mandibular anterior teeth • Devitalization of the mandibular anterior teeth • Alteration of facial contours (pendulous chin) • Scarring • Wound dehiscence It takes surgical prudence and plenty of experience to avoid these complications. The surgical instrument has to steer clear of the root tips to avoid damaging these structures. Temporary or permanent desensiti- zation of the anterior teeth is a routine outcome and therefore needs to be discussed with the patient. Engaging the mandibular border with the instru- ment carries a risk of contour alterations and has to be strictly avoided. Furthermore, care must be taken to accurately prepare the soft-tissue structures (mucosa, subepithelial connective tissue, muscles, periosteum) layer by layer. Failure to do so can lead to local wound dehiscence, unpleasant scarring or even contour alterations (Figure SY1). Depending on the individual anatomical situation, large amounts of bone can be harvested from the symphyseal region. EDI Case Studies 9 Fig. KW4 Bone block harvested from the mandibular angle. Fig. FL1 Block harvest- ing from the mandibular angle. Fig. FL2 Wound dress- ing with equine colla- gen fleece (Tissufleece, Baxter). Fig. FL3 Postoperative radiograph of a bone block harvested from the retro- molar mandibular segment, fixat- ed with a Cor- ticofix screw (CAMLOG) at the first molar position. Figure SY1: Block harvesting from the symphyseal region. The anterior roots and mandibular border must be strictly avoided. Care must be taken to accu- rately prepare the soft-tissue cover layer by layer, exposing the site and followed by wound dressing.