Bone may be harvested from several intraoral sites, most commonly in the mandible from the buccal cortical plate of the horizontal ramus or the symphysial (chin) area. The maxillary tuberosity area and the zygomaticoalveolar crest are also used.
Most patients will experience less discomfort from intraoral than extraoral donor site. As recently in a controlled study comparing effects of extra versus intraoral donor sites on OHRQOL-HRQOL (oral-health-related and health-related-quality of life) outcomes.
HARVESTING BONE FROM THE MANDIBULAR RAMUS
The surgical rationale being that confining the procedure to the cortical portion of the mandible will eliminate the risk of injury to the mandibular canal or any teeth located within the cancellous portion of the mandible completely.
If the mandibular molars are present, two alternative incision lines can be used to access the area: 1) Marginal incision with a short oblique releasing incision toward the ascending ramus
2) Paramarginal incision directly over the external oblique ridge within the alveolar mucosa. A less preferable variant is a paramarginal incision within the alveolar mucosa, starting atleast 3mm buccal from the Mucogingival junction of the first molar.
If grafting is planned and the posterior mandible and the molars are missing, the same flap is used for both the donor and the recipient site. The procedure is started by performing sulcular incision at the residual teeth and extending them distally at the crest of the ridge, splitting the keratized tissue in two. Then the incision is angled (45 ̊) and extended bucally toward the ascending ramus in the third molar region.
For more details on bone harvesting, join the next batch of Clinical training on bone augmentation in Implantology .Contact Dr.Prof. Rajat Sachdeva 01142464041 for details