A reliable approach to bone augmentation with reduced donor site morbidity: A prospective case series of buccal bone plate repositioning osteotomy for severe mandibular atrophy.

PURPOSE: Severe mandibular atrophy poses a significant challenge for dental implant placement due to insufficient bone volume. This study aimed to introduce and evaluate the efficacy of a buccal bone plate repositioning osteotomy technique for horizontal bone augmentation while preserving vertical bone height.

METHODS

In this prospective case series, 10 patients with severe mandibular atrophy (alveolar crest width 5 mm) underwent buccal bone plate repositioning osteotomy. Autogenous bone blocks were harvested from the surgical site, rotated 180 degrees and rigidly fixed to the lingual cortical plate with titanium screws. Guided bone regeneration was performed using xenograft, collagen membrane and platelet-rich fibrin. Horizontal bone width (at the crest and 1 mm below) and vertical height were measured by CBCT preoperatively, immediately postoperatively and at 6 months. Data were analysed with paired t tests.

RESULTS

All patients experienced uneventful healing. At 6 months, significant horizontal bone gain was achieved (crest 4.67 ± 1.27 mm; 1 mm below crest 4.41 ± 1.33 mm; both P 0.001). Vertical bone height remained stable (13.26 ± 2.78 mm vs 13.31 ± 2.65 mm). All 12 implants placed after healing were successful, with stable bone levels at the 1-year follow-up.

CONCLUSION

The buccal bone plate repositioning osteotomy technique provides predictable horizontal bone augmentation and maintains vertical height in cases of severe mandibular atrophy, eliminating the need for a secondary donor site. Rigid fixation to the lingual plate is crucial for success. Within the limitations of this case series, this approach appears to be a feasible solution for horizontal bone augmentation, with the advantage of avoiding a secondary donor site.