Hydroxyapatite Augmentation of the Mandible

Hydroxyapatite Augmentation of the Mandible

The problems associated with bone grafting, including resorption, donor-site morbidity, and the need for hospitalization, have in part been responsibte for the search for an alloplastic material that would function as an adequate graft: material for the atrophic mandible. HA is a dense biocompatible material that can be produced synthetically or obtained from biologic sources such as :”’~’:::. At this time the granular, or particle, form is most commonly used for augmenting alveolar ridge contour
defects. When placed in a subperiosteal environment adjacent to bone, HA bonds physically and chemically to the bone. Although some bony growth may occur adjacent to the particles at the area of the interface,   ,lo:~ic”lly c.u h p.rrtick: appedr~ to Ill’ surrounded in a fibrous tissue capsule, with some infiltration of vascular  tissue throughout the graft material. This fibrous encapsulation of the HA particles appears to occur without
the production of any  ignificant inflammation. IX HA aucmentauon 01 till’ mandible can be performed on an outpatient basis, using local anesthetic combined with conscious sedation techniques. i\. subperiosteal tunnel
techniqu.•  is used, which exposes the entire aspect of . . ..• the mandible in the area to be augmented but carefully avoids the neurovascular bundles, f er the tunnel-is created,   preloaded beveled syringe containing HA is inserted into the most posterior aspect of the tunnel; then the 1-1..\ is injected until the desired contour of the mandible is obtained (Fig, 13-33). Similarly insertion of the Hi\. from each lateral incision area augments the anterior area of the mandible. Some surgeons prefer splints to minimize
I-IA displacement and to improve vestibular form during the postoperative period. The splint, constructed on a cast that’ has been waxed to, the desired contour of the mandible after augmentation, is secured in place with circummandibular sutures for 7 to 10 days. Vestibuloplast~’ and skin grafting can be performed 8 to 12 weeks.after augmentation. During this time the HA granules consolidate and become firmly fixed by connective tissue. _ The advantages of HA augmentation are that donor-site, ”Surgery is eliminated and that most patients can undergo this type of procedure in an outpatient setting. Because HA is nonresorbable, no postoperative loss of the graft augmenting the mandible occurs; vascular tissue ingrowth
around the HA provides an adequate vascular bed for future softtissue grafts, if necessary. The disadvantages of HA are the difficulty sometimes encountered in containing the material within the subperiosteal tunnel and in achieving the adequate contour that is often desirable. Some nerve dysesthesias have also been associated with H augmentation,

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