Posterior mandible vertical defect Part 1

126 Rating(s).

Posted on By Juan In Bone Grafting

Hello everyone,

The posterior mandible is one of the most difficult places to achieve vertical bone augmentation due to the density of the mandible bone, the thinness soft tissue and other factors.

This patient was referred to Jose Luis Dominguez-Mompell and me after losing two implants out of three and leaving a vertical bone defect.

A tunnel approach approach was performed combined with a Khoury box technique using bone autogenous blocks with particulate bone inside the box frame.

After 5 months two implants were placed.

Hope you like it and all comments are very welcome!

Next post:
Posterior mandible vertical defect Part 2

Juan Lara Chao
Jose Luis Dominguez-Mompell
Madrid - Spain
Reconstructive Surgery in Oral Implantology

Previous situation

Tunnel approach

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Very impressive. Can you explain the advantages of tunnel flap over conventional flap approach as well as that of Khoury plates over conventional blocks? Thanks Dr. Salama


Thank you Maurice,

When doing vertical bone augmentations we usually perform a tunnel approach because there are very little chances of wound dehiscence and there is intact periosteum over the bone graft which means more blood supply.

On the other hand makes the surgery a little bit more difficult, but in our experience it is not as hard as it might look.

One of the main problems with conventional bone blocks is the resorption, mandible bone blocks are thick (4-5mm) and it is difficult to get the graft revascularizated. If it doesn't fully revascularizated then it is a matter of time to suffer resorption processes.

With the thin bone blades (1 mm) we make it easier for the angiogenesis, the particulate bone chips inside the bone box will get blood supply much more easily too.


Do you know why the 2 implants failed, what size fixation screws did you use Thanks


The aim of this narrative review is to describe treatment options for the posterior regions of the mandible and the maxilla, comparing short implants vs. longer implants in an augmented bone. The dental literature was screened for treatment options enabling the placement of dental implants in posterior sites with a reduced vertical bone height in the maxilla and the mandible. Short dental implants have been increasingly used recently, providing a number of advantages including reduced patient morbidity, shorter treatment time, and lower costs. In the posterior maxilla, sinus elevation procedures were for long considered to be the gold standard using various bone substitute materials and rendering high implant survival rates. More recently, implants were even placed without any further use of bone substitute materials, but the long-term outcomes have yet to be documented. Vertical bone augmentation procedures in the mandible require a relatively high level of surgical skill and allow the placement of standard-length dental implants by the use of autogenous bone blocks. Both treatment options, short dental implants, and standard-length implants in combination with vertical bone augmentation procedures, appear to result in predictable outcomes in terms of implant survival rates. According to recent clinical studies comparing the therapeutic options of short implants vs. long implants in augmented bone, the use of short dental implants leads to a number of advantages for the patients and the clinician. You can visit at fro more information.


Dear Dr Barton,

We absolutely agree with you that short implants are giving us a great `new´ tool to treat many many patients. Nevertheless We have to keep in ming that short and ultrashort implants are not the panacea for all cases. We also need to say that short implants need a learning curve, IMHO short implants should be considered as 1st option in many cases but as, for example the guided surgery, need to be performed properly.
Would you consider placing a 5-6 mm implant + a GBR around it?
In mi opinion, placing the implant its important but its maintenance it even more important, that why soft tissue management with our a vertical augmentation in this case (Look very the floor of the mouth is) would be really difficult.
Thanks for your comment
Jose L. Mompell


360 Imaging