Posterior mandible vertical defect Part 2

121 Rating(s).

Posted on By Juan In Bone Grafting

Continuing the previous post: Posterior mandible vertical defect Part 1
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After 5 months we performed a modified Kazanjian's vestibuloplasty approach to place two implants and achieve fund of vestibule. This technique does not provided of keratinized tissue.

As you can see the aspect of the bone is pretty good, we could place two implants 10 mm long.

After a 4 months osseointegration we performed the gingival former surgery + free gingival graft to achieve keratinized tissue.

One of the things we most like is how changes the aspect of the reconstruction with the time, at first we can see perfectly well every part of the bone reconstruction (bone blades, the particulate bone inside), due to remodeling process this aspect will be changing until it is almost impossible to see any difference with the rest of the mandible.

Last xray is 3 years after situation (sorry for the bad quality of that xray)

Hope you all like it

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

Kazanjian's approach
Implant placement

4 months later: gingival former surgery + Free Gingival Graft
Free gingival graft

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Very Impressive 2nd phase of treatment which is so important. Can you better describe your Flap approach for vestibuloplasty and where you anchor your sutures prior to the FGG? Great. Dr. Salama


Totally agree with you Maurice, 2nd phase so important.

When a tunnel is perform the vestibule becomes flap so we usually perform a Kazanjian to recover it again.

Modified Kazanjian's vestibuloplasty: consists in raising a mucosal flap, pedicle lingually, then we would reject the underneath muscle fibers downwards until we get to the periosteum. At this point an incision is perform in the periosteum to get to the bone and place the implants.

Once the implants are place we suture the crestal periosteum to buccal periosteum and the mucosal flap to the periosteum located down in the vestibule.



Excellent job Juan. Do you suggest an occlusal guard or other options for the cross-bite on the first molar? In our office some patients are not so compliant and sometimes Botox injections or muscle relaxants may become necessary to avoid late failures from mechanical overload


Thank you Hisham!

Very good point! One problem of this kind of grafting is that the implants could be a little bit displaced to more buccal situation, like happened in this case.

Yes an occlusal guard is a good idea. Never try botox injections but it sound like a good idea too.

Big hug my friend!


Thank you Juan, you're just an all around great guy 👍🏻


Juan and Jose,

Ideal Khoury technique utilization, nothing is missed.
But don`t even try to convince us that it`s not difficult to perform!

Love it, congratulations!




Thank you so much Snjezana!


Great case and tissue management. Always a fan of the khoury technique. Very impressive. Regards, Naheed


Thank you Naheed, I'm glad you like it


Juan & Jose

Nice work- how much vertical gain do you think you achieved and what was your implant length?l will you splint restorations ?




Thank you Richard,

I think more or less we achieved like 6 mm, implants are 10 mm long. We don't do the prothesis but yes we prefer splint restorations between implants in this kind of reconstructions.

Best regards


Juan and Pepo, love this case! As usual your Khory´s tech has good outcome. And you manage well the 2nd part that is so important. As Snjezana´s only for skilled surgeons cases like this. Thanks again for sharing!.


Thank you so much Jorge!

Warm regards