A comparative study of the efficacy and morbidity of five techniques for ridge augmentation of the mandible

Severely atrophic mandibles were augmented in 254 patients using five different surgical procedures, followed by total lowering of the floor of the mouth, vestibuloplasty, and skin graft. Patients were evaluated on a long-term basis to compare efficacy of treatment subjectively by recording patient complaints and by objectively assessing ridge form clinically and radiographically. Patients, in general, were pleased with the short- and long-term results of all five procedures. The ideal ridge form, comma-shaped, was obtained at a much higher rate with the three procedures using hydroxylapatite (HA) alone or in combination with collagen (HA-PFC). Ridge height loss both anteriorly and posteriorly was more severe in the two visor groups with bone graft or with HA than in those with only the alloplast. Labial sensory alterations more frequently occurred in the visor bone graft group, and wound dehiscence and lack of skin graft take were seen most often in the HA-PFC groups. Despite great differences in the quality of ridges obtained and in the number of complications between the visor groups and the alloplast groups, general patient satisfaction with any of the five procedures could be explained by the severity of the original complaints and because muscle interference has been eliminated in all cases by lowering of the floor of the mouth.