Advances in endosseous implants: the 'sandwich' split cortical graft for dental implant placement

Endosseous implants have restored normal function and dental health to many patients. When implants were introduced as an effective treatment modality, their efficacy was limited by the amount of available bone. Today, various grafting procedures can surgically create bone width and volume. Implants can be placed in more ideal locations for successful prosthetic reconstruction. Autogenous bone has been considered the "gold standard," and the most predictable graft material. However, harvesting autogenous bone requires a second surgical site, increased surgical and healing time, and increased morbidity. A loss of a single tooth or multiple teeth leads to atrophy of the alveolus and reduction of osseous width and height (volume). "Sandwich" split cortical graft surgery can be used as the surgical procedure of choice to re-establish bone volume and contour. With this procedure, the recipient site is also the site for the donor cortical bone. A bone replacement graft material is placed within the cancellous compartment and is contained by the autogenous cortical block harvested from the recipient bed. Sandwich split cortical graft surgery offers the obvious advantage of autogenous bone without the need for a second surgical site.