Mandibular cortical bone grafts part 1: anatomy, healing process, and influencing factors

Mandibular cortical grafts are the gold standard in the restoration of intraoral osseous volume. Mandibular cortical grafts do not produce immune reactions and are incorporated by osteoclastic resorption with a short healing period when compared with other methods of osseous repair. Intraoral donor sites include the mandibular ramus, angle of the mandible, mandibular symphysis, and mandibular exostoses. The mandibular ramus provides primarily a dense cortical graft. Other advantages of a mandibular ramus transplant are minimal resorption, maintenance of osseous density, intraoral access, and proximity to the recipient site. This article is Part 1 of a 2-part presentation. It reviews anatomical considerations of mandibular cortical grafts, the associated healing process, and the factors influencing graft incorporation. Part 2 will discuss surgical technique, applications, and morbidity.