Pedicled segmental rotation techniques for posterior mandible augmentation: a preliminary study

Rehabilitation of the atrophic posterior mandible is a challenge in dental practice. Conventional treatments include the segmental sandwich osteotomy or inlay bone grafting (IBG), onlay bone grafting (OBG), short implants, distraction osteogenesis, and inferior alveolar nerve transposition (IANT), each with its downsides. This case series is reported to introduce a modification of IBG - pedicled segmental rotation (PSR) for the reconstruction of co-existing vertical and horizontal defects in the posterior mandible. Ten healthy patients with vertical-horizontal defects (no vertical bone walls and basal bone width <5 mm) were included. Posterior mandibular defects were treated with PSR, PSR + IANT, or PSR + OBG. In PSR, a pedicle-preserved segment is up-fractured superiorly and then flipped 90° to a vertical position. The segment is then supported with inorganic bovine bone and autogenous bone particulates. Cone beam computed tomography was performed preoperatively and at the 4-month follow-up, in addition to clinical examinations. Soft tissue healing was uneventful. Radiomorphometric analysis showed a mean new bone volume of 647.79 ± 81.31 mm³ (ΔH = 7.13 mm), 836.99 ± 119.14 mm³ (ΔH = 7.8 mm), and 640.20 ± 50.13 mm³ (ΔH = 6.59) in the PSR, PSR + OBG, and PSR + IANT groups, respectively. The proposed PSR technique used in this case series showed promising results for vertical and horizontal augmentation of the atrophic posterior mandible before placement of dental implants.