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Hexahedral Graft Bed Formation Enhances Outcomes in Secondary Alveolar Bone Grafting: Surgical Technique and Graft
Toru Miyanaga1, Takayoshi Kaneko1, Miyuki Kishibe1
1From the Department of Plastic Surgery, Kanazawa Medical University, Ishikawa, Japan.
Background:
Successful secondary alveolar bone grafting (SABG) requires an appropriate recipient bed and sufficient graft volume, yet bone formation may fail, and the optimal volume remains unclear. We developed a modified approach to create an expanded hexahedral graft bed, identified a suitable bone harvesting technique for this configuration, and determined computed tomography-based thresholds for the bone formation rate (BFR) and graft volume associated with surgical success.
Methods:
We retrospectively analyzed 147 patients undergoing primary SABG. Pre- and postoperative computed tomography scans quantified defect volume and BFR, which was compared between the standard pyramid-shaped graft bed and the modified hexahedral approach. Surgical technique, graft-to-volume rate, and preoperative factors were assessed to identify predictors and quantitative thresholds of clinical success.
Results:
BFR showed a strong positive correlation with clinical success. Bone bridging required a minimum BFR of 50%, whereas BFR ≥80% consistently yielded favorable outcomes. The optimal graft-to-volume rate ranged from 1.4 to 2.4. The trap door bone harvesting technique achieved significantly higher BFR than the burr hole method (65.5% versus 48.9%, P < 0.001). In cleft palate cases, posterior wall suturing reconstructed a stable hexahedral graft bed and improved BFR from 59% to 84%.
Conclusions:
Successful SABG was enhanced by creating an expanded, well-contained hexahedral graft bed and providing an appropriate graft volume. Even in anatomically challenging cleft palate cases, posterior wall suturing facilitated the construction of this configuration, whereas the trap door technique supplied sufficient graft volume to adequately fill the expanded recipient bed.
