Orbital floor reconstruction with autogenous bone harvested from the mandibular lingual cortex

Effectiveness of maxillary cortical bone graft chips harvested by bone scraper, covered with platelet-rich fibrin (PRF), in reconstruction of alveolar clefts: comparative study

PURPOSE

The aim of this study is to assess the effectiveness of maxillary cortical bone graft chips harvested by bone scraper, covered with platelet-rich fibrin (PRF) in alveolar clefts.

PATIENTS AND METHODS

Seventy-two cleft patients were examined for their eligibility to be part in this comparative study; they were randomly divided into group A, thirty-six patients had received cancellous bone chips from iliac crest; group B, thirty-six had received cortical bone chips harvested from maxilla using a curved bone scraper, covered with PRF. The clinical success over the follow-up period was evaluated on the basis of elimination of the oronasal fistula, radiographic assessment of bone graft volume, achievement of the osseous continuity of the alveolar arch, and the extent of the vertical bone height.

RESULTS

The mean of volume gained in group A was 0.8053 ± 0.9682, while for group B was 0.7397 ± 0.7703. The amount of vertical bone loss between groups was registered, and the chi-square test revealed insignificant differences between study groups (p = 0.547). The result of the frequency of fistula development after grafting in both groups was insignificant (p = 0.074). Also, for the continuity of the maxilla as a one piece, the results were insignificant differences between study groups (p = 0.058).

CONCLUSION

In conclusion of our study, intraoral harvesting of maxillary cortical chips by bone scraper covered with PRF is able to achieve a valid functional and aesthetic support in alveolar cleft patients, meeting the reconstructive goals.

Management of Orbital Floor Fractures: Our Experience in 10 Years

Purpose

Orbital floor Fractures are the most common fractures involving the facial skeleton and usually occurs after traumatic events. The reconstruction of the orbital floor can be performed with different biocompatible materials. The aim of our retrospective study is to analyze the short- and long-term outcomes of surgically treated patients based on the material used to repair the orbital floor.

Methods

We enrolled 146 patients hospitalized for orbital floor fractures in the Maxillofacial Surgery Unit of the Federico II University of Naples from 1 to 2010 to July 2020. All the fractured orbital floors were reconstructed with non-resorbable (Titanium Mesh, SynPor, SuPor and MedPor implants) or resorbable (collagen membrane, bovinum pericardium membrane, autologous bone graft) materials.

Results

We utilized non-resorbable materials in 56% (82 cases) and resorbable implants in 44% (64 cases). An improvement of the preoperative symptomatology and an aesthetical good outcome was achieved in most cases.

Conclusions

Data obtained supports that both resorbable and non-resorbable materials for orbital floor reconstruction are a safe and effective alternatives and offer satisfactory results in functional and aesthetic evaluations.

Examination of the Quality of Particulate and Filtered Mandibular Bone Chips for Oral Implants: An In Vitro Study

(1) Background: Autologous bone is supposed to contain vital cells that might improve the osseointegration of dental implants. The aim of this study was to investigate particulate and filtered bone chips collected during oral surgery intervention with respect to their osteogenic potential and the extent of microbial contamination to evaluate its usefulness for jawbone reconstruction prior to implant placement. (2) Methods: Cortical and cortical-cancellous bone chip samples of 84 patients were collected. The stem cell character of outgrowing cells was characterized by expression of CD73, CD90 and CD105, followed by osteogenic differentiation. The degree of bacterial contamination was determined by Gram staining, catalase and oxidase tests and tests to evaluate the genera of the found bacteria (3) Results: Pre-surgical antibiotic treatment of the patients significantly increased viability of the collected bone chip cells. No significant difference in plasticity was observed between cells isolated from the cortical and cortical-cancellous bone chip samples. Thus, both types of bone tissue can be used for jawbone reconstruction. The osteogenic differentiation was independent of the quantity and quality of the detected microorganisms, which comprise the most common bacteria in the oral cavity. (4) Discussion: This study shows that the quality of bone chip-derived stem cells is independent of the donor site and the extent of present common microorganisms, highlighting autologous bone tissue, assessable without additional surgical intervention for the patient, as a useful material for dental implantology.

Patient-Specific Orbital Implants: Development and Implementation of Technology for More Accurate Orbital Reconstruction

Fracture of the orbital floor is commonly seen in facial trauma. Accurate anatomical reconstruction of the orbital floor contour is challenging. The authors demonstrate a novel method to more precisely reconstruct the orbital floor on a 50-year-old female who sustained an orbital floor fracture following a fall. Results of the reconstruction show excellent reapproximation of the native orbital floor contour and complete resolution of her enopthalmos and facial asymmetry.

Applications of coronoid process as a bone graft in maxillofacial surgery

The coronoid process can be easily harvested as a donor bone by an intraoral approach during many maxillofacial surgery procedures. The purpose of this study was to evaluate the utility of autogenous coronoid process bone grafts for maxillofacial reconstructive surgery. Twelve patients, who underwent coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or temporomandibular joint ankylosis, were included in the study. There were 3 orbital defects after extended maxillectomy, 1 blowout fracture of the orbit, 2 cases of reconstruction after temporomandibular joint ankylosis surgery, 1 case of additional chin augmentation following horizontal flip genioplasty, 1 defect of anterior wall of maxilla due to trauma, 2 mandibular defects, and 2 cases of bone augmentation for implants.We recommend the use of coronoid process of the mandible as a source for autogenous bone graft as it can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

Use of anteriolateral wall of maxilla for reconstruction of orbital floor fracture: A clinical study

Purpose:

The aim of the present study was to assess the utility of anterolateral wall of maxilla as a bone graft to reconstruct the continuity of orbital floor.

Materials and Methods

This study was carried out at Datarkar Institute of Maxillofacial Surgery, Pratap Nagar, Nagpur. Out of five patients selected, three were male and two were female. All the patients had intact anterolateral wall of maxilla on contralateral side. In all the patients the reduction of the zygomatic complex fracture was done by Keen's approach. The fractures were stabilized by miniplates. From the contralateral sides,bone graft of 1.5 × 2 cm size was harvested from which were intact in all the patients. All the patients were reviewed at regular interval, initially once every week for 1 month, followed by once in every month for next 6 months postoperatively.

Results:

Five patients with orbital floor defects of medium size average 1.16 cm size (range 0.8-1.5 cm) were grafted by using autogenous bone graft harvested from anterolateral wall of maxilla. All the patients were successfully reconstructed with restoration of the orbital wall continuity. We have not come across any complications like infection, exposure, and extrusion of the graft. Only one patient did not show much improvement in enopthalmous where the size of the defect was large.

Conclusions:

The use of harvested bone graft from the anterolateral wall of the maxilla is better option for the reconstruction of orbital floor defects.

Biomaterials for reconstruction of the internal orbit

Orbital floor injuries, alone or combination with other facial fractures, are one of the most commonly encountered midface fractures. Techniques for orbital reconstruction have migrated away from autogenous bone grafts to well-tolerated alloplasts, such as titanium and Medpor. Material for reconstructing the orbit can then be selected based on requirements of the defect matched to the mechanical properties of the material. Material selection is largely and ultimately dependent upon surgeon preference.

Reconstruction of orbital floor fractures using autologous nasal septal bone graft

We describe herein a new technique for reconstruction of the orbital floor, using autologous nasal septal bone and report the surgical results achieved in maxillofacial trauma patients.Prior to its clinical surgical application, a cadaver practice was carried out on 5 formalin-fixed adult human cadavers to establish the feasibility and efficacy of the method. Fifteen patients with orbital floor fractures, operated between 2005 and 2008, using this technique, were included in the current study.Cadaveric practice revealed that an adequate and appropriate size of septal bone graft can be harvested for reconstruction of the orbital floor. All patients except one had satisfactory clinical and radiologic late results. One patient experienced persistent enophthalmos, possibly due to delayed repair and associated displaced zygomatic bone fracture.Autologous nasal septal bone as an orbital floor bone graft has many advantages, including low donor site morbidity, adequacy and appropriateness of size, and similarity of its bicortical morphology and histologic nature compared with the orbital floor bone. Our clinical results strongly support that this technique can become a satisfactory alternative to existing reconstruction methods.

Reconstruction of Traumatic Orbital Floor Fractures With Resorbable Mesh Plate

Various materials such as autogenous bone, cartilage and alloplastic implants have been used to reconstruct orbital floor fractures. A new material is needed because of disadvantages of nonresorbable alloplastic materials and difficulties in harvesting autogenous tissues. In this study safety and value of the use of resorbable mesh plate in the treatment of orbital floor fractures are discussed. Between 2002 and 2004 a total of 17 maxillofacial trauma patients complicated with orbital floor fractures were treated with resorbable mesh plate through subciliary or transconjunctival incisions. Pure blow-out fractures were determined in 6 patients and 11 patients had accompanying maxillofacial fractures. Resorbable plate was easily shaped to fit to the orbital floor by cutting with scissors. Patients were evaluated clinically and with computed tomography scans preoperatively and at 3-, 6- and 12-month intervals postoperatively. Twelve patients had preoperative enophthalmos. Two patients had diplopia that was corrected postoperatively. In all 17 cases there was no evidence of infection, diplopia and gaze restriction postoperatively. Scleral show appeared in three patients by the second postoperative week but resolved totally within 3 to 6 weeks except one patient. In this patient anterior displacement of mesh was evident which caused ectropion and enophthalmos and required re-operation. No any other mesh related problems were seen at 15 months mean follow-up time. The advantage of the resorbable mesh system in orbital floor fracture is the maintenance of orbital contents against herniation forces during the initial phase of healing and then complete resorption through natural processes after its support is no longer needed. Our experience represents that resorbable mesh is a safe and effective material for reconstruction of the selected, non-extensive orbital floor fractures.

A novel bone scraper for intraoral harvesting: a device for filling small bone defects

AIM

To evaluate histologically the morphology and characteristics of bone chips harvested intraorally by Safescraper, a specially designed cortical bone collector.

MATERIAL AND METHODS

Bone chips harvested near a bone defect or in other intraoral sites were grafted into a post-extractive socket or applied in procedures for maxillary sinus floor augmentation or guided bone regeneration. Core biopsies were performed at implant insertion. Undecalcified specimens embedded in PMMA were studied by histology, histochemistry and SEM.

RESULTS

Intraoral harvesting by Safescraper provided a simple, clinically effective regenerative procedure with low morbidity for collecting cortical bone chips (0.9-1.7 mm in length, roughly 100 microm thick). Chips had an oblong or quadrangular shape and contained live osteocytes (mean viability: 45-72%). Bone chip grafting produced newly formed bone tissue suitable for implant insertion. Trabecular bone volume measured on biopsies decreased with time (from 45-55% to 23%). Grafted chips made up 50% or less of the calcified tissue in biopsies. Biopsies presented remodeling activities, new bone formation by apposition and live osteocytes (35% or higher).

DISCUSSION AND CONCLUSIONS

In conclusion, Safescraper is capable of collecting adequate amounts of cortical bone chips from different intraoral sites. The procedure is effective for treating alveolar defects for endosseous implant insertion and provides good healing of small bone defects after grafting with bone chips. The study indicates that Safescraper is a very useful device for in-office bone harvesting procedures in routine peri-implant bone regeneration.

The anterior palate as a donor site in maxillofacial bone grafting: a quantitative anatomic study

PURPOSE

The goal of this study was to quantify the amount of bone graft material present in the anterior palate site.

MATERIALS AND METHODS

Twenty-one fixed cadavers, dentulous and edentulous maxilla, were studied. Osteotomies were performed in monocortical fashion, 2 mm from the bone crest and parallel to the tooth axis and 3 mm from the incisive foramen at the midline. The bur penetration was indicated by radiographic index. The amount of the corticocancellous block was then measured with displacement volumetric technique.

RESULTS

The average volume obtained were 2.03 mL in dentate and 2.40 mL in edentulous patients ( P = .2135, not significant between the 2 groups).

CONCLUSIONS

Based on the results of this study, it is apparent that the anterior region of the palate can be reliably selected as the donor site in the oral and maxillofacial reconstructive, implantology, and periodontal regeneration procedure.

The medial surface of the mandible as an alternative source of bone grafts in orthognathic surgery

A technique of harvesting bone grafts from the medial surface of the angle of the mandible during a bilateral sagittal split osteotomy procedure is described. In 20 patients who underwent mandibular setback for the correction of class III dentofacial deformities, bone grafts were harvested from the medial mandibular angle and used for simultaneous augmentation of the midface or for interpositioning and stabilization of the maxilla after LeFort I maxillary anterior or inferior repositioning. The mean postoperative follow-up was 6 months (range, 3-12 months). No complications occurred, and postoperative morbidity was similar to that encountered by patients who undergo sagittal split osteotomy without bone harvest. The technique described shows that the medial mandibular angle is a suitable donor site for membranous bone grafts in patients who undergo sagittal split osteotomy.

Orbital wall reconstruction with bone grafts from the outer cortex of the mandible

AIM

The purpose of the study was to assess the efficacy of bone grafting from the mandibular outer cortex for reconstructing the orbital walls.

MATERIAL AND METHODS

Bone grafting was performed in 75 patients. The site the transplants were harvested from were: A: mental region, B: area posterior to the mental foramen, C: ramus region. In order to obtain the appropriate curvature for the orbital floor, proper selection of the donor area is required. The bony defect size was confirmed pre-operatively from 3D-CT data. Bone, characteristically 2-3 mm thick, was harvested from each area and grafted into the blow-out fractures.

RESULTS

Out of the 75 patients 13 cases underwent reconstruction using mandibular outer cortex bone from area A, 8 from area B, and 54 from area C. The maximum size available for harvest from area C was 7 x 4 cm; material from this area could also be used for the repair of both medial and inferior orbital wall defects if necessary.

CONCLUSION

Bone harvest from the mandible affords several advantages including (1) ease of harvest, (2) ease of trimming, (3) appropriate size and curvature, (4) absence of functional disability, (5) no secondary deformity, (6) no visible scars, (7) post-operative immobilization not necessary, (8) absence of post-operative difficulties with respect to breathing and walking and (9) major complications are rare.

Dorsal nasal reconstruction using bone harvested from the mandible

PURPOSE

This article describes a technique for reconstructing nasal deformities resulting from trauma. Bone harvested from the lateral ramus/body of the mandible is used to provide nasal support for major nasal deformities.

PATIENTS AND METHODS

Ten patients underwent repair of their nasal deformities with an autogenous bone graft harvested from the mandible. Primary bone grafting was used to repair a nasal deformity associated with a naso-orbito-ethmoidal fracture in 8 patients. Secondarily, 2 patients underwent placement of a graft for correction of a saddle nose deformity.

RESULTS

All patients achieved aesthetic results. There was maintenance of nasal projection and symmetry without displacement of the graft. None of the patients complained of an unnatural hardness of the nasal tip or dorsum. All grafts healed without evidence of infection, dehiscence, or necrosis.

CONCLUSION

The lateral ramus/body of the mandible provide an excellent donor site alternative for nasal reconstruction.

Particulated bone grafts - effectiveness of bone cell supply

OBJECTIVE

The objective of this study was to measure the amount of viable bone cells present in different types of bone graft.

MATERIAL AND METHODS

Bone chips were harvested from the trabecular or cortical bone of the mandible or the iliac crest and either milled or not. The average size of unmilled bone particles was 5 x 5 x 5 mm and that of milled was 2 x 2 x 2 mm. Drill sludge was obtained using either a ball reamer, a diamond ball or an implant drill (the latter from mandibular bone and of average dimension 1 x 1 x 1 mm). A measure of 0.5 g of each category was cultured in Dulbecco's modified Eagle's medium with additives for four weeks. Cell counts were performed. An analysis of the osteocalcin synthesis, the alkaline phosphatase (ALP) activity, the collagen types and the concentration of bone-specific collagen cross-links in medium supernatants was performed.

RESULTS

Cells stained positively for osteocalcin and ALP in all groups. Bone-specific collagen cross-links could be quantified and collagen of types I and V was present with no difference in all groups. Unmilled spongy bone chips revealed greater cell counts than milled (P<0.05). Spongy bone chips revealed greater cell counts than cortical bone chips (P<0.05). Drill sludge obtained by hard alloy ball reamer showed the least amount of viable cells (P<0.05).

CONCLUSIONS

Bone milling reduces the quantity of osteoblasts. Bone obtained by the ball reamer supplies a smaller number of cells than bone obtained by other methods. Unmilled spongy bone chips appear to offer the greatest amount of viable osteoblasts.

The ascending ramus of the mandible as a donor site in maxillofacial bone grafting

PURPOSE

The goal of this study was to quantify the amount of bone graft material present in the anterior part of ascending ramus while avoiding the inferior alveolar neurovascular bundle injury.

MATERIALS AND METHODS

This study was made on 16 samples of dry skull. Osteotomies were made in front of the mandibular canal from the mandibular notch to 3 mm posterior of the root of the third molar. The dimensions, the surface area, and the volume of the bone grafts were measured and evaluated.

RESULTS

The average dimensions of the graft material obtained from the anterior part of ascending ramus were 37.60 x 33.17 x 22.48 x 9.15 mm; the average bone volume was 2.36 mL; and the average surface area of the graft material was 495.13 mm(2).

CONCLUSION

The results of the present study show that the anterior part of ascending ramus can be used as the donor site for reconstruction of small bone defects in the oral and maxillofacial region.

Morbidity of harvesting of retromolar bone grafts: a prospective study

20 retromolar bone grafts were harvested in outpatients for augmentation of the implant site from January to June 2000 (10 female, 10 male, 40.9 +/- 12.8 years, minimum 17 years, maximum 66 years). The aim of the study was to assess typical complications of this procedure in a prospective manner. For the determination of the superficial sensory function of the inferior alveolar and the lingual nerve, an objective method was used. The bone grafts were harvested for single tooth reconstruction. In 14 cases a ridge augmentation and in 6 cases an endoscopically controlled crestal sinus floor elevation was performed. Preoperatively, the height of bone above the cranial aspect of the inferior alveolar nerve in the retromolar region was assessed radiologically with known markers. The maximum mouth opening was determined. The superficial sensory function of the inferior alveolar and the lingual nerve was assessed with the Pointed-Blunt Test, the Two-Point-Discrimination Test and the objective method of the 'Pain and Thermal Sensitivity' Test (PATH Test). Moreover, the pulp sensitivity of the teeth of the donor site was determined by cold vitality testing. All tests were repeated 1 week postoperatively. Intraoperatively, the width of the retromolar region was measured with a caliper. The patients rated the operative strain on a visual analogue scale. The height of bone above the inferior alveolar nerve in the retromolar region was 11.0 +/- 2.2 mm. The width of the retromolar area was 14.2 +/- 1.9 mm. Postoperatively, the maximal mouth opening changed significantly (40.8 +/- 3.5 mm preoperatively, 38.9 +/- 3.7 mm postoperatively, P = 0.006). However, the reduction was not relevant clinically. A direct injury of the inferior alveolar or lingual nerve did not occur. A sensitivity impairment could not be detected for either of the nerves by the different test methods 1 week postoperatively. The operative strain related to the donor site was significantly less than the strain generated by the implant placement (rating on a visual analogue scale 2.8 +/- 1.0 and 4.1 +/- 2.0, respectively, P = 0.027). Retromolar bone grafts are a viable method for augmentation of the implant site in conjunction with single tooth reconstruction with low strain on the patient and minimal risk of complications.

The mandibular symphysis as a donor site in maxillofacial bone grafting: a quantitative anatomic study

PURPOSE

The goal of this study was to quantify the amount of bone graft material present in the mandibular symphysis as well as to determine the maximal size of the corticocancellous bone block that can be harvested while avoiding mental nerve injury, tooth injury, and simultaneously preserving the preoperative facial contour.

MATERIALS AND METHODS

Sixteen fixed dentate cadaver mandibles were studied. Osteotomies were performed in a monocortical fashion, 5 mm anterior to the mental foramen, cephalad to the inferior border of the mandible, caudal to the expected position of the apices of the anterior teeth, and at the midline. The size of the corticocancellous block was then measured. Bone volume, using 2 techniques, was measured by displacement volumetry.

RESULTS

The average volumes obtained were 4.84 mL and 4.71 mL (range, 3.25 to 6.50 mL), respectively, for the 2 techniques of volumetry. The average block size was 20.9 x 9.9 x 6.9 mm; the smallest block was 21.0 x 6.5 x 6.0 mm, and the largest was 25.0 x 13.0 x 9.0 mm.

CONCLUSION

Based on the results of this study, it is apparent that the mandibular symphysis can be reliably selected as the harvest site in a variety of oral and maxillofacial reconstructive procedures.

Contralateral coronoid process bone grafts for orbital floor reconstruction: an anatomic and clinical study

PURPOSE

This study compares the contour of the coronoid process with the orbital floor using skulls and shows the use of this bone as a graft for orbital floor reconstruction.

METHODS

Measurements and contour evaluations of the orbital floor and the contralateral mandibular coronoid process (12 right orbital floors with the lateral surface of the left coronoid process and 12 left orbital floors with the lateral surface of the right coronoid processes) were made in 24 dried adult human skulls (age, race, gender unknown) to assess the feasibility of using the mandibular coronoid process for orbital floor reconstruction. Applying the findings of this study, eight patients who had sustained either an isolated orbital floor blowout fracture (n = 2) or orbital floor compromise with an associated zygomatic bone fracture (n = 6) were treated by using their contralateral coronoid process for repair of the orbital floor.

RESULTS

Anatomic Study: Measurements and contour comparisons of the right orbital floor with the left lateral cortex of the coronoid process in 12 skulls and the left orbital floor with the right lateral cortex of the coronoid process in the another 12 skulls showed a close match in contour and demension.

CLINICAL STUDY

Although minimal trimming of the peripheral bony margins and medial coronoid cortical plate was needed, none of the grafts required recontouring of their lateral cortical surface in the eight patients. Postoperative radiographic studies showed a correct anatomic contour of the orbital floor. A 1-year follow-up of each patient showed no occurrence of diplopia, enophthalmia, muscle entrapment, or infection. All eight patients had transient (1 to 2 weeks) trismus.

CONCLUSION

Based on the anatomic studies and clinical results, the coronoid process makes an excellent donor graft site for reconstruction of orbital floor deformities.

Orbital floor reconstruction with autogenous mandibular symphyseal bone grafts

PURPOSE

This article shows the usefulness of the mandibular symphysis as a source of bone graft for the reconstruction of the orbital floor.

PATIENTS AND METHODS

A retrospective study was conducted on 16 patients who had isolated blowout fractures (n = 10) or orbital floor defects (n = 6) reconstructed with mandibular symphyseal bone grafts. Symphyseal bone grafts were used when the defects were less than 2 cm in diameter. Patients were examined at recall visits for any evidence of unsuccessful reconstruction by checking extraocular movements, and evidence of diplopia or enophthalmous.

RESULTS

During a mean follow-up of 12 months (range, 9 to 36 months), patients had no postoperative complaints. There were no instances of infection at the surgical sites, and none of the grafts were extruded or lost. There was good restoration of the orbital floor, with no clinical evidence of enophthalmous or diplopia. Extraocular movements were intact in all patients.

CONCLUSION

The mandibular symphysis is a readily available source of autogenous bone that can be harvested with minimal morbidity. Its contour is suitable for use in orbital floor reconstruction. It merits consideration when autogenous bone grafts are considered for orbital floor defects less than 2 cm in diameter.

Self-reinforced polyglycolic acid membrane: a bioresorbable material for orbital floor repair. Initial clinical report

A self-reinforced polyglycolic acid membrane has been used successfully to repair 15 orbital floor fractures in 12 consecutive patients. As polyglycolic acid is absorbable it does not cause the complications of long-term infection and migration associated with non-absorbable bioinert alloplastic repair materials.

Ectomesenchymal mandibular symphysis bone graft: an improvement in alveolar cleft grafting?

Bone grafting the alveolar cleft in cleft lip and palate (CLP) patients is widely accepted. A traditional graft is the iliac crest. Other bone graft donor sites are briefly discussed. The ratio for an ectomesenchymal bone graft in alveolar cleft repair is explained. Aspects of the embryology, bone graft physiology, and reports on mandibular symphysis bone grafting are discussed.

The response of cultured bone cells to resorbable polyglycolic acid and silicone membranes for use in orbital floor fracture repair

Two membranes intended for use in repairing fractures of the orbital floor--reinforced silicone and biodegradable polyglycolic acid (PGA)--were evaluated in vitro using a rat bone cell culture model. After two weeks in culture, cells had colonised the surface of both materials. Bone cells penetrated the weave of the PGA membrane after three weeks in culture, forming a calcified collagenous bone-like tissue within the weave of the PGA at the same time as there was evidence of resorption of the PGA. In contrast, cells could easily be dislodged from the surface of the reinforced silicone membrane and there was less evidence of mineralised extra cellular matrix production. The production of a bone-like tissue within the weave of the PGA membrane supported previous reports of osteoconductive activity of this material.

The mandibular body bone (MBB) graft: an alternative source of membranous bone

The use of mandibular body bone (MBB) as an alternative source of membranous bone graft is described. The MBB technique is a simple, safe and rapid method of obtaining cortical bone for grafting. Furthermore MBB is membranous bone, which has been reported to be more dimensionally stable after grafting than is endochondral bone. The donor site is more readily accessible than is that for cranial bone, the other source of membranous bone. Two 1.5 x 3 cm rectangular grafts are generally available. We recommend the use of MBB in situations where the technique provides sufficient bone.