SYMPHYSIS BLOCK BONE GRAFT

Dental implantology has evolved into an accepted, predictable treatment for restoring lost teeth. In the era of prosthetic driven implant dentistry, the final prosthesis type and design dictates the number, size and the ideal implant position. Often in clinical practice, the deficiency of bone volume is shown to be the primary reason for avoiding implant treatment. The solution lies in re-establishing the ridge volume consistent with prosthetic design and with suitable load-bearing lamellar bone for long-term stability of the implant therapy.
Despite recent advances in bone grafts and bone-substitute technology, intramembranous autogenous osseous transplants are regarded as the gold standard for reconstruction of the deficient alveolar ridge. If the amount of bone necessary for augmentation is modest, intramembranous autografts can be easily obtained from regional intraoral sites such as maxillary palate and tuberosity, mandibular symphysis, angle of the mandible, ramus and bony exostosis.
Chin offers a large amount of cortico-cancellous autograft and easy access among all the intraoral sites. It can be easily harvested in the office settings under local anesthesia on an out-patient basis. Proximity of the donor and recipient sites reduce operative time and cost. Convenient surgical access, low morbidity, elimination of hospital stay, minimal donor site discomfort and avoidance of cutaneous scars are the added advantages.
Chin bone block can be used for predictable bone augmentation of up to 6 mm in horizontal and vertical dimensions. Cortico-cancellous graft ranging from 3 mm to 11 mm thickness, with most of the sites providing 5-8 mm can be harvested from symphysis. Up to three teeth edentulous site can be augmented.
The chin musculature is composed of three muscle groups: mentalis, orbicularis oris . Orbicularis oris and depressors have little effect on the chin position and of not so much surgical concern.
A mentalis muscle is a short, stout and paired muscle; usually separated by a small column of adipose tissue in the midline. It originates from the incisive fossa of the mandible at the level of the root of the lower lateral incisors, just below the attached gingiva and insert into the integument of the chin. It is innervated by the marginal mandibular branch of the facial nerve. Over-reflection of the mentalis muscle may lead to loss of facial contour by inversion of the lower lip and flattening of the labiomental fold.
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