Mandibular Bone Block Harvesting from the Retromolar Region: A 10-Year Prospective Clinical Study

Purpose: The aim of this prospective study was to evaluate the outcome of bone block harvesting from the external oblique ridge with the MicroSaw, assess the volume of the harvested block, and identify possible morbidity and complications related to the procedure. Materials and Methods: Bone blocks were harvested from the external oblique line of the mandible according to the MicroSaw protocol. The bone blocks were split into two thinner blocks with a diamond disk according to the split bone block (SBB) technique for biologic grafting procedures. Results: In all, 3,874 bone blocks were harvested from the external oblique line of the mandible in 3,328 patients. Four hundred nineteen patients (12.59%) underwent bilateral bone block harvesting, and 127 patients (3.82%) had more than one block harvested from the same area during the study period. In 431 cases (11.12%), only one block was required, so the second was repositioned to reconstruct its donor site. The average harvesting time was 6.5 ± 2.5 minutes, and a mean volume of 1.9 ± 0.9 cm3 was obtained (maximum 4.4 cm3). In 168 (4.33%) cases, the alveolar nerve was exposed, leading to sensory problems lasting up to 6 months. In 20 cases (0.5%), minor nerve injury resulted in hypesthesia or paresthesia that lasted for up to 1 year in most patients. No major nerve lesions with permanent anesthesia were observed. Sixty-one (1.58%) donor sites showed primary healing complications, most in smokers (80.4%). Reentry of 16 reimplanted harvested areas was performed between 6 and 40 months later, showing a well-regenerated and healed external oblique ridge. Conclusion: This study demonstrated that relatively large volumes of bone block graft can be retrieved in the mandible with a low complication rate. Reimplantation of half of the bone block offers the possibility for complete regeneration of the donor site. Keywords: autogenous bone block, diamond disk, external oblique line, mandibular bone graft, mandibular bone harvesting, MicroSaw, split bone block