Introduction:
In the oral and maxillofacial surgery field, the most challenging task for surgeons is to reconstruct the jaw or perform bone harvesting procedures. It has to be done in a very authentic way from the donor to the recipient site in a safe way in the outpatient or an in-office setting. The tibia metaphysis from the proximal part is considered one of the best sources for autogenous cancellous bone grafts for most oral and maxillofacial surgery procedures. These procedures may include gaining bone volume via maxillary sinus augmentation for dental implants for mandibular or lower jaw reconstruction surgeries, dentoalveolar reconstruction surgeries, or even post-cystic enucleation surgeries. The rationale of this bone harvesting from the tibia of the individual is that the recipient site in the jaw will be prepared by the surgeon and the harvested bone graft will be placed in the area to be augmented in the oral cavity. The oral and maxillofacial surgeon usually uses a resorbable bone membrane to cover the augmented area with the bone graft placed and the aim of the surgeon is usually to achieve this closure in a tension-free manner (primary closure). After a 3 to 5-hour surgical observation for such oral and maxillofacial procedures, the patient is usually discharged on the same day.
What Are the Factors Influencing the Success of a Tibial Graft?
Several factors influence the selection of the proximal tibial bone graft for mandibular or lower jaw reconstruction surgeries. These factors usually include :
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Correlation with the bone quantity.
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The degree of patient morbidity.
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Operating time involved.
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The postoperative complications involved or encountered commonly.
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The surgical challenges or complexity.
In comparison to other sites, dental researchers now regard the proximal tibial bone graft to be well integrated into the recipient sites of the jaw, almost with nearly 100 percent accuracy. Dental research now shows that all dental implants that are placed into the reconstructed bony sites of the jaw after bone graft placement (with the help of the autogenous bone grafts from individuals like the tibial bone graft) can easily undergo osseointegration or in simple words, achieve bone-implant fusion well without any post-operative complications. When the osseointegration and the long-term survival of dental implants are taken into consideration, the best bone graft material can be deemed the autogenous cancellous bone grafts. The focus in the field of dental implantology is to prepare the deficient sites for the placement of dental implants. The procedure before dental implantation involves the placement of cancellous autogenous bone that is obtained from the proximal tibia, which is known to work efficiently and predictably for bone graft or jaw construction surgery purposes specifically.
What Are the Success Rates of Tibial Graft?
The tibial bone provides a valuable source of cancellous bone for bone harvesting, making the proximal tibia an excellent option. The oral surgical reconstruction that is done using the proximal tibial graft has been advocated for a decade after extensive medical research and it is based on case reports conducted by several authors. Bone harvesting from the tibia was introduced into this field as a primary alternative to iliac crest harvesting. In the dental as well as implantology literature, most research studies have compared the post-operative and pre-operative complication rates that are associated with the amounts of bone collected with tibial harvesting, to that of the bone that is obtained through the iliac crest harvesting. Over the last decade, dental and medical research studies have indicated significant operative complications encountered by operators or oral surgeons, when the iliac crest is removed from individuals compared to that of the tibia bone. These studies show that 25 percent of patients who were treated with autogenous bone that was harvested from the iliac crest have the probability of experiencing postoperative pain after the surgery at some point in time, within an average period of five years post the oral or maxillofacial surgical procedure.
What Are the Possible Complications With Tibial Bone Graft?
Based on the research findings, it has been observed that individuals who have undergone common surgical procedures before dental implantation, such as maxillary sinus augmentation using a tibial bone graft, may face the risk of osteomyelitis affecting the jaw bone. This risk is particularly higher in individuals who are undergoing oral bisphosphonate therapy, those who are immunocompromised, or those with a history of radiation or cancer therapy treatment, including chemotherapy. This means that the incidence of developing jaw infections is much higher in individuals with a medical or dental history. If such individuals need to get their bone harvest grafted at the recipient site in the jaw, the oral surgeons need to be prepared to treat infections that are either localized or chronic such as osteomyelitis. These complications post the bone graft in such individuals are usually treated with appropriate antibiotic drugs and local debridement.
Research shows that even these post-bone graft complications are only a result of localized bone vascular insufficiencies or due to an inhibition in the normal bone turnover remodeling. Such incidents are more prevalent in individuals who are predisposed to jaw infections or those taking systemic medications like bisphosphonate drugs. On the other hand, for healthy individuals, the autogenous bone grafts obtained from the proximal tibia are not only considered effective in comparison to iliac crest bone grafts, but they are also highly successful for maxillary or mandibular jaw reconstruction.
Conclusion:
Autogenous bone is the gold standard procedure that has been standardized for dentoalveolar reconstruction or jaw reconstruction procedures in current-day oral surgery and dental implantology practice. Dental research indicates that, for most mild to moderate bone graft procedures of the oral cavity, the tibia graft has fewer post-operative complications and higher success rates in the long term compared to the other autogenous site harvesting procedures such as from the iliac crest.
