Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications.

BACKGROUND: The placement of endosseous implants in edentulous areas is frequently limited by inadequate bone volume of the residual ridge. Local bone grafts from the mandible are a convenient source of autogenous bone for alveolar reconstruction prior to implant placement.
PURPOSE: The aim of the present study was to document and compare the morbidity and the frequency of complications occurring at two intraoral donor sites: the mandibular symphysis and the mandibular ramus.
MATERIAL AND METHODS: This study reviewed 53 consecutively treated patients: 29 with autogenous bone grafts from the mandibular symphysis and 24 with mandibular ramus bone grafts. Each patient received a questionnaire 18 months after surgery regarding problems that may have occurred during the postoperative period.
RESULTS: In the patients in whom bone was harvested from the mandibular ramus, there were fewer postoperative symptoms immediately after the operation than with mandibular symphysis harvesting. Twenty-two of the 29 patients with symphysis grafts experienced decreased sensitivity in the skin innervated by the mental nerve 1 month after the operation. Five of the 24 patients with ramus grafts experienced decreased sensitivity in the vestibular mucosa corresponding to the innervation of the buccal nerve. Eighteen months after the surgery, 15 of the 29 patients in the symphysis group still had some decreased sensitivity and presented with permanent altered sensation. Only one of the patients grafted from the mandibular ramus presented with permanent altered sensation in the posterior vestibular area. No major complication occurred in the donor sites in any of the 53 patients.
CONCLUSION: The results of this study favored the use of the ascending mandibular ramus as an intraoral donor site for bone grafting.