Comparison of tunnel and crestal incision techniques in reconstruction of localized alveolar defects with introral onlay bone grafts

Comparison of Tunnel and Crestal Incision Techniques in Reconstruction of Localized Alveolar Defects with Introral Onlay Bone Grafts The aim of this study is to compare the complication rates of the recipient areas those prepared by using two different incision techniques, crestal and tunnel. Volunteer patients at the ages of 24-65 with alveolar crest atrophy applied to Maxillofacial Surgery Clinic of Dentistry Faculty of Başkent University between February 2013 and January 2014 to receive dental implants were included in this study without any gender discrimination. The patients to be included in the study operated consecutively one by using crest incision technique and the next by using tunnel incision technique. The mandibular ramus or the symphysis were used as donor sites. The location of the receiving site, the quality and the quantity of the required bone and the possible surgical complications are considered to choose the donor site of the bone graft. The mandibular ramus or symphysis were chosen as donor site for all of the augmentation procedures for crestal and tunnelling groups. Autogenous bone block grafts were harvested by piezoelectric surgery device and two screw (Syntess) fixed to the receiving site. The Platelet Rich Fibrin (PRF) was used as membrane on the block bone grafts. After a period of 6 month waiting implant surgeries were done. The minor complications (transient paresthesia, modest infection, minor graft exposure), major complications (major graft exposure, permanent paresthesia, infection resulting graft loss), surgery time, VAS parameters were evaluated for both groups in the operations and follow-up visits. In tunnel group 5 bilateral out of 27 horizontal and 11 vertical augmentations made for 33 patients. In tunnel group out of 38 augmentation procedures ramus was used in 16 and symphysis was used in 22 procedures as donor sites. In tunnel group totally 59 implants (Straumann) with diameters of 3.3, 4.1 and 4.8 mm and with height of 10 and 12 mm were placed to 37 sites. In the crestal group 2 bilateral out of 27 horizontal and 10 vertical augmentations were applied for 35 patients. In crestal group totally 61 implants with diameters of 3.3, 4.1 and 4.8 mm and with height of 8, 10 and 12 mm were placed to 34 sites. In tunnel group minor exposure developed in 4 out of 38 donor sites. The graft had lost in one donor site as a result of major exposure and infection. In crestal group out of 37 donor sites in 12 sites minor and in 3 sites major exposures developed. As a result of 6 months follow-up period the minor exposure frequency in crestal group was found significantly higher than the tunnel group (p<0,001). Frequencies of moderate infection, major exposure, infection resulted with graft loss, paresthesia in mucosa and skin, gingival recession in adjacent tooth are found as statistically similar between crestal and tunnel groups. The significantly lower frequency of the exposure rate in the incision line that is declared as the most frequent complication of the recipient sites prepared by tunnel incision technique revealed that the minimally invasive tunnel technique can be used as an alternative to the frequently used crestal incision technique. Key Words: Subperiosteal Tunnel Technique, Minimal Invasive Surgery, Alveolar Ridge Augmentation, Autogenous Bone, Failure, Complication