Gender-based variations in autogenous bone block graft availability within the mandibular ramus: a cone beam computed tomographic comparative analysis

Alfas Rasi M. P.; Shaleen Khetarpal; Madhu Singh Ratre; Shivangi Singh; Shreyansh Ahirwar; Amrita Bansal

doi:10.18203/2394-6040.ijcmph20261021

Authors

Alfas Rasi M. P. Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India https://orcid.org/0009-0009-7997-0926
Shaleen Khetarpal Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
Madhu Singh Ratre Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
Shivangi Singh Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
Shreyansh Ahirwar Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India https://orcid.org/0009-0003-6126-3760
Amrita Bansal Department of Public Health Dentistry, Government College of Dentistry, Indore, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20261021

Keywords:

Age differences, Autogenous graft, Bone density, CBCT, Cortical bone, Gender analysis, Mandibular ramus

Abstract

Background: Alveolar ridge resorption following tooth loss often necessitates regenerative procedures prior to implant placement. Autogenous bone grafts, particularly from the mandibular ramus, are widely used due to their favourable properties. However, anatomical variations influenced by gender and age can affect graft suitability. Objective was to evaluate gender- and age-related differences in the volume, density, cortical thickness, and vertical height of harvestable bone from the mandibular ramus using cone-beam computed tomography (CBCT).

Methods: This analytical cross-sectional study analyzed CBCT scans of 40 patients (20 males, 20 females) aged 20-60 years. Measurements of bone volume, density (gray values), cortical plate thickness, and vertical height were taken. Data were statistically analyzed, significance level set at p<0.05.

Results: No significant gender-based differences were observed in bone volume (males: 2.0±0.22 cm³; females: 1.92±0.25 cm³), cortical thickness, height, or density (p>0.05). However, age had a significant inverse relationship with bone quality. Participants aged 20-40 years demonstrated higher bone density (1212.2±157.7 GV) and cortical thickness (2.32±0.18 mm) compared to those aged 41-60 years (975.8±59.6 GV; 1.80±0.12 mm), with p<0.001 for both. Bone volume and height were not significantly affected by age.

Conclusions: Mandibular ramus offers a reliable intraoral donor site for autogenous bone grafting across genders. However, bone quality parameters such as density and cortical thickness decline significantly with age, highlighting the importance of age-specific assessment during preoperative planning.

Metrics

Metrics Loading ...

References

Van der Weijden F, Dell’Acqua F, Slot DE. Alveolar bone dimensional changes of post‐extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048-58. DOI: https://doi.org/10.1111/j.1600-051X.2009.01482.x

Misch CM. Autogenous bone: is it still the gold standard? Implant Dent. 2010;19(5):361. DOI: https://doi.org/10.1097/ID.0b013e3181f8115b

Misch CM. Autogenous bone is still the gold standard of graft materials in 2022. J Oral Implantol. 2022;48(3):169-70. DOI: https://doi.org/10.1563/aaid-joi-D-22-Editorial.4803

Sittitavornwong S, Gutta R. Bone Graft Harvesting from Regional Sites. Oral Maxillofac Surg Clin N Am. 2010;22(3):317-30. DOI: https://doi.org/10.1016/j.coms.2010.04.006

Chiapasco M, Zaniboni M, Boisco M. Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants. Clin Oral Implants Res. 2006;17(S2):136-59. DOI: https://doi.org/10.1111/j.1600-0501.2006.01357.x

Donos N, Akcali A, Padhye N, Sculean A, Calciolari E. Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome? Periodontol 2000. 2023;93(1):26-55. DOI: https://doi.org/10.1111/prd.12518

Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A. Autogenous bone grafts in oral implantology-is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures. Int J Implant Dent. 2017;3(1):23. DOI: https://doi.org/10.1186/s40729-017-0084-4

Sakkas A, Ioannis K, Winter K, Schramm A, Wilde F. Clinical results of autologous bone augmentation harvested from the mandibular ramus prior to implant placement. An analysis of 104 cases. GMS Interdiscip Plast Reconstr Surg DGPW. 2016;5:Doc21.

Cordaro L, Torsello F, Tindara Miuccio M, Mirisola Di Torresanto V, Eliopoulos D. Mandibular bone harvesting for alveolar reconstruction and implant placement: subjective and objective cross-sectional evaluation of donor and recipient site up to 4 years: Morbidity of mandibular bone harvesting and implant success. Clin Oral Implants Res. 2011;22(11):1320-6. DOI: https://doi.org/10.1111/j.1600-0501.2010.02115.x

Rabelo GD, De Paula PM, Rocha FS, Jordão Silva C, Zanetta-Barbosa D. Retrospective study of bone grafting procedures before implant placement. Implant Dent. 2010;19(4):342-50. DOI: https://doi.org/10.1097/ID.0b013e3181e416f9

Reininger D, Cobo-Vazquez C, Monteserin-Matesanz M, Lopez-Quiles J. Complications in the use of the mandibular body, ramus and symphysis as donor sites in bone graft surgery. A systematic review. Med Oral Patol Oral Cirugia Bucal. 2016;e241-9. DOI: https://doi.org/10.4317/medoral.20938

Kadkhodazadeh M, Shafizadeh M, Rahmatian M, Safi Y, Amid R. Determination of the volume and density of mandibular ramus as a donor site using CBCT. J Maxillofac Oral Surg. 2022;21(4):1140-7. DOI: https://doi.org/10.1007/s12663-021-01546-9

Güngörmüş M, Yavuz MS. The ascending ramus of the mandible as a donor site in maxillofacial bone grafting. J Oral Maxillofac Surg. 2002;60(11):1316-8. DOI: https://doi.org/10.1053/joms.2002.35731

Yates DM, Brockhoff HC 2nd, Finn R, Phillips C. Comparison of intraoral harvest sites for corticocancellous bone grafts. J Oral Maxillofac Surg. 2013;71(3):497-504. DOI: https://doi.org/10.1016/j.joms.2012.10.014

Zeltner M, Flückiger LB, Hämmerle CHF, Hüsler J, Benic GI. Volumetric analysis of chin and mandibular retromolar region as donor sites for cortico-cancellous bone blocks. Clin Oral Implants Res. 2016;27(8):999-1004. DOI: https://doi.org/10.1111/clr.12746

Ataman-Duruel E, Duruel O, Nares S, Stanford C, Tözüm T. Quantity and quality of intraoral autogenous block graft donor sites with cone beam computed tomography. Int J Oral Maxillofac Implants. 2020;35(4):782-8. DOI: https://doi.org/10.11607/jomi.8079

Montazem A, Valauri DV, St-Hilaire H, Buchbinder D. The mandibular symphysis as a donor site in maxillofacial bone grafting: a quantitative anatomic study. J Oral Maxillofac Surg. 2000;58(12):1368-71. DOI: https://doi.org/10.1053/joms.2000.18268

Whitmarsh T, Otake Y, Uemura K, Takao M, Sugano N, Sato Y. A cross-sectional study on the age-related cortical and trabecular bone changes at the femoral head in elderly female hip fracture patients. Sci Rep. 2019;9(1):305. DOI: https://doi.org/10.1038/s41598-018-36299-y

Hernandez CJ, Beaupré GS, Carter DR. A theoretical analysis of the changes in basic multicellular unit activity at menopause. Bone. 2003;32(4):357-63. DOI: https://doi.org/10.1016/S8756-3282(03)00037-1

Padayachee S, Holmes H. Determining an average distance from the external mandibular cortex to the inferior alveolar canal using cone beam computed tomography (CBCT) imaging: an aid to harvesting mandibular ramus autogenous grafts. S Afr Dent J. 2016;71(9):390-4.