Horizontal vascular-stalked split osteotomy (HVSO): a bone augmentation technique for the atrophic jaw- a retrospective cohort study in 29 patients.

Abstract

Background: Implant therapy in the advanced atrophic jaw remains challenging in oral and maxillofacial surgery. Hence, a plethora of different augmentation procedures to increase bone volume in the maxilla and mandible have been published. Horizontal vascular-stalked split osteotomy (HVSO) represents a safe and effective approach for the three-dimensional jaw augmentation since it combines maximum vascularization through lingual or palatinal periosteal stalking with reduced grafting morbidity.

Objective: To analyze the efficacy of HVSO for implantation therapy in atrophic jaws by assessing vertical bone gain and implant survival rates.

Materials and methods: A total of n = 29 patients (14 females, 15 males) with a mean age of 55.4 ± 10.0 years and reduced volume of the alveolar ridge were retrospectively analyzed after treatment with 34 HVSOs in the maxilla and mandible. After controlled clinical follow-up of six months after augmentation, enossal implantation of 79 implants (maxilla 45, mandible 34) was performed. A standardized two-dimensional radiological assessment with panoramic tomography (OPTG) of the augmented bone height and clinical evaluation of the implants was performed over a mean follow-up period of 2.3 years.

Results: HVSO resulted in a significant increase in vertical bone height by 4.4 mm ± 2.0 mm (mean vertical gain: +59.4%) with + 101% in the maxilla and + 27.5% in the mandible directly after the procedure (T1), with both p < 0.001. After a mean observation period of 2.3 years bone height remained stable with a total gain of 41.4% (maxilla: 72.6%, mandible: 18.6%), with p < 0.001 and p = 0.001, respectively. Overall implant survival rate was 91% (maxilla: 89%; mandible: 94%).

Conclusion: HVSO reliably supports significantly enhanced vertical bone height with long-term stable results, thereby facilitating successful implantation in atrophic jaws with high implant survival rates observed over an extended follow-up period.

Clinical trial number: Not applicable as the study was no clinical trial.