The osteoperiosteal flap

  • O. T. Jensen
UK: Quintessence price £140.00; pp 320 ISBN 9780867154184 | ISBN: 978-0-8671-5418-4

A stimulating read and excellent reference text for all dentists, in particular those with a keen interest in oral and maxillofacial surgery and implantology.

Brilliant illustrations guide you through cases. The book is designed to teach you what options are available for manipulation of unfavourable edentulous spans, covering an extensive range of scenarios from narrow alveolus width to trauma and clefts.

Section 1 identifies the importance of the biological complex and introduces a classification for bone augmentation techniques according to vascularisation. Sections 2 and 3 take you through each of the new classifications and provide an in depth guide to bone augmentation and implant restoration using these techniques.

The first is free bone flaps. These composite flaps transplant vascularised bone as a pedicled graft to another site and are revascularised via microanastomsis. Examples include the fibula free flap, composite radial, iliac and scapula free flap. The resulting new bone is very similar to native bone and can be reconstructed with the aid of implants following complete healing of the graft. The second technique is distraction osteogenesis, a widely used procedure in orthopaedics. However, it is relatively new in maxillofacial surgery with the first clinical application to the craniofacial skeleton taking place as late as 1992. This technique consists of osteotomised bone which is gently spread via callus distraction leading to osteogenesis and consists of three phases: latency, activation and consolidation. Pedicled segmental osteotomies are the next class and involve a similar method to distraction osteogenesis but the interpositional gap is filled with nonvascularised material. Another type of augmentation includes bone morphogenetic induction grafts. These are relatively new and have been used successfully for large alveolar defects following cystic lesions and fistulas in clefts. Class V are nonvascularised grafts which include onlay block grafts and guided bone regeneration.

The penultimate section explores restorative techniques, an important element of this book. Aesthetics is what drives us to achieve the best results for our patients and so prostheses must be planned at the outset. We are taken through a number of cases that illustrate the importance of this and why excess augmentation can have a desirable biological effect.

Finally future developments are discussed including the application of tissue-engineered injectable bone and de novo tooth engineering.

A truly invaluable reference text for dentists deciding on viable treatment options for edentulous spans and for oral and maxillofacial surgeons.