Mandibular reconstruction remains one of the most demanding challenges in oral and maxillofacial surgery. Segmental defects resulting from trauma, tumor resection, infection, or congenital anomalies require biologically reliable graft materials capable of restoring both form and function. While the iliac crest and fibula are traditionally considered primary donor sites, autogenous tibial bone grafts for mandibular reconstruction have emerged as a valuable alternative in selected cases.
Recent clinical evaluations, including studies published and indexed through MDPI and ResearchGate, highlight the proximal tibia as a reliable donor site offering adequate bone volume with relatively low donor-site morbidity. This article reviews the biological rationale, surgical approach, clinical outcomes, and indications of tibial bone grafting in mandibular reconstruction, with a focus on current and foundational clinical evidence.
Understanding Autogenous Tibial Bone Grafts for Mandibular Reconstruction
Autogenous bone grafting remains the gold standard in mandibular reconstruction due to its osteogenic, osteoinductive, and osteoconductive properties. The proximal tibia, specifically the lateral metaphyseal region, provides cancellous bone that is biologically active and highly suitable for maxillofacial applications.
In the context of autogenous tibial bone grafts for mandibular reconstruction, the graft material is harvested extraorally and transferred to the mandibular defect site. The cancellous nature of tibial bone promotes rapid revascularization and integration, which is particularly advantageous in non-load-bearing mandibular defects and ridge augmentation procedures before implant placement.
Anatomical and Biological Advantages of the Proximal Tibia as a Donor Site
The proximal tibia offers several anatomical and biological advantages that make it an appealing donor site for mandibular reconstruction:
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High volume of cancellous bone suitable for moderate to large defects
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Ease of surgical access with predictable anatomy
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Reduced postoperative pain compared to iliac crest harvesting
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Low risk of functional impairment, allowing early ambulation
Unlike cortical-dominant grafts, tibial cancellous bone demonstrates superior remodeling capacity, making it ideal for mandibular defects requiring rapid integration rather than immediate load-bearing strength.
Autogenous Tibial Bone Grafts for Mandibular Reconstruction: Surgical Technique Overview
Harvesting tibial bone typically involves a lateral approach to the proximal tibial metaphysis. After careful soft tissue dissection, a cortical window is created, allowing access to cancellous bone using curettes or bone harvesters.
Key surgical considerations include:
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Preservation of the tibial plateau and joint space
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Avoidance of excessive cortical removal
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Adequate hemostasis to prevent postoperative hematoma
Once harvested, the graft is packed into the mandibular defect and stabilized using fixation devices when necessary. In ridge augmentation cases, the graft may be combined with membranes or fixation screws to maintain volume and contour.
Clinical Outcomes of Autogenous Tibial Bone Grafts for Mandibular Reconstruction
Evidence from MDPI Clinical Evaluation
The MDPI-published retrospective clinical evaluation assessed the use of lateral proximal tibial bone grafts in oral and maxillofacial reconstruction, including mandibular applications. The study demonstrated:
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High graft survival rates
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Favorable bone integration at recipient sites
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Minimal donor-site complications
Patients experienced limited postoperative discomfort and were able to resume normal ambulation shortly after surgery. The authors concluded that the proximal tibia is a dependable donor site for mandibular augmentation and reconstruction procedures, particularly when large volumes of cancellous bone are required.
Findings from Proximal Tibial Cancellous Bone Grafting Studies
Older but highly relevant retrospective work available through ResearchGate evaluated proximal tibial cancellous bone grafting in mandibular reconstruction, including continuity defects up to approximately 6–7 cm. This study reported:
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Successful restoration of mandibular continuity
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Satisfactory facial symmetry and function
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Acceptable complication rates
Despite its age, this study remains one of the most direct clinical evaluations of tibial bone grafting specifically for mandibular reconstruction, reinforcing its role as a viable alternative to more invasive donor sites.
Indications and Case Selection for Tibial Bone Grafting
Proper patient selection is critical when considering autogenous tibial bone grafts for mandibular reconstruction. Indications generally include:
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Segmental mandibular defects of moderate length
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Alveolar ridge augmentation before implant placement
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Reconstruction in medically stable patients where iliac or fibular harvest is contraindicated
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Cases requiring cancellous bone rather than structural cortical grafts
Tibial grafts are less suitable for extensive load-bearing reconstructions, where vascularized fibula flaps may be preferred.
Donor-Site Morbidity and Patient Recovery
One of the most compelling arguments for tibial bone harvesting is the relatively low donor-site morbidity. Clinical studies report:
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Minimal postoperative pain
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Low incidence of infection or fracture
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Short hospital stays
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Early return to daily activities
Compared to iliac crest harvesting, patients often report higher satisfaction due to reduced discomfort and faster functional recovery.
Comparison with Other Autogenous Donor Sites
While the iliac crest remains a popular choice for large-volume grafting, it is associated with higher morbidity and postoperative pain. Fibular grafts, although structurally superior, require microsurgical expertise and are more invasive.
In contrast, autogenous tibial bone grafts for mandibular reconstruction offer a balanced solution, providing adequate bone volume with reduced surgical complexity and patient morbidity, particularly for non-vascularized reconstruction cases.
Future Perspectives in Tibial Bone Grafting for Mandibular Reconstruction
Advancements in surgical planning, imaging, and biomaterials may further enhance the role of tibial bone grafts. Combining tibial cancellous bone with growth factors, membranes, or digital planning techniques could expand its indications and improve long-term outcomes.
Ongoing comparative studies are expected to further define the optimal indications and long-term success rates of tibial grafts relative to other autogenous options.
References
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Mandibular Reconstruction with Lateral Tibial Bone Graft. MDPI – Clinical retrospective evaluation of proximal tibia as a donor site for oral and maxillofacial bone grafting.
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Proximal Tibial Cancellous Bone Grafting in Mandibular Reconstruction. ResearchGate – Retrospective clinical experience with mandibular continuity defects reconstructed using tibial cancellous bone.
Frequently Asked Questions (FAQ)
Is the tibial bone suitable for mandibular reconstruction?
Yes, proximal tibial cancellous bone is suitable for selected mandibular reconstruction cases, particularly moderate defects and ridge augmentation procedures.
What are the advantages of tibial bone grafts over iliac crest grafts?
Tibial grafts offer lower donor-site morbidity, less postoperative pain, and faster recovery while still providing adequate bone volume.
Can tibial bone grafts be used for dental implant preparation?
Yes, tibial cancellous bone is commonly used for alveolar ridge augmentation before implant placement due to its high osteogenic potential.
Are tibial bone grafts load-bearing?
No, tibial cancellous grafts are primarily used for non-load-bearing reconstruction. Load-bearing defects often require vascularized fibula grafts.
What complications are associated with tibial bone harvesting?
Reported complications are minimal and may include temporary pain, swelling, or rarely infection or fracture.
Is tibial bone grafting still relevant with modern biomaterials?
Yes, despite advances in biomaterials, autogenous tibial bone grafts remain a biologically superior option due to their inherent osteogenic properties.
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