Answer:
Whitaker describes posterior mandible augmentation using Proplast implants
in 22 patients. Autogenous material such as rib and calvarial bone
graft have been used in the past to augment the mandible, placed as onlay
grafts or interposed into the split mandible. These were met with
unpredictable amounts of reabsorption and asymmetry. The area to
be augmented starts just posterior to the 2nd bicuspid and mental foramen
intraorally and posterior jowl externally. In the ideal face, the
bitemporal, bimalar and bigonial distances approximate each other.
Based on life size photographs, Panorex and intraop measurements, the implant
is custom carved. It is inserted thru a vertical posterior buccal
incision after the lateral surface of the posterior mandible is bared completely.
The implant must not extend beyond the limits of the bone to prevent it
from being palpable. One patient who had received radiation developed
implant exposure; no other complications were noted. Length of follow
up is not stated.