Aesthetic augmentation of the posterior mandible.

The posterior mandible begins just behind the mental nerve and second bicuspid bilaterally, extends to the posterior edge of the ramus, and then runs superiorly to the zygomatic arch. Augmentation of the posterior mandible is possible by use of a synthetic implant that is tailored individually to each patient's specific needs. Implant plant thickness varies from 4 to 8 mm, with an average thickness of 6 mm. Careful preoperative planning is done based on an aesthetic assessment of the amount of highlighting desired, thickness of the soft tissues, and the use of life-size photographs and cephalometric and Panorex x-rays. A pattern is cut, and the implant is carved to fit the patient. Insertion of the material after careful tailoring to the individual patient's own mandibular size and configuration requires a generous posterior lower buccal sulcus incision. Antibiotic irrigation and systemic antibiotics are essential, and careful closure in two layers completes the procedure. One implant in the series extruded in a patient who had had radiation therapy, and one patient required repositioning of the implant. Otherwise, in 22 patients there were no infections or permanent morbidity. The procedure seems to be a realistic and safe one for both the youthful and aging face, as demonstrated in patients in this series, with ages varying from 16 to 40 years.