A method of dentoalveolar reconstruction using a manual non-impact mucotome-osteotome for harvesting a three-layer autograft from the maxillary tuberosity in immediate dental implant placement

Immediate implant placement after extraction of teeth lost due to complications of caries, traumatic cracks and fractures, or inflammatory periodontal disease is often associated with hard and soft tissue deficiency, which requires simultaneous dentoalveolar reconstruction. The choice of donor material and of a minimally traumatic harvesting technique remains a relevant problem in oral surgery. Objective. To improve the outcomes of immediate implant placement with dentoalveolar reconstruction by using a developed technique in which a three-layer bone—gingival autograft is harvested from the maxillary tuberosity with a manual non-impact mucotome-osteotome. Materials and methods. In 2024—2025, 104 patients aged 29—63 years underwent flapless immediate implant placement with simultaneous dentoalveolar reconstruction using an autograft from the maxillary tuberosity. In the study group (n=73), the three-layer bone—gingival autograft (triple graft) was harvested with the developed manual non-impact mucotome-osteotome; in the control group (n=31), it was harvested with a chisel and mallet. Buccal bone thickness (CBCT) and buccal mucosal thickness were measured immediately after surgery and at 6 months; donor-site pain was assessed with a visual analogue scale (VAS) on days 1 and 3, and mucosal hyperaemia on days 1, 3 and 7. Welch’s t-test, the Mann—Whitney U test and Fisher’s exact test were used for between-group comparisons; p<0.05 was considered statistically significant. Results. On day 3, donor-site pain was absent in 57 (78.1%) patients of the study group versus 5 (16.1%) patients of the control group (p≤0.001). Normal mucosal colour on day 3 was observed in 57.5% and 9.7% of patients, respectively (p≤0.001). On day 7, mild hyperaemia persisted in 5.5% of patients in the study group, whereas moderate hyperaemia persisted in 19.4% of controls (p=0.019). At 6 months, buccal bone thickness was 2.55+0.42 mm in the study group (2.68+0.37 mm at baseline) and 2.48+0.05 mm in the control group (2.71+0.03 mm at baseline; between-group difference not significant, p=0.17). Mucosal thickness increased from 1.08+0.02 to 1.65+0.01 mm in the study group and from 1.14+0.03 to 1.49+0.02 mm in the control group. Conclusion. Harvesting a three-layer autograft from the maxillary tuberosity with a manual non-impact mucotome-osteotome is associated with less donor-site pain and faster resolution of mucosal hyperaemia than chisel harvesting and allows simultaneous restoration of the hard and soft tissue components around immediately placed implants over a 6-month follow-up.