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Cucchi A, Maiani F, Franceschi D, Sassano M, Fiorino A, Urban IA, Corinaldesi G. The influence of vertical ridge augmentation techniques on peri-implant bone loss: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2024; 26:15-65. [PMID: 38114425 DOI: 10.1111/cid.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The primary aim of this systematic review was to investigate and compare the outcomes of different vertical ridge augmentation (VRA) techniques in relation to peri-implant bone loss (PBL), after at least 12 months of functional loading. MATERIAL AND METHODS The search was conducted to find all the studies about VRA and measurements of PBL with at least 12 months follow-up. Three pairwise meta-analysis (MA) was performed to completely evaluate the outcomes. RESULTS A total of 42 studies were included, of which 11 were randomized clinical trials (RCTs). RCTs were available only for guided bone regeneration (GBR), onlay, and inlay techniques. The weighted mean estimate (WME) of PBL value was found to be 1.38 mm (95% confidence interval [95% CI]: 1.10-1.66) after a mean follow-up of 41.0 ± 27.8 months. GBR, Inlay, Onlay, osteodistraction, and SBB represented in weight 32.9%, 30.6%, 25.0%, 7.6%, and 3.9%, respectively; and their WME (95% CI) were 1.06 (0.87-1.26) mm, 1.72 (1.00-2.43) mm, 1.31 (0.87-1.75) mm, 1.81 (0.87-1.75) mm, and 0.66 (0.55-0.77) mm, respectively. Among the secondary outcomes, the analysis was conducted for vertical bone gain, healing complication rate, surgical complication rate, implant survival, and success rate. CONCLUSIONS The primary findings of the meta-analysis, based on the changes between final and baseline values, showed that the peri-implant bone loss could be influenced by the type of intervention but there is a need to evaluate in RCTs the behavior of the peri-implant bone levels after long-term follow-up for all techniques.
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Affiliation(s)
| | | | - Debora Franceschi
- Department of Experimental and Clinic Medicine, University of Florence, Firenze, Italy
| | - Michele Sassano
- Department of Life Sciences and Public Health, Catholic University of The Sacred Heart, Rome, Italy
| | - Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, "Federico II" University of Naples, Napoli, Italy
| | - Istvan A Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontics, University of Szeged, Szeged, Hungary
- Urban Regeneration Institute, Budapest, Hungary
| | - Giuseppe Corinaldesi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Nickenig HJ, Zöller JE, Kreppel M. Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants. Periodontol 2000 2023; 93:327-339. [PMID: 37940190 DOI: 10.1111/prd.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 11/10/2023]
Abstract
When bone is limited, short, ultra-short, or narrow implants help to restore oral rehabilitation with an acceptable long-term outcome. This becomes more difficult with severe vertical bone loss. Guided bone regeneration, onlay block transplantation, or sandwich osteotomy have been established to build up these defects. The alternative to the alveolar distraction osteogenesis (ADO) has only been established in some centers, with a standardized protocol. On the one hand, ADO is a biological procedure that allows almost a "restitutio ad integrum" when building up hard and soft tissue. On the other hand, there are clear indications, limitations, and complications of the procedure in the literature. In addition to the literature, concept of Tissue Regeneration by Alveolar Callusdistraction Cologne (TRACC), which has been practiced successfully for over two decades, will be presented for different indications.
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Affiliation(s)
- Hans-Joachim Nickenig
- Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
- Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
- Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
- Interdisciplinary Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
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Park WB, Han JY, Kang P. The Bone Bridge Technique Utilizing Bone from the Lateral Wall of the Maxillary Sinus for Ridge Augmentation: Case Reports of a 1-7 Year Follow-Up. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1626. [PMID: 37763747 PMCID: PMC10536201 DOI: 10.3390/medicina59091626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
The post-extraction socket of a periodontally compromised tooth/implant is oftentimes accompanied by a very wide-deep alveolar ridge defect. The commonly utilized treatment is ridge preservation followed by delayed implant placement 4 to 6 months after extraction. In the four cases presented in this study, a novel technique of utilizing a bone block obtained from the lateral wall of the maxillary sinus is introduced. Due to the severe localized vertical ridge deficiency, an intraoral autogenous bone block was obtained from the ipsilateral sinus bony window. After the obtained bone block was properly trimmed, it was fixed in the form of a bridge over the vertical defect by the press-fit method. In two cases, the gap between the autogenous bone and defect was filled with a particulate synthetic bone graft, and in another two cases, the gap was left without grafting. All cases were covered with a resorbable collagen membrane. At the time of re-entry after 5 to 6 months, the bone bridge was well incorporated beside the adjacent native bone and helped by the implant placement. Uncovering was performed after 3 to 6 months, and prostheses were delivered after 2 months. Oral function was maintained without any change in the marginal bone level even after the 1- to 7-year post-prosthesis delivery. This case series showed that the bone bridge technique performed using an ipsilateral sinus bony window for a localized vertical deficiency of a post-extraction socket can be used for successful vertical ridge augmentation (VRA).
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Affiliation(s)
- Won-Bae Park
- Department of Periodontology, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea;
- Private Practice in Periodontics and Implant Dentistry, Seoul 02771, Republic of Korea
| | - Ji-Young Han
- Department of Periodontology, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Philip Kang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences Columbia University College of Dental Medicine, #PH7E-110, 630 W. 168 St., New York, NY 10032, USA
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Wadde K, Kri M, Venkatakrishnan L, Landge J, Nadkarni S. Vertical Ridge Augmentation Using Distraction Osteogenesis Versus Autogenous Bone Grafting: A Systematic Review and Meta-Analysis. J Maxillofac Oral Surg 2023; 22:672-679. [PMID: 37534356 PMCID: PMC10390398 DOI: 10.1007/s12663-023-01943-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 05/20/2023] [Indexed: 08/04/2023] Open
Abstract
Aim The aim of this systematic review was to systematically assess the papers comparing the surgical techniques of Alveolar Distraction Osteogenesis(ADO) and Autogenous Bone grafting (ABG) for Vertical Ridge Augmentation in terms of bone gain, bone resorption and incidences of complications. Metholodology The review was registered on PROSPERO with the ID : CRD42021237671. A broad electronic survey was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and Virtual Health Library databases of all studies published till 08/03/2022. Four studies fulfilled the criteria to carry out a meta-analysis a in which a total of 58 patients underwent ADO and 43 patients for ABG. A total of 133 implants were placed in the ABG group and 124 in the ADO group. Statistical Analysis DerSimonian-Laird estimator of variance was used for Random effect meta-analysis. The estimates of an intervention were expressed as the odds ratio (OR) and standard mean difference (SMD) in millimeters. Results There was statistically significant difference in terms of bone height gain with SMD of - 0.78 (95% 0.04-1.55) in ABG. Bone resorption and complications were statistically insignificant with SMD of 0.52 (95% - 1.59 to 0.56) and OR 0.55 (95% 0.18-1.70), respectively.PROSPERO Registration ID: CRD42021237671.
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Affiliation(s)
- Kavita Wadde
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, 49 PD’Mello Road, Near CSMT, Fort, Mumbai, Maharashtra 400001 India
| | - Mrimingsi Kri
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, 49 PD’Mello Road, Near CSMT, Fort, Mumbai, Maharashtra 400001 India
| | - Lakshmi Venkatakrishnan
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, 49 PD’Mello Road, Near CSMT, Fort, Mumbai, Maharashtra 400001 India
| | - Jayant Landge
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, 49 PD’Mello Road, Near CSMT, Fort, Mumbai, Maharashtra 400001 India
| | - Shambhavi Nadkarni
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, 49 PD’Mello Road, Near CSMT, Fort, Mumbai, Maharashtra 400001 India
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Kim KM, Choi SY, Park JH, Kim HY, Kim SJ, Kim JW. Six-month stability following extensive alveolar bone augmentation by sausage technique. Maxillofac Plast Reconstr Surg 2023; 45:16. [PMID: 37087707 PMCID: PMC10123023 DOI: 10.1186/s40902-023-00384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/19/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Resorption of alveolar bone is a common sequela of tooth loss and presents a clinical problem, especially in the esthetic zone. When ridge resorption occurs, adequate bone augmentation is essential to obtain satisfactory esthetic results. The purpose of this study was to determine the increase and retention rate of bone height or width in patients who received extensive bone augmentation and to analyze factors affecting its prognosis and stability. METHODS This study was performed on patients who received extensive bone augmentation by sausage technique at the Department of Oral and Maxillofacial Surgery at Ewha Womans University Mok-dong Hospital from January 1, 2018, to February 28, 2022. CBCT images were taken before and 6 months after surgery to compare the amount of increase in bone height or width at the graft site. They were measured using reliable points such as adjacent implants or cephalometric landmarks, inferior alveolar nerve canals as reference points. RESULTS A total of 8 patients underwent extensive bone grafting during the given period (mean age was 53.75 years, 2 males and 6 females). Four patients received horizontal augmentation, and 4 received vertical augmentation. When divided by surgical site, 4 patients are in maxilla and 4 in mandible. The average amount of increase in bone width or bone height was 5.38 mm, and the retention rate was about 79.9% after 6 months. The retention rate of horizontal augmentation was 88.8%, which was higher than that of vertical augmentation, which was 74.5%. The maxillary area accounted for 92.2%, and the amount of bone resorption was lower than that of the mandibular area, which was 72.6%. The average stitch out period was about 2.4 weeks, and postoperative dehiscence was observed about 37.5% of the total, more frequently in the mandible (50.0%) than in the maxilla (25.0%). CONCLUSION In conclusion, extensive bone augmentation achieved significant horizontal or vertical bone height or width increase, and the retention rate after 6 months was also high. In addition, surgery in the maxillary region showed a more successful bone augmentation than in the mandible, with a higher maintenance rate and fewer cases of dehiscence.
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Affiliation(s)
- Kang-Min Kim
- Department of Oral and Maxillofacial Surgery, Mok-dong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Soo-Young Choi
- Department of Oral and Maxillofacial Surgery, Mok-dong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jung-Hyun Park
- Department of Oral and Maxillofacial Surgery, Mok-dong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Heon-Young Kim
- Department of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Seoul Hospital, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Sun-Jong Kim
- Department of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Seoul Hospital, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, Mok-dong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea.
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Shineh G, Patel K, Mobaraki M, Tayebi L. Functional Approaches in Promoting Vascularization and Angiogenesis in Bone Critical-Sized Defects via Delivery of Cells, Growth Factors, Drugs, and Particles. J Funct Biomater 2023; 14:99. [PMID: 36826899 PMCID: PMC9960138 DOI: 10.3390/jfb14020099] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Critical-sized bone defects, or CSDs, are defined as bone defects that cannot be regenerated by themselves and require surgical intervention via employing specific biomaterials and a certain regenerative strategy. Although a variety of approaches can be used to treat CSDs, poor angiogenesis and vascularization remain an obstacle in these methods. The complex biological healing of bone defects depends directly on the function of blood flow to provide sufficient oxygen and nutrients and the removal of waste products from the defect site. The absence of vascularization can lead to non-union and delayed-union defect development. To overcome this challenge, angiogenic agents can be delivered to the site of injury to stimulate vessel formation. This review begins by introducing the treatment methods for CSDs. The importance of vascularization in CSDs is subsequently highlighted. Delivering angiogenesis agents, including relevant growth factors, cells, drugs, particles, cell secretion substances, their combination, and co-delivery to CSDs are fully explored. Moreover, the effects of such agents on new bone formation, followed by vessel formation in defect areas, are evaluated.
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Affiliation(s)
- Ghazal Shineh
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia
| | - Kishan Patel
- School of Dentistry, Marquette University, Milwaukee, WI 53207, USA
| | - Mohammadmahdi Mobaraki
- Biomaterial Group, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran 15916-34311, Iran
| | - Lobat Tayebi
- School of Dentistry, Marquette University, Milwaukee, WI 53207, USA
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Evaluation of the Proximal Tibia as a Donor Site of Cancellous Bone for Intraoral Grafting Procedures-A Retrospective Study. J Clin Med 2022; 11:jcm11061493. [PMID: 35329821 PMCID: PMC8953495 DOI: 10.3390/jcm11061493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Autogenous bone grafts remain the “gold standard” in maxillofacial reconstructive procedures. The objective of this study was to evaluate the proximal tibia as a donor site of cancellous bone for bone grafting procedures of the mandible on the basis of intraoperative parameters and clinical observations. Methods: The study was based on a medical record search of 40 patients who underwent surgical procedures because of benign pathological lesions of the jaws resulting in 3-wall bone defects of the mandible and qualified for surgical removal of the lesion with simultaneous bone grafting of the defect with autogenous cancellous bone harvested from the proximal tibia. Results: The use of the proximal tibia for bone grafting procedures enables large amounts of cancellous bone (15.09 cc in average) to be obtained. The procedure is characterized by a low risk of early and late complications, which include excessive bleeding, wound infection, lengthy healing time, scars, a loss of sensation around the scars, aching, a dip in bone, swelling and tenderness. Conclusions: The ability to obtain large amounts of cancellous bone and a low risk of intra- and postoperative complications make the proximal tibia an attractive donor site for the bone grafting procedures in maxillofacial surgery.
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Survival Rates of Dental Implants in Autogenous and Allogeneic Bone Blocks: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121388. [PMID: 34946333 PMCID: PMC8705565 DOI: 10.3390/medicina57121388] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/11/2021] [Accepted: 12/14/2021] [Indexed: 12/17/2022]
Abstract
Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.
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Altaweel AA, Baiomy AABA, Shoshan HS, Abbas H, Abdel-Hafiz AAS, Gaber AEH, Zewail AA, Elshiekh MAM. Evaluation of osteogenic potential of Cissus quadrangularis on mandibular alveolar ridge distraction. BMC Oral Health 2021; 21:491. [PMID: 34607598 PMCID: PMC8489104 DOI: 10.1186/s12903-021-01847-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This randomized clinical trial was designed to evaluate osteogenic potential of Cissus quadrangularis in alveolar distraction to facilitate implant installation. MATERIAL AND METHODS Twenty patients with atrophic ridge were treated by alveolar distraction. After completing distractor activation, patients were randomly divided into two equal groups according to administered drug (placebo and Cissus quadrangularis group). After a consolidation period, distractors were removed and implants were inserted. Clinical evaluation was done to assess wound healing, and distractor and implant stability. Histological evaluation was performed at time of implant insertion. Radiographic evaluation was performed to assess bone volume and density after distraction, as well as, density and bone loss around implant. RESULTS Radiographic and histological results showed that bone formation and maturation of study group were faster than that of control group. There was a significant increased bone density in distracted area and around implant in study group than control group. A significant bone loss at end of consolidation period, and around implant at end of the study was reported in control group than study group. CONCLUSION Cissus quadrangularis administration during the consolidation period is associated with increased osteogenic potential of distracted bone. The histological and radiographic findings of current study proved that Cissus quadrangularis not only enhances rate of new bone formation, but also bone density to withstand the biomechanical requirements of implant placement in a shorter time. Trial registration This study was retrospectively registered on www.ClinicalTrial.gov : NCT04669795-17\12\2020.
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Affiliation(s)
- Alaa Abdelqader Altaweel
- Oral and Maxillofacial Surgery Department, Faculty of Dental Medicine for Boys, Al-Azhar University, Al Mokhaym Al Daem St., Nasr City, Cairo, 11751, Egypt.
- Oral and Maxillofacial Surgery Department, Vision Colleges, Jeddah, Saudi Arabia.
| | | | - Hazem Shawky Shoshan
- Oral and Maxillofacial Surgery Department, Vision Colleges, Jeddah, Saudi Arabia
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Hisham Abbas
- Oral and Maxillofacial Radiology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Oral and Maxillofacial Radiology Department, Vision Colleges, Jeddah, Saudi Arabia
| | | | - Abd El-Hamid Gaber
- Clinical Pharmacology, Department of Clinical Pharmacology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Marwa A M Elshiekh
- Oral and Dental Biology Department, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Comparison of Success Rate of Dental Implants Placed in Autogenous Bone Graft Regenerated Areas and Pristine Bone. J Craniofac Surg 2021; 31:1572-1577. [PMID: 32282668 DOI: 10.1097/scs.0000000000006401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Autogenous bone grafting still has been considered as the "gold standard" and wildly used in the case of alveolar bone reconstruction. The aim of the present study is to evaluate the success rate of implants placed in autogenous block augmented ridges and implants placed in pristine bone (PB). This study included 113 patients. Fifty-three patients were treated with autogenous block grafts and particulate bone, after 6 months of healing implant placements were performed in autogenous bone augmented (ABA) areas. In 60 patients implant placement was performed, with no need for grafting and implants were placed into the PB. Follow-up data (pain, mobility, exudation from peri-implant space, success rate, marginal bone resorption) were collected after 5 years of prosthetic loading. The cumulative implant success rate at the 5-year examination was 92.45% for the ABA group and 85% for PB group. There were 3 failed implants in the ABA group and 3 in PB group. Average marginal bone loss was 1.47 mm on ABA group and 1.58 mm on PB group. No statistically significant differences for pain, exudation from peri-implant space, implant mobility, implant success, peri-implant bone loss parameters, and patient satisfaction level were found between groups. The obtained data demonstrated that the success rate of implants placed in regenerated areas are very similar to the success rate of implants those placed in PB.
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11
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Tenting effect of dental implant on maxillary sinus lift without grafting. J Dent Sci 2020; 15:278-285. [PMID: 32952885 PMCID: PMC7486502 DOI: 10.1016/j.jds.2020.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
Background/purpose Maxillary sinus lift without grafting is an alternative procedure that is used to lower the risk of infection and facilitate the surgical procedure. The objective of this study was to evaluate the tenting effect of the dental implant by measuring the amount and morphology of bone formation around it. Material and methods 49 implants were placed in 26 patients by maxillary sinus lift without grafting. Radiographic images were taken preoperatively and at 6 months postoperatively and used to evaluate the height of the residual bone, the width of the maxillary sinus, the amount of bone formation, and the adjacent tooth. Results The most common type of bone formed around the implant, as seen in 23 cases, was the same height as the apex of the implant; in 11 cases, it was 0–2 mm above the apex of the implant, and in 7 cases, 2 mm or more. Meanwhile, 5 cases showed defects. The tent type of bone formation, which showed more bone formation at the implant apex than in the surrounding bone, was overwhelmingly the most common. (80.4%) The amount of bone formation increased in proportion to the difference between the residual bone height and the implant length. (P < .001). Conclusion The amount of bone formation in the sinus lift without grafting increased in proportion to the length of the implants in the maxillary sinus due to the tenting effect of the implant in the maxillary sinus membrane.
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Bone Augmentation Techniques for Horizontal and Vertical Alveolar Ridge Deficiency in Oral Implantology. Oral Maxillofac Surg Clin North Am 2020; 31:163-191. [PMID: 30947846 DOI: 10.1016/j.coms.2019.01.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bone deficiency is the major obstacle in implant dentistry. Guided bone regeneration (GBR) with particulate bone and barrier membranes has been the primary surgical technique used to regenerate alveolar bone for dental implant therapy. This procedure has been used in implant dentistry for more than 30 years and continues to be developed and refined for more predictable surgical outcomes. This article reviews GBR and alternative ride expansion procedures and reviews the use of various particulate graft materials. Alveolar distraction osteogenesis, used as an augmentation technique, is also presented.
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Abstract
Bone augmentation is an extremely common procedure in implant dentistry today because of significant advancements with reactive biomaterials, a better understanding of the mechanism of action that is found with growth factors contained in platelets, and improvements in surgical techniques. The expectation is for the surgeon to place the dental implant in the position that best serves the requirements of the prosthetic restorations. With the increasing demands that patients have for ideal prosthetic results, surgeons are expected to predictably augment both hard and soft tissues to provide the anticipated esthetic and functional outcomes. Bone grafting can be performed before, during, and after the implant placement; however, these augmentation procedures come with increased cost, the risk of complications such as infection or failure, and lengthening of the total treatment time. In addition, a plethora of grafting materials are available commercially, where they are often inadequately studied, or there is minimal information regarding their predictability or long-term success, or ability to support dental implants. It is clear that although the surgical field has seen major progress since early implant surgical techniques in the 1980s, major challenges still exist with hard tissue augmentation procedures. This review will discuss these challenges that are increased and often specific to bone graft healing, and which are becoming more common as implant site development often requires bone augmentation to improve volume or contour deficiencies. The risk factors that patients may present with that will affect outcomes with bone augmentation procedures are identified, and recommendations for the prevention of complications or managing complications once they have occurred are provided.
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Affiliation(s)
- Peter K Moy
- Department of Oral & Maxillofacial Surgery, UCLA, School of Dentistry, Los Angeles, California, USA
| | - Tara Aghaloo
- Department of Oral & Maxillofacial Surgery, UCLA, School of Dentistry, Los Angeles, California, USA
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Hameed MH, Gul M, Ghafoor R, Khan FR. Vertical Ridge Gain with Various Bone Augmentation Techniques: A Systematic Review and Meta‐Analysis. J Prosthodont 2019; 28:421-427. [DOI: 10.1111/jopr.13028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2019] [Indexed: 01/23/2023] Open
Affiliation(s)
- Muhammad Hasan Hameed
- Department of Surgery, Section of DentistryAga Khan University Hospital Karachi Pakistan
| | - Meisha Gul
- Department of Surgery, Section of DentistryAga Khan University Hospital Karachi Pakistan
| | - Robia Ghafoor
- Department of Surgery, Section of DentistryAga Khan University Hospital Karachi Pakistan
| | - Farhan Raza Khan
- Department of Surgery, Section of DentistryAga Khan University Hospital Karachi Pakistan
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Toledano-Serrabona J, Sánchez-Garcés MÁ, Sánchez-Torres A, Gay-Escoda C. Alveolar distraction osteogenesis for dental implant treatments of the vertical bone atrophy: A systematic review. Med Oral Patol Oral Cir Bucal 2019; 24:e70-e75. [PMID: 30573711 PMCID: PMC6344013 DOI: 10.4317/medoral.22750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/06/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To determine if alveolar vertical distraction osteogenesis obtains better results compared to other bone regeneration treatments (guided bone regeneration with membranes and / or filling material, or autogenous bone graft) in terms of bone gain, complications, and implant survival and success rates. MATERIAL AND METHODS An electronic search was performed in Pubmed (MEDLINE), Cochrane Library and Scopus databases in March 2017. Besides, a manual search was carried out. Inclusion criteria were randomized controlled trials published within the last 10 years with at least 1 year of follow-up after implant placement. No language restriction was applied. Exclusion criteria were studies in patients with bone defects produced by trauma, congenital malformation or oncologic surgical treatment. The methodological quality of the selected studies was evaluated by means of the Cochrane Collaboration's Tool for assessing risk of bias. The reports were classified into different levels of recommendation according to the "Strength of Recommendation Taxonomy ". RESULTS Out of 221 articles, two randomized controlled trials were finally selected for the inclusion in the systematic review. Bone gain and complications were higher with the alveolar vertical distraction osteogenesis compared to the autologous bone graft. There was higher bone resorption with the autologous bone graft. Implant survival and success rates were similar between studies, despite of the used technique. CONCLUSIONS Both alveolar distraction osteogenesis and autogenous bone graft are effective bone regeneration techniques for the treatment of mandibular vertical bone atrophy. A level B recommendation can be established for the use of alveolar vertical distraction osteogenesis for the treatment of the mandibular vertical bone atrophy.
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Pérez-Sayáns M, Martínez-Martín JM, Chamorro-Petronacci C, Gallas-Torreira M, Marichalar-Mendía X, García-García A. 20 years of alveolar distraction: A systematic review of the literature. Med Oral Patol Oral Cir Bucal 2018; 23:e742-e751. [PMID: 30341270 PMCID: PMC6261008 DOI: 10.4317/medoral.22645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022] Open
Abstract
Background The Vertical Alveolar Distraction Osteogenesis (VADO) technique is an excellent solution for bone and soft tissue neoformation in areas in which there has been significant bone atrophy that hinders normal rehabilitation using dental implants. The goal of this systematic review is to analyze the most relevant articles published on VADO in the literature over the past 20 years. Material and Methods The review was performed by using the keywords: “alveolar ridge”, “distraction ostegenesis” and “dental implant”. This search produced a total result of 240 articles. The clinical studies and cases reported in humans amounted to 113 articles, 18 articles referred to studies developed on animals and 33 review articles. The presentation of this systematic analysis follows the criteria described in the PRISMA declaration. Results 22 articles complied with the inclusion criteria and 7 articles more were added manually, reaching a total sample of 29 studies. Following the analysis of the studies, they were classified into 18 high-quality, 10 mediumquality and 1 low-quality study. Only 4 studies achieved a maximum score of 9 (according to NewCastle Ottawa Scale, NOS). Conclusions VADO is a technique with greater potential in vertical gain. The performance of dental implants has a success and survival rate similar to dental implants placed on bones that are not subject to increase techniques. Key words:Vertical distraction osteogenesis, alveolar ridge, distraction osteogenesis, dental implant.
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Affiliation(s)
- M Pérez-Sayáns
- Facultad de Odontología, Santiago de Compostela, Entrerríos s/n, Santiago de Compostela, C.P. 15782, Spain,
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17
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Fuglsig JMDCES, Thorn JJ, Ingerslev J, Wenzel A, Spin-Neto R. Long term follow-up of titanium implants installed in block-grafted areas: A systematic review. Clin Implant Dent Relat Res 2018; 20:1036-1046. [PMID: 30238612 DOI: 10.1111/cid.12678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/28/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND An enduring clinical question concerns the outcome (ie, success) of implants placed in areas grafted with block-grafts. OBJECTIVE To undertake a systematic review of the literature on the long term results (≥5 years) of implants placed in maxillofacial areas grafted with any type of osseous block-grafts in two-stage surgeries. Further, the review addresses how available success criteria were used within the studies. MATERIALS AND METHODS The MEDLINE (PubMed) and EMBASE bibliographic databases were searched up to March 2017 for studies evaluating the long term results of implants placed in grafted areas. The search strategy was restricted to English language publications using combined terms which referred to the treatment method (implants placed in areas grafted with bone blocks), and follow-up characteristics (≥5 years and assessment of at least one parameter related to implant success criteria). To qualify for inclusion, studies should present outcome measurements indicating the success (or at least the survival) of the implants. RESULTS The search strategy yielded 17 studies, which were included in this systematic review. These studies presented survival rates ranging from 88.7% (after 15 years follow-up) to 98.7% (after 5 years follow-up). Five studies presented data based on predefined success criteria with success rates ranging from 86.8% to 100%. In these studies, the term "success" was often not properly defined. CONCLUSION The long term survival (≥5 years) of implants placed into block-grafted areas in two-stage surgeries was not lower than 75%, while success rates ranged from 86.8% to 100%. Although it was possible to identify published success criteria for implant follow-up, there is no broad consensus on how to report implant success in a consistent manner.
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Affiliation(s)
| | - Jens Jørgen Thorn
- Department of Oral and Maxillofacial Surgery, Hospital of South Western Denmark, Esbjerg, Denmark
| | - Janne Ingerslev
- Department of Oral and Maxillofacial Surgery, Hospital of South Western Denmark, Esbjerg, Denmark
| | - Ann Wenzel
- Department of Dentistry and Oral Health-Oral Radiology, Aarhus University, Aarhus, Denmark
| | - Rubens Spin-Neto
- Department of Dentistry and Oral Health-Oral Radiology, Aarhus University, Aarhus, Denmark
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18
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Osterne RLV, Nogueira RLM, Abreu RT, Cavalcante RB, Medeiros ÉA, Mello MDJR. A retrospective study of an alternative technique for implant repositioning in the maxillary esthetic region. Clin Implant Dent Relat Res 2018; 20:915-922. [PMID: 30230678 DOI: 10.1111/cid.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/06/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implant-bone block segment repositioning may be an option of treatment for patients with vertical alveolar bone atrophy. PURPOSE To assess implant-bone block movement, gingival outcome and the subjective appreciation of patients after an alternative treatment of an implant-bone block segment repositioning in the maxillary esthetic region. MATERIALS AND METHODS Patients who underwent implant-bone block segment relocation in areas of vertical alveolar bone atrophy in the anterior esthetic region were assessed. The outcome measures were implant failure, complications after initial loading, vertical bone augmentation, papilla index, width of the keratinized mucosa, and patient satisfaction. RESULTS Twenty-five implants in nine consecutive patients were included in this study. During the follow-up period, only one implant failed. Vertical bone augmentation ranged from 3.0 to 8.4 mm (mean 4.9 mm). A significant improvement (P < .001) in the papilla index was observed, improving the esthetic outcome. Six patients (66.6%) had more than 2 mm of keratinized mucosa and all of the patients were satisfied with the treatment. CONCLUSIONS The esthetics and functional gingival outcome of oral rehabilitation in areas with vertical alveolar bone atrophy can be successfully improved with the presented technique, which had a high overall implant survival rate within a short period.
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Affiliation(s)
- Rafael Lima Verde Osterne
- Department of Pathology, University of Fortaleza/Universidade de Fortaleza, School of Medicine, Fortaleza, Ceará, Brazil
| | - Renato Luiz Maia Nogueira
- Department of Dental Clinic, Discipline of Oral and Maxillofacial Surgery and Stomatology, Federal University of Ceará, School of Dentistry, Fortaleza, Ceará, Brazil.,Department of Oral and Maxillofacial Surgery, Memorial Batista Hospital, Fortaleza, Ceará, Brazil
| | | | - Roberta Barroso Cavalcante
- Department of Oral Pathology, University of Fortaleza/Universidade de Fortaleza, School of Dentistry, Fortaleza, Ceará, Brazil
| | | | - Manoel de Jesus Rodrigues Mello
- Department of Oral and Maxillofacil Surgery, School of Dentistry, Christus University Center (Centro Universitário Christus), Fortaleza, Ceará, Brazil.,Federal University of Ceara School of Dentistry, Fortaleza, Ceará, Brazil
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Zhao K, Wang F, Huang W, Wang X, Wu Y. Comparison of Dental Implant Performance Following Vertical Alveolar Bone Augmentation With Alveolar Distraction Osteogenesis or Autogenous Onlay Bone Grafts: A Retrospective Cohort Study. J Oral Maxillofac Surg 2017; 75:2099-2114. [DOI: 10.1016/j.joms.2017.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
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20
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Kim CH, Ju MH, Kim BJ. Comparison of recombinant human bone morphogenetic protein-2-infused absorbable collagen sponge, recombinant human bone morphogenetic protein-2-coated tricalcium phosphate, and platelet-rich fibrin-mixed tricalcium phosphate for sinus augmentation in rabbits. J Dent Sci 2017; 12:205-212. [PMID: 30895052 PMCID: PMC6400000 DOI: 10.1016/j.jds.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/02/2022] Open
Abstract
Background/purpose Numerous grafting materials have been used in the bone regeneration of maxillary sinus to obtain a sufficient amount of new bone in implant dentistry. The objective of this study was to compare the potentials of Type I absorbable collagen sponge (ACS) impregnated with recombinant human bone morphogenetic protein (rhBMP)-2, rhBMP-2-coated tricalcium phosphate (TCP), platelet-rich fibrin-mixed TCP for enhancing bone regeneration in sinus augmentation in rabbits. Materials and methods The sinus defects were grafted with rhBMP-2+ACS (Group A), rhBMP-2-coated TCP (Group B), and platelet-rich fibrin-mixed TCP (Group C). The specimens underwent decalcification, and were stained for histomorphometric analysis. Results There were no significant differences in inflammatory features among the groups 1-week postoperation. In a histomorphometric analysis, the new bone formation ratio showed significant differences between groups at 2 weeks. rhBMP-2+ACS showed a larger and more rapid bone formation area at 2 weeks than those of Groups B and C. Conclusion Our histological evaluation demonstrates that Type I ACS can be used as a carrier of rhBMP-2, and rhBMP-2+ACS showed rapid bone formation, remodeling, and calcification at Week 2 in rabbit.
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Affiliation(s)
- Chul-Hun Kim
- Department of Oral and Maxillofacial Surgery, Assistant Professor, Dong-a Univ. College of Medicine, Busan, South Korea
| | - Mi-Ha Ju
- Department of Pathology, Faculty of Pathology, Dong-a University College of Medicine, Busan, South Korea
| | - Bok-Joo Kim
- Department of Oral and Maxillofacial Surgery, Assistant Professor, Dong-a Univ. College of Medicine, Busan, South Korea
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Rachmiel A, Shilo D, Aizenbud D, Emodi O. Vertical Alveolar Distraction Osteogenesis of the Atrophic Posterior Mandible Before Dental Implant Insertion. J Oral Maxillofac Surg 2017; 75:1164-1175. [PMID: 28208057 DOI: 10.1016/j.joms.2017.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Augmentation of deficient mandibular posterior alveolar ridges poses a great challenge because of extensive bone deficiency and the presence of the inferior alveolar nerve. This study sets its focus on vertical alveolar distraction osteogenesis (ADO) at the posterior mandible before dental implant placement. MATERIALS AND METHODS The study included 21 sites in 18 patients with severe mandibular posterior alveolar ridge deficiency. A trapezoidal osteotomy was performed, and an extraosseous alveolar distraction device was fixed and activated after a 4-day latency period at a rate of 0.5 mm/day. After a 4-month retention period, the distraction device was removed and titanium dental implants were placed. RESULTS A mean vertical augmentation of 14.47 mm was gained. The newly formed bone was shown using panoramic radiography and computed tomography. We placed 56 dental implants, and during a minimum follow-up period of 36 months, 2 implants were lost, resulting in a success rate of 96.42%. CONCLUSIONS ADO offers marked vertical ridge augmentation with simultaneous soft tissue expansion and stable results. ADO diminishes the need for autogenous bone graft, thus sparing donor-site morbidity. ADO of the deficient posterior mandibular alveolar ridge is useful in moderate to severe bony deficiencies and allows for adequate bone formation, which allows implant insertion.
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Affiliation(s)
- Adi Rachmiel
- Professor, Department of Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel; and Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dekel Shilo
- Resident, Department of Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel.
| | - Dror Aizenbud
- Professor, Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; and Department of Orthodontics and Cleft Palate, School of Dental Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Omri Emodi
- Attending Physician, Department of Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel; and Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Keestra JAJ, Barry O, Jong LD, Wahl G. Long-term effects of vertical bone augmentation: a systematic review. J Appl Oral Sci 2016; 24:3-17. [PMID: 27008252 PMCID: PMC4775004 DOI: 10.1590/1678-775720150357] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/22/2015] [Indexed: 11/21/2022] Open
Abstract
Extraction, periodontitis, or trauma can cause a reduction on the alveolar ridge. This could result in an insufficient alveolar bone width and height. Different techniques of vertical bone augmentation are described in literature. However, nowadays there is not enough evidence against lateral augmentation procedures to verify if these techniques are stable over a long period of time.
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Affiliation(s)
| | - Obada Barry
- Mund- und Kieferheilkunde, Poliklinik für Chirurgische Zahn-, Universität Bonn, Bonn, Germany
| | | | - Gerhard Wahl
- Mund- und Kieferheilkunde, Poliklinik für Chirurgische Zahn-, Universität Bonn, Bonn, Germany
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23
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Motamedian SR, Khojaste M, Khojasteh A. Success rate of implants placed in autogenous bone blocks versus allogenic bone blocks: A systematic literature review. Ann Maxillofac Surg 2016; 6:78-90. [PMID: 27563613 PMCID: PMC4979349 DOI: 10.4103/2231-0746.186143] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The aim of this study is to review and compare survival/success rate of dental implants inserted in autogenous and allogenic bone blocks (ALBs). A PubMed search was performed from January 1990 to June 2014 limited to English language and human studies. Studies that reported treatment outcome of implants inserted in augmented alveolar ridges with autogenous or ALBs were included. Primary search identified 470 studies. For autogenous bone block (ABB) 36 articles and for ALB 23 articles met the inclusion criteria. Evidence on implant survival/success rate of both techniques was limited to observational studies with relatively small sample sizes. Study design, treatment methods, follow-ups, defect location, and morphology varied among studies. The range of implant survival and success rates in ABB was from 73.8% to 100% and 72.8% to 100%, respectively. The corresponding numbers for ALB were 95.3-100% and 93.7-100%, respectively. A definite conclusion could not be reached. Future studies with long-term follow-ups are required to further elucidate this issue.
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Affiliation(s)
- Saeed Reza Motamedian
- Department of Orthodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moein Khojaste
- Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Khojasteh
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Troeltzsch M, Troeltzsch M, Kauffmann P, Gruber R, Brockmeyer P, Moser N, Rau A, Schliephake H. Clinical efficacy of grafting materials in alveolar ridge augmentation: A systematic review. J Craniomaxillofac Surg 2016; 44:1618-1629. [PMID: 27622971 DOI: 10.1016/j.jcms.2016.07.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/22/2016] [Accepted: 07/29/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the efficacy of grafting materials in lateral and vertical ridge augmentations. MATERIALS AND METHODS A systematic review of the literature on the clinical use of grafting materials of the years 1995 to April 2015 was conducted using electronic search of PubMed and Cochrane libraries and hand search of eight print journals. A total of 184 papers were included, comprising 6182 patients. Parameters evaluated were observation period [months], bone formation [histologic area%], defect fill [%], horizontal and vertical gain [mm], loss of augmented volume [mm], complication rate [%], and implant survival rate [%]. Results are expressed as weighted means ± SD. RESULTS Results were obtained after a weighted mean observation period of 27.4 months (range 3-168 months). Bone formation in the augmented areas varied from 33.2 ± 14.9% for allogeneic grafts to 56.0 ± 25.6% for mixtures of autogenous and other grafting materials. Defect fill in dehiscence defects ranged from 51.0 ± 13.6% (synthetic) to 85.8 ± 13.4% (xenogeneic) for the different materials, with an overall weighted mean of 79.8 ± 18.7%. Weighted mean horizontal gain for all particulate grafting materials was 3.7 ± 1.2 mm, with variation between 2.2 ± 1.2 mm (synthetic) and 4.5 ± 1.0 mm (mixtures of autogenous bone with allogeneic/xenogeneic grafting material) without statistical significance. Weighted overall mean vertical gain was 3.7 ± 1.4 mm. Vertical gain was substantially higher when space-making barrier materials such as titanium meshes were used; however this was also associated with strong increase in complication rate. Block grafts achieved higher horizontal gain by approximately 1 mm. The use of block grafts achieved significantly increased vertical gain compared to particulate material only when autogenous block grafts from extraoral donor sites were used. CONCLUSION Horizontal and vertical gain by 3.7 mm on average can be achieved using particulate materials. This can be increased by using titanium meshes. Substantial vertical gains beyond this dimension require the use of extraoral bone block grafts.
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Affiliation(s)
- Markus Troeltzsch
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany.
| | - Matthias Troeltzsch
- Department of Maxillofacial Surgery, Ludwig - Maximilians - University of Munich, Germany
| | - Philipp Kauffmann
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Rudolph Gruber
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Phillipp Brockmeyer
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Norman Moser
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Anna Rau
- Department of Anesthesiology, University of Goettingen, Germany
| | - Henning Schliephake
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
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The Effect of Crown-to-Implant Ratio on the Clinical Performance of Extra-Short Locking-Taper Implants. J Craniofac Surg 2016; 27:675-81. [DOI: 10.1097/scs.0000000000002562] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Jensen AT, Jensen SS, Worsaae N. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study. Oral Maxillofac Surg 2016; 20:115-22. [PMID: 26932593 DOI: 10.1007/s10006-016-0551-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge. METHODS From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure. RESULTS A total of 223 patients (132 women, 91 men; mean age 23.5 years; range 17-65 years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7 % after GBR procedures, 25.9 % after staged horizontal ridge augmentation, and 18.2 % after staged vertical ridge augmentation. Infections were diagnosed in 2 % after GBR procedures, 12.5 % after sinus floor elevation (SFE) (transcrestal technique), 5 % after staged SFE, 11 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2 % after GBR procedures, 37 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7 %), four after GBR procedures (1.6 %), and two (12 %) after staged vertical ridge augmentation. CONCLUSIONS Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.
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Affiliation(s)
- Anders Torp Jensen
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Simon Storgård Jensen
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Nils Worsaae
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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Cardinal L, Dominguez GC, Marodin AL, Rau LH. Unusual Spontaneous Mandibular Regeneration of a Large Defect Followed by Orthodontics, Alveolar Distraction, and Dental Implant Rehabilitation: A 10-Year Follow-Up. J Oral Maxillofac Surg 2015; 74:786-93. [PMID: 26706489 DOI: 10.1016/j.joms.2015.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/22/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
This report describes an atypical case of spontaneous mandibular regeneration of a large size bony defect after resection of an aseptic osteonecrotic area near the symphysis and parasymphyseal area. The patient underwent orthodontic therapy, vertical osteogenic distraction of the alveolar bone, and oral rehabilitation with an implant borne prosthesis. This case study also describes the 10-year follow-up of comprehensive multidisciplinary treatment and successful recovery of a patient's esthetic and functional aspects.
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Affiliation(s)
- Lucas Cardinal
- PhD Student, Department of Orthodontics and Pediatric Dentistry, University of São Paulo, São Paulo, SP, Brazil.
| | - Gladys Cristina Dominguez
- Associate Professor, Department of Orthodontics and Pediatric Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Aline Luiza Marodin
- Chief Resident, Department of Maxillofacial Surgery, Joana de Gusmao Children Hospital, Florianópolis, SC, Brazil
| | - Levy Hermes Rau
- Program Director, Department of Maxillofacial Surgery, Joana de Gusmao Children Hospital, Florianópolis, SC, Brazil
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28
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Al-Abedalla K, Torres J, Cortes ARG, Wu X, Nader SA, Daniel N, Tamimi F. Bone Augmented With Allograft Onlays for Implant Placement Could Be Comparable With Native Bone. J Oral Maxillofac Surg 2015; 73:2108-22. [DOI: 10.1016/j.joms.2015.06.151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 02/08/2023]
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Liu L, Ma L, Lin J, Zhang C, Jia Y. Assessing the Interdental Septal Thickness in Alveolar Bone Grafting Using Cone Beam Computed Tomography. Cleft Palate Craniofac J 2015; 53:683-689. [PMID: 26444319 DOI: 10.1597/15-143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the interdental septal thickness of grafted bone bridges using cone beam computed tomography (CBCT). PATIENTS Of 71 patients with cleft lip and/or palate having undergone alveolar bone grafting for the first time at least 6 months previously, 52 patients with 57 grafted sites rated type I or II based on the Bergland scale using occlusal radiographs were selected. INTERVENTIONS CBCT was performed for each bone-grafted alveolar cleft within 1 week after the occlusal radiographs were taken. MAIN OUTCOME MEASURES The thickness of the grafted bone bridge was evaluated using CBCT according to the relationship between crest thickness and the root width of cleft-adjacent teeth, and the results were classified into four categories, with scores of 1 to 4 indicating that the thickness of the bony bridge was ≥100%, ≥75%, ≥50%, and <50% of the root width of the cleft-adjacent teeth, respectively. RESULTS Of the 34 grafted sites rated type I on the Bergland scale, 15 (44.12%), 10 (29.41%), 4 (11.76%), and 5 (14.71%) clefts were scored 1 to 4 on interdental septal thickness using CBCT, respectively. Of the 23 cases of type II, 3 (13.04%), 9 (39.13%), 1 (3.45%), and 10 (43.48%) clefts were scored 1 to 4, respectively. CONCLUSIONS The interdental septal thickness of grafted bone bridges with clinically successful heights based on the Bergland scale (type I or II) using occlusal radiographs varied significantly in the evaluation using CBCT.
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Bassi A, Pioto R, Faverani L, Canestraro D, Fontão F. Maxillary sinus lift without grafting, and simultaneous implant placement: a prospective clinical study with a 51-month follow-up. Int J Oral Maxillofac Surg 2015; 44:902-7. [DOI: 10.1016/j.ijom.2015.03.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 02/06/2015] [Accepted: 03/24/2015] [Indexed: 11/16/2022]
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Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge. Case Rep Dent 2015; 2015:941265. [PMID: 26064701 PMCID: PMC4442008 DOI: 10.1155/2015/941265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/21/2015] [Indexed: 12/20/2022] Open
Abstract
This report documents the clinical, radiographic, and histologic outcome of a custom-made computer-aided-design/computer-aided-manufactured (CAD/CAM) scaffold used for the alveolar ridge augmentation of a severely atrophic anterior mandible. Computed tomographic (CT) images of an atrophic anterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model; this was transferred to a CAD program, where a custom-made scaffold was designed. CAM software generated a set of tool-paths for the manufacture of the scaffold on a computer-numerical-control milling machine into the exact shape of the 3D design. A custom-made scaffold was milled from a synthetic micromacroporous biphasic calcium phosphate (BCP) block. The scaffold closely matched the shape of the defect: this helped to reduce the time for the surgery and contributed to good healing. One year later, newly formed and well-integrated bone was clinically available, and two implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. The histologic samples retrieved from the implant sites revealed compact mature bone undergoing remodelling, marrow spaces, and newly formed trabecular bone surrounded by residual BCP particles. This study demonstrates that custom-made scaffolds can be fabricated by combining CT scans and CAD/CAM techniques. Further studies on a larger sample of patients are needed to confirm these results.
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Öncü E, Isik K, Alaaddinoğlu EE, Uçkan S. Combined use of alveolar distraction osteogenesis and segmental osteotomy in anterior vertical ridge augmentation. Int J Surg Case Rep 2015; 8C:124-6. [PMID: 25661636 PMCID: PMC4353954 DOI: 10.1016/j.ijscr.2015.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 11/16/2022] Open
Abstract
30-year old woman admitted with generalized aggressive periodontitis. Her periodontal treatment was completed and maxillary four incisors were extracted. There were a vertical hard tissue deficit that needed to be improved for implant placement. An alveolar distraction osteogenesis was done, but left side of the transport segment lagged. A segmental osteotomy was performed and the segment was brought into proper position. After six months, two implants were placed. Two years later there were no clinical or radiographic complications.
Introduction Vertical defects of the anterioral veolar ridge are challenging cases in implant dentistry. Various techniques, such as onlay bone grafting, segmental osteotomy (SO) oral veolar distraction osteogenesis (ADO), have been suggested to manage those situations. ADO has an advantage of being capable of enhancing both hard and soft tissue simultaneously. Presentation of case One of the possible complications of ADO is rotation ortilting the transport segment (TS). In this report, we present a 30-year old woman who had a severe anterior vertical deficiency. ADO was started to manage the case, but advancement of the TS lagged on the left side and the segment rotated. A SO was planned and the lagged side was corrected. Two years after the surgery, hard and soft tissue gains were found to be preserved. Discussion Vertical alveolar bone deficiencies are challenging cases for dental implantology. Alveolar DO promotes soft tissue along with hard tissue, and the bone regeneration process and shows lower infection rates and greater stability over the long term. However, the technique has some disadvantages and can lead to complications, such as breaking of the distraction device, nerve injury or paresthesia, fracture of transport bone, hematoma, wound dehiscence, severe bleeding, and even jaw fractures. Deviation of the TS from the distraction path is another undesired situation. The rigidity of the device, the width of the mucosa, the volume of the transport and anchor segments, and the amount of augmentation can affect vector deviation. Conclusion We suggest that SO can be used in similar cases in which TS could not be distracted on a straight vector line.
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Affiliation(s)
- Elif Öncü
- Necmettin Erbakan University, Departmant of Periodontolgy, Karaciğan Mah, Ankara Cad. No. 74/A Karatay, Konya, Turkey.
| | - Kubilay Isik
- Necmettin Erbakan University, Departmant Of Oral And Maxillofacial Surgery, Karaciğan Mah., Ankara Cad. No. 74/A Karatay, Konya, Turkey.
| | - E Emine Alaaddinoğlu
- Baskent University, Departmant Of Periodontolgy, Bahçelievler mah. No. 16 Çankaya, Ankara, Turkey.
| | - Sina Uçkan
- Baskent University, Departmant Of Oral And Maxillofacial Surgery, Bahçelievler mah. No. 16 Çankaya, Ankara, Turkey.
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Schwartz-Arad D, Ofec R, Eliyahu G, Ruban A, Sterer N. Long Term Follow-Up of Dental Implants Placed in Autologous Onlay Bone Graft. Clin Implant Dent Relat Res 2014; 18:449-61. [DOI: 10.1111/cid.12288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Devorah Schwartz-Arad
- Oral and Maxillofacial Surgery; Advanced Implantology, Periodontology & Endodontology; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Ronen Ofec
- Department of Statistics and Operations Research; Tel Aviv University; Tel Aviv Israel
| | - Galit Eliyahu
- Oral and Maxillofacial Surgery; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Angela Ruban
- Clinical Research Units; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Nir Sterer
- Clinical Research Units; Oral and Maxillofacial Surgery; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
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Stimmelmayr M, Beuer F, Schlee M, Edelhoff D, Güth JF. Vertical ridge augmentation using the modified shell technique--a case series. Br J Oral Maxillofac Surg 2014; 52:945-50. [PMID: 25266138 DOI: 10.1016/j.bjoms.2014.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 08/15/2014] [Indexed: 01/05/2023]
Abstract
Vertical defects of the alveolar crest often restrict the placement of implants. The outcome of vertical augmentation is unpredictable so we aimed to develop a technique that has predictable results. We used autogenous grafts trimmed to shells less than 1mm thick to rebuild the vertical dimensions of the alveolar ridge. The shells were fixed with microscrews and the vertical space between the shell and the residual bone was filled with autogenous particulate bone. Vertical dimensions before and after augmentation were measured and descriptive statistics calculated. A total of 17 patients (10 female, 7 male, mean (SD) age 46 (17) years) had 18 sites augmented (2 sites in one patient). In 2 cases the wound dehisced and healing was by secondary intention. The rest healed uneventfully. The mean (SD) vertical defect was 4.7 (1.4) mm and mean (SD) resorption during consolidation was 0.5 (0.7) mm. All 30 previously planned implants were placed, and none failed during the first year. Loading was monitored for a mean (SD) period of 14.6 (10.5) months. The technique showed promising results and could be an alternative to procedures that use extraoral donor sites.
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Affiliation(s)
- Michael Stimmelmayr
- University of Munich, Department of Prosthodontics, Goethestr. 70, 80336 Munich, Germany; Private Practice for Oral Surgery, Josef-Heilingbrunnerstrasse 2, 93413 Cham, Germany.
| | - Florian Beuer
- University of Munich, Department of Prosthodontics, Goethestr. 70, 80336 Munich, Germany
| | - Markus Schlee
- Private Practice, Bayreutherstr. 39, 91301 Forchheim, Germany
| | - Daniel Edelhoff
- University of Munich, Department of Prosthodontics, Goethestr. 70, 80336 Munich, Germany
| | - Jan-Frederik Güth
- University of Munich, Department of Prosthodontics, Goethestr. 70, 80336 Munich, Germany
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