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Sáez-Alcaide LM, González Gallego B, Fernando Moreno J, Moreno Navarro M, Cobo-Vázquez C, Cortés-Bretón Brinkmann J, Meniz-García C. Complications associated with vertical bone augmentation techniques in implant dentistry: A systematic review of clinical studies published in the last ten years. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101574. [PMID: 37499904 DOI: 10.1016/j.jormas.2023.101574] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
Vertical bone augmentation procedures are increasingly necessary in daily practice. However, it has been reported that vertical ridge augmentation is one of the least predictable techniques in terms of complications. The aim of this systematic review was to evaluate and compare complications in relation to the different procedures used for vertical bone augmentation prior to implant placement. This review was conducted according to PRISMA guidelines. An electronic search was carried out in four databases: The National Library of Medicine (MEDLINE/PubMed); Web of Science; SCOPUS; and Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale, the Cochrane Collaboration tool for assessing risk of bias, and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. Twenty-five studies with a total of 749 vertically augmented sites were included in the review. Complication rates varied among the different procedures: 51.02% for distraction osteogenesis, 38.01% for bone blocks, and 16.80% for guided bone regeneration. Vertical bone augmentation procedures prior to implant placement are associated with frequent surgical complications and should be approached with caution due to their possible impact on clinical treatment success.
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Affiliation(s)
- Luis Miguel Sáez-Alcaide
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Berta González Gallego
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Javier Fernando Moreno
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Miguel Moreno Navarro
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Carlos Cobo-Vázquez
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Jorge Cortés-Bretón Brinkmann
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain; Surgical and Implant Therapies in the Oral Cavity Research Group, University Complutense, Madrid, Spain.
| | - Cristina Meniz-García
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain; Surgical and Implant Therapies in the Oral Cavity Research Group, University Complutense, Madrid, Spain
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Monje A, Roccuzzo A, Buser D, Wang HL. Influence of buccal bone wall thickness on the peri-implant hard and soft tissue dimensional changes: A systematic review. Clin Oral Implants Res 2023; 34 Suppl 26:8-27. [PMID: 37750522 DOI: 10.1111/clr.14177] [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: 09/07/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 09/27/2023]
Abstract
BACKGROUND The significance on the association between the peri-implant bucco-lingual dimension (BLD) at the stage of implant placement and the occurrence of biological and esthetic complications is yet unknown. MATERIAL AND METHODS Systematic screening of electronic sources was carried out to identify clinical and preclinical studies reporting on the baseline BLD and/or buccal bone thickness (BBT) values. A secondary objective was to assess the effect of simultaneous grafting at sites with deficient or no buccal bone wall (BBW) at baseline. The primary outcome variables were BBT, BLD, and buccal vertical bone loss (VBL) at re-evaluation. Moreover, radiographic, clinical, and patient-reported outcome measures (PROMs) were evaluated. RESULTS Overall, 12 clinical and four preclinical studies met the inclusion criteria. Inconsistencies were found in defining the critical BBT across the clinical and preclinical data evaluated. The clinical evidence demonstrated that during healing, dimensional changes occur in the alveolar bone and in the BBW that may compromise the integrity of the peri-implant bone, leading to VBL and mucosal recession (MR), particularly in scenarios exhibiting a thin BBW. The preclinical evidence validated the fact that implants placed in the presence of a thin BBW, are more prone to exhibit major dimensional changes and VBL. Moreover, the clinical data supported that, in scenarios where dehiscence-type defects occur and are left for spontaneous healing, greater VBL and MR together with the occurrence of biologic complications are expected. Furthermore, the augmentation of dehiscence-type defects is associated with hard and soft tissue stability. PROMs were not reported. CONCLUSIONS Dimensional changes occur as result of implant placement in healed ridges that may lead to instability of the peri-implant hard and soft tissues. Sites presenting a thin BBW are more prone to exhibit major changes that may compromise the integrity of the buccal bone and may lead to biologic and esthetic complications.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Oral Maxillofacial Surgery, Copenaghen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Daniel Buser
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Monje A, Roccuzzo A, Buser D, Wang HL. Significance of buccal bone wall thickness on the fate of peri-implant hard and soft tissues: A systematic review. Clin Oral Implants Res 2023; 34:157-176. [PMID: 36626118 DOI: 10.1111/clr.14029] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The significance of the association between the peri-implant buccolingual dimension (BLD) at the stage of implant placement and the occurrence of biological and esthetic complications is yet unknown. MATERIAL AND METHODS Systematic screening of electronic sources was carried out to identify clinical and preclinical studies reporting on the baseline BLD and/or buccal bone thickness (BBT) values. A secondary objective was to assess the effect of simultaneous grafting at sites with deficient or no buccal bone wall (BBW) at baseline. The primary outcome variables were BBT, BLD, and vertical bone loss (VBL) at re-evaluation. Moreover, radiographic, clinical- and patient-reported outcome measures (PROMs) were evaluated. RESULTS Overall, 12 clinical and four preclinical studies met the inclusion criteria. The clinical evidence demonstrated that during healing, dimensional changes occur in the alveolar bone and in the BBW that may compromise the integrity of bone around a dental implant. The preclinical evidence validated the fact that implants placed in the presence of thin BBW are more prone to exhibit major dimensional changes. Moreover, the clinical and preclinical data supported that in scenarios where dehiscence-type defects are left for spontaneous healing, greater VBL and mucosal recession (MR) together with the occurrence of biologic complications are expected. Furthermore, the augmentation of dehiscence-type defects is associated with hard and soft tissue stability. CONCLUSIONS Dimensional changes occur as a result of implant placement in healed ridges that may lead to VBL and MR. Thin BBW (≲2 mm) are prone to exhibit major postchanges that may compromise the integrity of the buccal bone, biologic and esthetic complications.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Daniel Buser
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Tay JRH, Ng E, Lu XJ, Lai WMC. Healing complications and their detrimental effects on bone gain in vertical-guided bone regeneration: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2022; 24:43-71. [PMID: 35048503 DOI: 10.1111/cid.13057] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Guided bone regeneration (GBR) utilizes a barrier membrane to allow osteogenic cells to populate a space by excluding epithelial and connective tissue cells. The purpose of this systematic review was to investigate the ratio of means (RoM) of vertical bone gained (Outcome) in vertical GBR procedures with healing complications (Intervention) and in vertical GBR procedures without healing complications (Comparison) in patients with vertically resorbed edentulous ridges that require dental implant placement (Population). A further aim was to investigate the incidence of complications after vertical GBR, and the influence of the timing of implant placement and regenerative devices on complications. MATERIALS AND METHODS MEDLINE (through PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched in duplicate up to, and including, November 2020 for randomized and controlled clinical trials and prospective and retrospective case series. Outcomes included patient-level and site-level RoM of vertical bone gain between healing complications and uneventful healing, and incidences of complications that occurred after vertical GBR. Random-effects and fixed-effects meta-analyses were performed where appropriate. This study was registered on PROSPERO (CRD42021226432). RESULTS A total of 31 publications were selected for the qualitative and quantitative analyses. The RoM of vertical bone gained was 0.65 [95% CI = 0.47, 0.91] and 0.62 [95% CI = 0.45, 0.85] when membrane exposure without suppuration and abscess formation without membrane exposure occurred respectively, in comparison to uneventful healing. The overall incidence proportion of healing complications occurring at the augmented site at a site- and patient-level was 11.0% [95% CI = 7.0, 15.6] and 10.8% [95% CI = 6.6, 15.7]. At a patient-level, there were no significant differences between a simultaneous or staged approach, or with the regenerative device used. The site-level incidence proportion of membrane exposure without suppuration, membrane exposure with suppuration, and with abscess formation without membrane exposure was 8.7% [95% CI = 4.2, 14.2], 0.7% [95% CI = 0.0, 2.9], and 0.5% [95% CI = 0.0, 1.7], respectively. The site-level weighted mean incidence proportion of neurologic complications occurring at the donor site was 0.8% [95% CI = 0.0, 5.3]. CONCLUSIONS There is a significant reduction in bone gain when healing complications occur. However, healing complications are relatively uncommon surgical complications after vertical GBR.
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Affiliation(s)
- John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Xiaotong Jacinta Lu
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore
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Vaquette C, Mitchell J, Fernandez-Medina T, Kumar S, Ivanovski S. Resorbable additively manufactured scaffold imparts dimensional stability to extraskeletally regenerated bone. Biomaterials 2021; 269:120671. [PMID: 33493771 DOI: 10.1016/j.biomaterials.2021.120671] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
Dimensionally stable vertical bone regeneration outside of the existing bony envelope is a major challenge in the field of orofacial surgery. In this study, we demonstrate that a highly porous, resorbable scaffold fabricated using additive manufacturing techniques enables reproducible extra-skeletal bone formation and prevents bone resorption. An additively manufactured medical grade polycaprolactone (mPCL) biphasic scaffold mimicking the architecture of the jaw bone, consisting of a 3D-printed outer shell overlying an inner highly porous melt electrowritten scaffold, was assessed for its ability to support dimensionally stable bone regeneration in an extraskeletal ovine calvarial model. To investigate bone formation capacity (stage 1), 7 different constructs placed under a protective dome were assessed 8 weeks post-implantation: Empty control, Biphasic scaffold with hydrogel (PCL-Gel), PCL-Gel with 75 or 150 μg of BMP-2 (PCL-BMP-75 and PCL-BMP-150), hydrogel only (Gel), Gel containing 75 or 150 μg of BMP-2 (Gel-BMP-75 and Gel-BMP-150). To assess dimensional stability (stage 2), in a separate cohort, 5 animals were similarly implanted with 2 samples of each of the Gel-BMP-150 and PCL-BMP-150 groups, and after 8 weeks of healing, the protective domes were removed and titanium implants were placed in the regenerated bone and allowed to heal for a further 8 weeks. Bone formation and osseointegration were assessed using micro-computed tomography, histology and histomorphometry. In stage 1, enhanced bone formation was found in the BMP-2 containing groups, especially the PCL-BMP constructs whereby regeneration of full bone height was achieved in a reproducible manner. There was no significant bone volume increase with the higher dose of BMP-2. In the dimensional stability assessment (stage 2), after the rtemoval of the protective dome, the biphasic scaffold prevented bone resorption whereas in the absence of the scaffold, the bone previously formed in the hydrogel underwent extensive resorption. This was attributed to the space maintenance properties and dimensional stability of the biphasic scaffold. Titanium implants osseointegrated into the newly formed bone within the biphasic scaffolds. In conclusion, additively manufactured biphasic scaffolds functionalized with BMP-2 facilitated dimensionally stable bone regeneration that supported dental implant osseointegration.
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Affiliation(s)
- C Vaquette
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia.
| | - J Mitchell
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia.
| | - T Fernandez-Medina
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia.
| | - S Kumar
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - S Ivanovski
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia.
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