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Wang YL, Shao WJ, Wang M. Bone block from lateral window - correcting vertical and horizontal bone deficiency in maxilla posterior site: A case report. World J Clin Cases 2024; 12:2109-2115. [PMID: 38680257 PMCID: PMC11045507 DOI: 10.12998/wjcc.v12.i12.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/29/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm. However, managing cases becomes more challenging when a maxillary sinus pseudocyst is present or when there is insufficient bone width. In this case, we utilized the bone window prepared during the lateral window sinus lift as a shell for horizontal bone augmentation. This allowed for simultaneous horizontal and vertical bone augmentation immediately after the removal of the maxillary sinus pseudocyst. CASE SUMMARY A 28-year-old female presented to our clinic with the chief complaint of missing upper left posterior teeth. Intraoral examination showed a horizontal deficiency of the alveolar ridge contour. The height of the alveolar bone was approximately 3.6 mm on cone beam computed tomography (CBCT). And a typical well-defined 'dome-shaped' lesion in maxillary sinus was observed on CBCT imaging. The lateral bony window was prepared using a piezo-ultrasonic device, then the bony window was fixed to the buccal side of the 26 alveolar ridge using a titanium screw with a length of 10 mm and a diameter of 1.5 mm. The space between the bony window and the alveolar ridge was filled with Bio-Oss, covered with a Bio-Gide collagen membrane, and subsequently sutured. Nine months later, the patient's bone width increased from 4.8 to 10.5 mm, and the bone height increased from 3.6 to 15.6 mm. Subsequently, a Straumann® 4.1 mm × 10 mm implant was placed. The final all-ceramic crown restoration was completed four months later, and both clinical and radiographic examinations showed that the implant was successful, and the patient was satisfied with the results. CONCLUSION The bone block harvested from the lateral window sinus lift can be used for simultaneous horizontal bone augmentation acting as a shell for good two-dimensional bone augmentation.
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Affiliation(s)
- Yu-Lan Wang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
| | - Wen-Jun Shao
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
| | - Min Wang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
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Tunkel J, Hoffmann F, Schmelcher Y, Kloss-Brandstätter A, Kämmerer PW. Allogeneic versus autogenous shell technique augmentation procedures: a prospective-observational clinical trial comparing surgical time and complication rates. Int J Implant Dent 2023; 9:52. [PMID: 38117445 PMCID: PMC10733239 DOI: 10.1186/s40729-023-00505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/04/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVES Autogenous and allogeneic blocks for shell augmentation of the jaw have shown comparable results. This observational clinical study aimed to compare both materials for shell augmentation concerning surgery time and intra- and postoperative complications. MATERIAL AND METHODS Bone augmentation with the shell technique using autogenous or allogenous bone was performed in 117 patients with segmental jaw atrophy. The primary study parameter was the surgical time, comparing both materials. Subsequently, intra- and postoperative complications were recorded. RESULTS Allogeneic (n = 60), autogenous (n = 52), or both materials (n = 5) were used. The use of allogeneic material led to a significantly shorter operation time (p < 0.001). A more experienced surgeon needed significantly less time than a less experienced surgeon (p < 0.001). An increasing number of bone shells (p < 0.001), an additional sinus floor elevation, and intraoperative complications also significantly increased the operation time (p = 0.001). Combining allogeneic and autogenous shells (p = 0.02) and simultaneous sinus floor elevation (p = 0.043) significantly impacted intraoperative complications. No correlations were found between the included variables for postoperative complications (all p > 0.05). In total, 229 implants were inserted after a healing time of 4-6 months, with a survival of 99.6% after a mean follow-up duration of 9 months. CONCLUSIONS Compared to the autogenous technique, allogeneic shell augmentation has a shorter surgical time and a similar rate of intra- and postoperative complications as autogenous bone. Together with its promising clinical results, this technique can be recommended.
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Affiliation(s)
- Jochen Tunkel
- Private Practice for Oral Surgery and Periodontology, Königstraße 19, 32545, Bad Oeynhausen, Germany
| | - Frederik Hoffmann
- Private Practice for Oral Surgery and Periodontology, Königstraße 19, 32545, Bad Oeynhausen, Germany
| | - Yannik Schmelcher
- Private Practice for Oral Surgery and Periodontology, Königstraße 19, 32545, Bad Oeynhausen, Germany
| | - Anita Kloss-Brandstätter
- Department of Engineering & IT, Carinthia University of Applied Sciences, Europastraße 4, 9524, Villach, Austria
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
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Sakaguchi R, Xavier SP, Morinaga K, Botticelli D, Silva ER, Nakajima Y, Baba S. Histological Comparison of Collagenated Cancellous Equine Bone Blocks Used as Inlay or Onlay for Lateral Bone Augmentation in Rabbits. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6742. [PMID: 37895725 PMCID: PMC10608602 DOI: 10.3390/ma16206742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The conformation of the recipient site for an inlay graft presents an increased contact with the parent bone compared to an onlay graft. This might favor bone growth within the inlay compared to onlay grafts. Hence, the objective of this study was to compare the bone incorporation and remodeling processes of xenogeneic en bloc grafts placed using two bone grafting techniques, i.e., onlay vs. inlay. METHODS In this prospective, randomized, split-mouth study (test and control sides in the same animal), two bone grafting techniques were comparatively evaluated. The lateral aspect of the rabbit mandible was used as the recipient site, bilaterally. On one side of the mandible, the cortical bone was perforated with drills to allow a better bone formation from the bone wound and the marrow spaces. A xenogeneic bone block was fixed in the center of the prepared region, representing the onlay site. On the other side of the mandible, a 7 mm wide and 3 mm deep circumferential defect was prepared using trephines and drills. A xenogeneic bone block was fixed in the center of the defect, representing the inlay site. Two healing periods were applied in the study: 2 and 10 weeks, each represented by 10 rabbits (n = 10 for each period). RESULTS After 2 weeks of healing, the mean percentage of new bone was 10.4% and 23.3% at the onlay and inlay grafts, respectively (p = 0.022). After 10 weeks of healing, new bone increased to 13.2% at the onlay sites and 25.4% at the inlay sites (p = 0.080). In the 10-week period, the inlay grafts presented a homogeneous growth of new bone in all regions, while in the onlay grafts, low percentages of new bone were observed in the external regions. CONCLUSION The percentage of new bone increased faster and was higher in the inlay grafts than in the onlay grafts. This outcome might be related to the self-contained conformation of the recipient site in the inlay group, which offered more sources for new bone formation compared to the one-wall conformation of the recipient sites in the onlay group. The osteoconductive properties of the biomaterial allowed the newly formed bone to reach the most peripheral regions in both groups. The osteoconductive properties of the biomaterial, together with the protection offered by the collagen membrane, allowed marginal closure of the defects by newly formed bone in the inlay group.
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Affiliation(s)
- Ryuichi Sakaguchi
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata 573-1121, Japan; (R.S.); (K.M.); (Y.N.); (S.B.)
| | - Samuel Porfirio Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café, Subsetor Oeste, 11 (N-11), Ribeirao Preto 14040-904, SP, Brazil; (S.P.X.); (E.R.S.)
| | - Kenzo Morinaga
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata 573-1121, Japan; (R.S.); (K.M.); (Y.N.); (S.B.)
| | - Daniele Botticelli
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata 573-1121, Japan; (R.S.); (K.M.); (Y.N.); (S.B.)
- ARDEC Academy, 47923 Rimini, Italy
| | - Erick Ricardo Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café, Subsetor Oeste, 11 (N-11), Ribeirao Preto 14040-904, SP, Brazil; (S.P.X.); (E.R.S.)
| | - Yasushi Nakajima
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata 573-1121, Japan; (R.S.); (K.M.); (Y.N.); (S.B.)
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café, Subsetor Oeste, 11 (N-11), Ribeirao Preto 14040-904, SP, Brazil; (S.P.X.); (E.R.S.)
| | - Shunsuke Baba
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata 573-1121, Japan; (R.S.); (K.M.); (Y.N.); (S.B.)
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Koo H, Hwang J, Choi BJ, Lee JW, Ohe JY, Jung J. Comparison of vertical bone resorption following various types of autologous block bone grafts. Maxillofac Plast Reconstr Surg 2023; 45:38. [PMID: 37845591 PMCID: PMC10579203 DOI: 10.1186/s40902-023-00406-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND This study aims to measure and compare the differences in vertical bone resorption after vertical augmentation using different types of autologous block bone. METHODS Data were collected from 38 patients who had undergone vertical ridge augmentation using an autologous block bone before implant insertion. The patients were divided into three groups based on the donor sites: ramus bone (RB), chin bone (CB), and iliac crestal bone (IB). RESULTS The surgical outcome of the augmentation was evaluated at the follow-up periods up to 60 months. In 38 patients, the mean amount of vertical bone gain was 8.36 ± 1.51 mm in the IB group, followed by the RB group (4.17 ± 1.31 mm) and the CB group (3.44 ± 1.08 mm). There is a significant difference in vertical bone resorption between the groups (p < 0.001), and the RB group demonstrated significantly lower resorption than the CB and IB groups (p = 0.011 and p < 0.001, respectively). The most common postoperative complications included neurosensory disturbance in the CB graft and gait disturbance in the IB graft. Out of the 92 implants inserted after augmentation, four implants were lost during the study period, resulting in an implant success rate of 95.65%. CONCLUSIONS The RB graft might be the most suitable option for vertical augmentation in terms of maintaining postoperative vertical height and reducing morbidity, although the initial gain was greater with the IB graft compared to other block bones.
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Affiliation(s)
- Hyejin Koo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Junghye Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Byung-Joon Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Joo-Young Ohe
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Junho Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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Yu SH, Saleh MHA, Wang HL. Simultaneous or staged lateral ridge augmentation: A clinical guideline on the decision-making process. Periodontol 2000 2023; 93:107-128. [PMID: 37529966 DOI: 10.1111/prd.12512] [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: 01/29/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
Lateral ridge augmentation is a standard surgical procedure that can be performed prior to (staged) or simultaneously with implant placement. The decision between a simultaneous or staged approach involves considering multiple variables. This paper proposed a decision-making process that serves as a guideline for choosing the best treatment choice based on the available evidence and the author's clinical experience.
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Affiliation(s)
- Shan-Huey Yu
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Private Practice, Vienna, Virginia, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Macedo LGSD, Pelegrine AA, Moy PK. Barbell Technique: A Novel Approach for Bidirectional Bone Augmentation: Clinical and Tomographic Study. J ORAL IMPLANTOL 2023; 49:458-464. [PMID: 37025052 DOI: 10.1563/aaid-joi-d-21-00286] [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: 02/13/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 04/08/2023]
Abstract
Horizontal bone augmentation is a common surgical procedure used in implant therapy to achieve adequate bone volume to permit dental implant placement. However, most current techniques are focused on unidirectional bone reconstruction (grafting only on the buccal side). This study was carried out to validate a new device that will permit bidirectional bone augmentation. Ten patients of both sexes (7 women and 3 men), with ages ranging from 29 to 62 years, who needed a bidirectional horizontal bone augmentation in maxilla were separated in accordance with the horizontal alveolar change (HAC) classification published by Pelegrine et al (2018). The patients classified as HAC 3 (ie, containing remaining cancellous bone at the recipient bed) received the Barbell device with xenogeneic biomaterial and a collagen membrane, whereas HAC 4 patients (ie, with no remaining cancellous bone at the recipient bed) received the Barbell device with a mixture of autogenous bone chips and xenogeneic biomaterial covered by a collagen membrane. For each patient, two computerized tomography scans were performed (T0 at baseline and T1 at 6 months postoperative examinations). Mean bone thickness (T0) in the studied sites were 3.25 ± 0.35 in HAC 3 and 1.98 ± 0.5 in HAC 4 patients. The mean bone thickness achieved after 6 months was 7.70 ± 0.89 mm and 8.62 ± 0.89 in HAC 3 and 4, respectively. All grafted sites were able to receive dental implants in adequate prosthetic positions. Based on these results, the use of this novel device permits bidirectional horizontal bone augmentation.
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Affiliation(s)
| | - André Antonio Pelegrine
- Professor and Head, Department of Implant Dentistry, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Peter Karyen Moy
- Clinical Professor in the Department of Oral & Maxillofacial Surgery, Nobel Biocare Endowed Chair, Surgical Implant Dentistry Clinical Professor, Department of Oral & Maxillofacial Surgery UCLA, Los Angeles, USA
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Yang S, Wang S, Shen X, Xu Y, Chen C, He F. Radiographic evaluation of the tenting screw technique in horizontal alveolar bone augmentation: A retrospective study. Clin Implant Dent Relat Res 2023. [PMID: 37130799 DOI: 10.1111/cid.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To radiographically analyze the effects of tenting screw technique (TS) and onlay bone grafts (OG) in horizontal bone augmentation. MATERIALS AND METHODS Patients receiving horizontal bone augmentation by TS or OG were selected. The clinical outcomes and cone beam computed tomography (CBCT) data were documented pre-grafting, immediately post-grafting, before and after implantation. The survival rates, clinical complications, alveolar bone width, and volumetric bone augmentation were evaluated and statistically analyzed. RESULTS A total of 25 patients and 41 implants were involved in this study, with no grafting failures observed in either the TS group (n = 20) or the onlay group (n = 21). Volumetric bone resorption rate in the TS group (21.34%) was significantly lower than that of the OG group (29.38%). In addition, significant horizontal bone gain was achieved in both groups (TS: 6.15 ± 2.12 mm; OG: 4.86 ± 1.40 mm) during the recovery period, with higher gain in the TS group. No apparent statistical difference in terms of volumetric bone gain was observed between the TS (748.53 mm3 , 607.47 mm3 ) and OG group (811.77 mm3 , 508.49 mm3 ) immediately post-grafting or after the recovery period. CONCLUSION Both TS and OG achieved satisfactory bone augmentation effects, yet TS resulted in more bone augmentation and better stability than OG, with a reduced use of autogenous bone. Overall, the tenting screw technique can serve as an effective alternative to autogenous bone grafts.
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Affiliation(s)
- Sijia Yang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
- Department of Prosthodontics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Siyuan Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xiaoting Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yuzi Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Cong Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Fuming He
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
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Kämmerer PW, Tunkel J, Götz W, Würdinger R, Kloss F, Pabst A. The allogeneic shell technique for alveolar ridge augmentation: a multicenter case series and experiences of more than 300 cases. Int J Implant Dent 2022; 8:48. [PMID: 36316597 PMCID: PMC9622968 DOI: 10.1186/s40729-022-00446-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Allogeneic cortical bone plates (CP) might be used for alveolar ridge augmentation as an alternative to autogenous grafts (AG) and bone substitutes (BS). We report about a multicenter case series and our experiences of more than 300 cases using CP and the shell technique for reconstruction of the alveolar process to illustrate surgical key steps, variations, and complication management. METHODS Different types of alveolar ridge defects were augmented using the shell technique via CP. The space between the CP and the alveolar bone was filled with either autogenous or allogeneic granules (AUG, ALG) or a mixture of both. Implants were placed after 4-6 months. Microscopic and histological assessments were performed. In addition, space filling using AUG, ALG and bovine BS was discussed. RESULTS Scanning electron microscopy demonstrated the compact cortical structure of CP and the porous structure of ALG allowing micro-vessel ingrowth and bone remodeling. Histological assessment demonstrated sufficient bone remodeling and graft resorption after 4-6 months. In total, 372 CP cases and 656 implants were included to data analysis. The mean follow-up period was about 3.5 years. Four implants failed, while all implant failures were caused by peri-implantitis. Next, 30 CP complications were seen, while in 26 CP complications implant placement was possible. CP rehydration, stable positioning by adjusting screws, smoothing of sharp edges, and a tension-free wound closure were identified as relevant success factors. Space filling using ALG and a mixture of AUG/ALG resulted in sufficient bone remodeling, graft resorption and stability of the augmented bone. CONCLUSIONS CP and the shell technique is appropriate for alveolar ridge augmentation with adequate bone remodeling and low complication rates. Allografts can prevent donor site morbidity and therefore may decrease discomfort for the patient.
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Affiliation(s)
- Peer W. Kämmerer
- grid.410607.4Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Jochen Tunkel
- Private Practice for Oral Surgery and Periodontology, Königstraße 19, 32545 Bad Oeynhausen, Germany
| | - Werner Götz
- grid.15090.3d0000 0000 8786 803XDepartment of Orthodontics, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - Robert Würdinger
- Private Practice for Oral Surgery and Periodontology, Frankfurter Str. 6, 35037 Marburg, Germany
| | - Frank Kloss
- Private Practice for Oral and Maxillofacial Surgery, Kärtnerstraße 62, 9900 Lienz, Austria
| | - Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstraße 170, 56072 Koblenz, Germany
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Le B, Hayashi N. The Aesthetic Contour Graft - Enhancing peri-implant soft tissue contours and pontic sites with guided bone regeneration. J ESTHET RESTOR DENT 2022; 34:188-202. [PMID: 35037745 PMCID: PMC9304277 DOI: 10.1111/jerd.12865] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
Objective In this article, we will discuss strategies for enhancing peri‐implant soft tissue contours and pontic sites with hard tissue augmentation. Clinical consideration One of the keys to the esthetic illusion of an implant‐supported restoration is to create an ideal emergence profile. A critical part of any emergence profile is based on the height and thickness of the tissue surrounding the restoration and whether there are any defects in this tissue. Even when there is adequate bone in which to place implants, if any irregular ridge anatomy that supports this tissue is not corrected, then an unesthetic appearance of the restoration can result due to the lack of soft tissue with which to develop a proper emergence profile. Conclusion Most peri‐implant soft tissue deficiencies represent an underlying bony defect that can be corrected or enhanced through bone augmentation. Clinical significance Traditional methods of enhancing soft tissue emergence profiles around implants and pontic sites mostly involve the use of soft tissue augmentation techniques. Although there are few reports of the use of bone augmentation for this purpose, soft tissue contours can be enhanced by augmenting the underlying bone contours and, in many instances, may obviate the need for subsequent soft tissue augmentation.
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Affiliation(s)
- Bach Le
- Clinical Associate Professor, Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, California, USA
| | - Naoki Hayashi
- Private Practice, Ultimate Styles Dental Laboratory, Irvine, California, USA
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Pelegrine AA, de Macedo LGS, Aloise AC, Moy PK. Barbell Technique: A Novel Approach for Bidirectional Bone Augmentation: Technical Note. J ORAL IMPLANTOL 2020; 46:446-452. [PMID: 32315413 DOI: 10.1563/aaid-joi-d-19-00323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Horizontal bone reconstruction is a common augmentation procedure used in implant dentistry to achieve adequate 3-dimensional ridge reconstruction to permit proper dental implant positioning. However, most available techniques are focused on unidirectional bone reconstruction (grafting only on the buccal side). This study was carried out to validate an innovative device that is indicated for bidirectional bone augmentation. The study consisted of 4 patients who required bidirectional horizontal bone augmentation of the upper jaw. Two computerized tomographies were performed (T0 at baseline and T1 at 6 months postoperative examinations). Mean bone thickness in the studied sites at T0 was 2.30 ± 0.65 and mean bone thickness achieved was 9.11 ± 1.08 mm at T1, with an overall bone gain of 6.81 ± 1.33 mm. Concerning the specific gains in direction, buccal and palatal bone augmentations were 4.89 ± 0.94 and 1.92 ± 0.42 mm, respectively. Based on these results, it can be concluded that the use of this novel device allows for the achievement of bidirectional horizontal bone augmentation.
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Affiliation(s)
- André Antonio Pelegrine
- Professor and Head, Department of Implant Dentistry, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | | | - Antonio Carlos Aloise
- Professor, Department of Implant Dentistry, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Peter Karyen Moy
- Clinical Professor in the Department of Oral & Maxillofacial Surgery, Nobel Biocare Endowed Chair, Surgical Implant Dentistry Clinical Professor, Department of Oral & Maxillofacial Surgery UCLA, Los Angeles, Calif
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Rahpeyma A, Khajehahmadi S. Mandibular Ramus Cortical Tenting Graft and Particulate Allograft in the Management of Unilateral Alveolar Cleft. Ann Maxillofac Surg 2019; 9:355-358. [PMID: 31909015 PMCID: PMC6933958 DOI: 10.4103/ams.ams_96_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Alveolar bone grafting in the mixed dentition stage is an important step in the management of cleft lip/palate patients. Intraoral donor sites are favored by patients and their parents. Objective: This study investigated a novel bilaminar cortical tenting grafting technique. The technique used a combination of autogenous mandibular ramus cortical bone and particulate allograft in unilateral cleft lip/palate patients during the mixed dentition stage. Materials and Methods: Five patients with nonsyndromic unilateral cleft lip and/or palate, in mixed dentition stage, were included in the study. Results: The operation was performed on five patients, and patients were followed up at least for one-year postoperation. Permanent maxillary canine erupted in the grafted alveolar region spontaneously in 80% of the patients. One wisdom tooth bud that had been exposed during the ramus bone harvest was removed. There was no alteration in the sensation of the lower lip as checked by light static and two discrimination tests. Conclusion: Unilateral alveolar clefts can be repaired using mandibular cortical block ramus bone in the form of bilaminar tenting grafts combined with particulate allografts.
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Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Khajehahmadi
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Oral and Maxillofacial Pathology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Pourdanesh F, Esmaeelinejad M, Aghdashi F. Clinical outcomes of dental implants after use of tenting for bony augmentation: a systematic review. Br J Oral Maxillofac Surg 2017; 55:999-1007. [DOI: 10.1016/j.bjoms.2017.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 10/30/2017] [Indexed: 12/16/2022]
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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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Khojasteh A, Motamedian SR, Sharifzadeh N, Zadeh HH. The influence of initial alveolar ridge defect morphology on the outcome of implants in augmented atrophic posterior mandible: an exploratory retrospective study. Clin Oral Implants Res 2016; 28:e208-e217. [PMID: 27804178 DOI: 10.1111/clr.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Clinicians commonly consider atrophic site topography as an important determinant in deciding the augmentation technique to utilize, as well as forecasting the likelihood of success. The purpose of this retrospective study was to examine the influence of initial atrophic posterior mandible morphology on the outcome of implants placed following augmentation. MATERIALS AND METHODS A total of 52 patients contributed 71 edentulous sites, and 185 implants were placed with mean follow-up of 37.97 months. The initial defect morphology was classified according to ABC classification (Journal of Oral Implantology, 37, 2013a and 361). Ridge augmentation was performed by "cortical autogenous tenting" (CAT) followed by either simultaneous or delayed implant placement after 4-6 months of healing. The European Academy of Osseointegration success criteria were used to evaluate implant outcomes. RESULTS The overall survival and success rates of dental implants were 98.91% and 80%, respectively. Cumulative success and survival rates in CAT group were 95% and 100% after 2 years of follow-up. The highest marginal bone loss (MBL) was observed (1.26 mm ± 0.99) around implants placed in augmented edentulous sites with initially narrow and flat alveolar crest (defect class CII). Conversely, least MBL (0.48 mm ± 0.78) was detected around implants placed into edentulous sites with two sloped boney walls (defect class AII). Differences between MBL observed around implants placed into initial defect class C, initial defect type and class A (I, II), as well as class BII, were statistically significant (P < 0.05). Among all implants, 148 were considered as successful, 26 exhibited satisfactory survival, nine with compromised survival, and two implants failed. CONCLUSION The present data confirmed the effect of initial ridge morphology on the outcome of implants placed into augmented bone. Specifically, class A and class B atrophic ridge defects, with one and two vertical boney walls, respectively, may be considered as more favorable recipient sites than class C defects with flat morphology. This conclusion is based on least MBL around implants placed into initial defect class A and class B augmented sites, and higher MBL in implants placed into class C recipient sites. A randomized controlled trial is warranted to examine these exploratory observations.
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Affiliation(s)
- Arash Khojasteh
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Reza Motamedian
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Sharifzadeh
- Laboratory for Immunoregulation and Tissue Engineering, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Homayoun H Zadeh
- Laboratory for Immunoregulation and Tissue Engineering, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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15
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Bach L, Borzabadi-Farahani A. Treatment of Labial Mucosal Recession Around Maxillary Anterior Implants With Tenting Screws, Particulate Allograft, and Xenogenic Membrane: A Case Report. J ORAL IMPLANTOL 2016; 42:427-431. [DOI: 10.1563/aaid-joi-d-16-00019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Le Bach
- Department of Oral & Maxillofacial Surgery, The Herman Ostrow School of Dentistry of USC, Los Angeles County/USC Medical Center, Los Angeles, Calif
- Private practice, Whittier, Calif
| | - Ali Borzabadi-Farahani
- Warwick Medical School, University of Warwick, Coventry, UK
- Orthodontics, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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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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Yu H, Chen L, Zhu Y, Qiu L. Bilamina cortical tenting grafting technique for three-dimensional reconstruction of severely atrophic alveolar ridges in anterior maxillae: A 6-year prospective study. J Craniomaxillofac Surg 2016; 44:868-75. [DOI: 10.1016/j.jcms.2016.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/08/2016] [Accepted: 04/12/2016] [Indexed: 01/01/2023] Open
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Treatment of Labial Soft Tissue Recession Around Dental Implants in the Esthetic Zone Using Guided Bone Regeneration With Mineralized Allograft: A Retrospective Clinical Case Series. J Oral Maxillofac Surg 2016; 74:1552-61. [PMID: 27206625 DOI: 10.1016/j.joms.2016.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/06/2016] [Accepted: 04/16/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE Soft tissue augmentation procedures are often performed to correct gingival recession on the facial aspects of implants in the esthetic zone. This retrospective clinical case series reports on the use of guided bone regeneration (GBR) and a coronal advancement flap with a resorbable membrane and allograft. MATERIALS AND METHODS We analyzed the records of 14 patients (7 men and 7 women) with a mean age of 36.78 years (SD, 13.9 years) who were treated for soft tissue recessions around implant-supported restorations in the maxillary central or lateral incisor location. Implant diameters ranged from 3.3 to 4.7 mm. All patients had bone loss confined to the labial surface of the implant. A solvent-dehydrated particulate mineralized allograft (Puros Cancellous Bone Allograft; Zimmer Biomet Dental, Palm Beach Gardens, FL) and a resorbable membrane (CopiOs Pericardium; Zimmer Biomet Dental) were used in a GBR surgical procedure in combination with a roughened titanium tenting screw placed 3 to 4 mm below the implant platform to restore unesthetic defects in the anterior maxilla. RESULTS All postoperative tissue changes from their preoperative states were statistically significant (P < .05, Wilcoxon signed rank test). Mean preoperative crestal bone thickness (measured 2 mm from crest) and mid-implant buccal bone thickness increased by 1.84 mm (SD, 0.89 mm; 95% confidence interval [CI], 1.32 to 2.35 mm) and 2.07 mm (SD, 0.81 mm; 95% CI, 1.60 to 2.53 mm), respectively, approximately 1 year after treatment (P < .001). Significant mean increases of 1.28 mm (SD, 0.53 mm; 95% CI, 0.97 to 1.58 mm), 1.29 mm (SD, 0.81 mm; 95% CI, 0.82 to 1.75 mm) and 1.23 mm (SD, 0.53 mm; 95% CI, 0.92 to 1.53 mm) also were noted in soft tissue thickness, keratinized tissue width, and gingival height, respectively (P < .001). CONCLUSIONS Use of the allograft and xenogeneic membrane effectively increased alveolar hard and soft tissue dimensions in the esthetic zone of the anterior maxilla. Future prospective clinical trials with a control group are needed to compare this technique with conventional methods such as connective tissue graft.
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Sfasciotti GL, Trapani CT, Powers RM. Mandibular Ridge Augmentation Using a Mineralized Ilium Block: A Case Letter. J ORAL IMPLANTOL 2016; 42:215-9. [DOI: 10.1563/aaid-joi-d-15-00023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gian L. Sfasciotti
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Charles T. Trapani
- Department of Scientific & Clinical Affairs, LifeNet Health, Virginia Beach, Va
| | - Ralph M. Powers
- Department of Scientific & Clinical Affairs, LifeNet Health, Virginia Beach, Va
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Ersanli S, Arısan V, Bedeloğlu E. Evaluation of the autogenous bone block transfer for dental implant placement: Symphysal or ramus harvesting? BMC Oral Health 2016; 16:4. [PMID: 26813232 PMCID: PMC4728796 DOI: 10.1186/s12903-016-0161-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background The absence of sufficient bone volume is the most relevant problem in implant dentistry. Grafting from exogenous sources may provide a limited gain but exhibits poor performance in large bone defects. Autogenous bone block transfer (ABBT) from the mandibular symphysis and ramus has been used with varying rates of success. The aim of this study was to compare the efficacy of symphysal and ramus ABBT for the restoration of lost horizontal alveolar bone volume in the anterior maxilla. Implants placed in the augmented areas were also evaluated. Methods The maxillary alveolar bone deficits of 32 patients were treated by similar-sized autogenous bone blocks (7 × 7 × 4 mm) harvested from the symphysis or ramus area. After 4 to 5 months of healing, implants were inserted. At the end of the osseointegration period, the implants were restored by fixed prostheses. Baseline bone thickness was determined by Cone beam computed tomography and was compared to post-op and one-year post-loading bone thickness values where the implants were inserted. Any complications or consequences were noted. The success and survival of the 45 implants were evaluated. The results were analyzed using the Student t-test and Fisher’s exact test (p < 0.05). Results Post-op complications were frequent in both groups. Baseline bone thickness values were similar at the beginning of the study (p = 0.71) and exhibited a significant increase after the ABBT surgery (6.29 (SD 0.86) and 6.01 (SD 0.92) mm in the symphysis and ramus groups, respectively). The amount of bone thickness gain was 4.34 mm (SD: 0.92) and 4.36 mm (SD: 1.01) in the symphysis and ramus groups, respectively. After one year, the mean surface resorption was 0.6 mm (SD: 0.78) and 0.80 mm (SD: 0.56) for the symphysis and ramus groups, respectively (p = 0.089). The success and survival rates of the implants were 94.11 and 96.42 %, respectively. No graft failures were observed. Conclusions Both symphysal and ramus ABBT procedures were successful for the restoration of a horizontal bone defect in the anterior maxilla. Ramus harvesting may be advisable due to fewer complications. Implants placed in the grafted regions exhibited a high success and survival rate within the one-year follow-up period.
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Affiliation(s)
- Selim Ersanli
- Department of Oral Impantology, Faculty of Dentistry, Istanbul University, 34093-Capa, Istanbul, Turkey.
| | - Volkan Arısan
- Department of Oral Impantology, Faculty of Dentistry, Istanbul University, 34093-Capa, Istanbul, Turkey
| | - Elçin Bedeloğlu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul Aydın University, 34088-Florya, Istanbul, Turkey
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Cortical tenting technique versus onlay layered technique for vertical augmentation of atrophic posterior mandibles: a split-mouth pilot study. IMPLANT DENT 2015; 22:566-71. [PMID: 24185462 DOI: 10.1097/01.id.0000433590.33926.af] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study intended to compare the efficacy of onlay layered and cortical tenting grafting techniques for vertical alveolar augmentation. MATERIALS AND METHODS Six patients with bilaterally edentulous atrophic posterior mandibles received 2 thin ramus blocks, covered with bovine bone mineral on 1 side (onlay layered technique), whereas in the opposite side (cortical tenting technique), a thin ramus block was placed over the ridge keeping a distance that was filled with particulate autogenous bone and bovine bone mineral (50:50). Bone height over the mandibular canal was measured on panoramic radiographies taken preoperatively, and 2 weeks and 4 months postoperatively. RESULTS The amount of augmentation in the tenting group (5.2 ± 0.76 mm) was higher than the onlay group (4.48 ± 0.51 mm). Graft resorption was 1.75 ± 1.08 mm in the onlay group and 1.17 ± 0.41 mm in the tenting group. Neither of the differences regarding the amount of augmentation and graft resorption was statistically significant (P = 0.345 and 0831, respectively). CONCLUSION Both of the examined techniques might be favorable methods for vertical augmentation.
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Borzabadi-Farahani A, Zadeh HH. Adjunctive Orthodontic Applications in Dental Implantology. J ORAL IMPLANTOL 2015; 41:501-8. [DOI: 10.1563/aaid-joi-d-13-00235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Implant placement is often necessitated for replacement of teeth with pathologically damaged alveolar bone due to periodontitis or traumatic injury. Surgical augmentation of resorbed bone has many limitations, including lower efficacy of vertical augmentation than horizontal augmentation, as well as morbidity associated with grafting procedure. Orthodontic therapy has been proposed as a useful method for augmenting the resorbed alveolar bone and reforming aesthetically appealing gingival margin, prior to implant placement. This narrative review summarizes the available evidence for the application of orthodontic strategies that can be used as adjunct in selected cases to augment bone volume for the future implant site and maintain space for the prosthetic parts of the implant. These are (1) orthodontic extrusion of compromised teeth to generate vertical bone volume and enhance gingival architecture, (2) tooth preservation and postponing orthodontic space opening to maintain bone volume in future implant site, (3) orthodontic implant site switching to eliminate the deficient bone volume or risky implant sites, and (4) the provision of a rigid fixed-bonded retainer to maintain the implant site. Although there are no randomized controlled clinical trials to evaluate the efficacy of orthodontic therapy for implant site development, clinical case reports and experience document the efficacy of orthodontic therapy for this application.
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Affiliation(s)
- Ali Borzabadi-Farahani
- Orthodontics, Warwick Dentistry, Warwick Medical School, University of Warwick, Coventry, UK, and NHS England, UK
| | - Homayoun H. Zadeh
- Laboratory for Immunoregulation and Tissue Engineering, Division of Periodontology, Diagnostic Sciences and Dental Hygiene, University of Southern California, Los Angeles, Calif
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Khojasteh A, Hassani A, Motamedian SR, Saadat S, Alikhasi M. Cortical Bone Augmentation Versus Nerve Lateralization for Treatment of Atrophic Posterior Mandible: A Retrospective Study and Review of Literature. Clin Implant Dent Relat Res 2015; 18:342-59. [PMID: 26082191 DOI: 10.1111/cid.12317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We sought to assess implant success/survival/failure rate following cortical autogenous tenting technique (CATT) versus inferior alveolar nerve transposition (IANT) in the posterior mandible. MATERIALS AND METHODS Patients who underwent these two procedures between 2007 and 2011 were analyzed. CATT was performed using lateral ramus block graft and implants were inserted simultaneously or after 4 to 6 months. In IANT, implants were placed simultaneously after nerve transposition with or without mental foramen involvement. Data regarding marginal bone level (MBL), pus discharge (PD), neurosensory dysfunction (NSD), implant mobility, and failure were collected. Success rate was measured based on Pisa Consensus. Independent sample t-test with a significance level of 0.05 was used to compare implant dimensions and MBL changes between the two techniques. RESULTS A total of 118 patients with a mean age of 54.85 years were included. The mean follow-up after CATT and IANT was 37.97 and 18.51 months, respectively. The overall survival and success rates of dental implants in the CATT group were 98.73% and 71.52%, respectively. The corresponding values for IANT subjects were 98.74% and 94.56%, respectively. Implant length and diameter in IANT group were significantly longer and wider than implants used after CATT (p value < .001). MBL changes in both techniques were less than 1 mm (p value = .79). Two cases of NSD, seven PD, and two implant failures were found in the CATT group. For IANT patients, seven permanent NSD, two PD, two implant failures, and one mandibular fracture were documented. CONCLUSION Both techniques had implant survival rates similar to implants placed in unaltered bone. A higher implant success rate, albeit with higher incidence of long-lasting nerve damage, was observed in the IANT group.
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Affiliation(s)
- Arash Khojasteh
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Dental Research Center, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hassani
- Department of Oral and Maxillofacial Surgery, Azad University of Medical Sciences Dental Branch, Tehran, Iran
| | - Saeed Reza Motamedian
- Dental Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Marzieh Alikhasi
- Department of Prosthodontics and Dental Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Tentpole technique for bone regeneration in vertically deficient alveolar ridges: A review. J Oral Biol Craniofac Res 2015; 5:92-7. [PMID: 26258021 DOI: 10.1016/j.jobcr.2015.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/04/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vertical augmentation is necessary in cases of extensive resorption of alveolar ridge for dental implants placement and esthetic prosthetic rehabilitation. Several surgical techniques have been used to increase bone height including distraction osteogenesis, and particulate or block bone graft. This study was done to describe the evolution of "tentpole technique" and to review the literature related to this technique and thus evaluate its effectiveness to augment large vertical alveolar ridge defects for implant placement. MATERIAL AND METHODS The evidence was obtained by PubMed and Google search using key words: tentpole technique, ridge resorption, and alveolar ridge augmentation . The years of search included from 2002 till 2013. RESULTS The technique was described as effective on review of outcome of existing studies. It was found that considerable and stable increase in alveolar ridge height was achieved using tentpole technique. CONCLUSIONS Tenting of periosteum and soft tissue matrix maintains space and enhances the effectiveness of bone graft. This technique offers predictable functional and esthetic reconstruction of large vertical alveolar defects.
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Simultaneous implant placement and bone grafting with particulate mineralized allograft in sites with buccal wall defects, a three-year follow-up and review of literature. J Craniomaxillofac Surg 2014; 42:552-9. [DOI: 10.1016/j.jcms.2013.07.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 06/07/2013] [Accepted: 07/31/2013] [Indexed: 12/18/2022] Open
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Role of cone beam computed tomography in rehabilitation of a traumatised deficient maxillary alveolar ridge using symphyseal block graft placement. Case Rep Dent 2013; 2013:748405. [PMID: 23762650 PMCID: PMC3674654 DOI: 10.1155/2013/748405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/30/2013] [Indexed: 12/04/2022] Open
Abstract
Deficiencies in the alveolar ridges cause multiple problems in achieving aesthetic and functional outcome of implant therapy and are commonly restored by using onlay graft from intraoral source. Careful assessment of the recipient as well as the donor site using cone beam computed tomography (CBCT) is a prerequisite to ideal treatment planning. This paper highlights the critical role of CBCT in planning a successful rehabilitation of traumatised deficient anterior maxillary alveolar ridge using autogenous block graft from mandibular symphysis, followed by implant placement. A 21-year-old male reported with missing right maxillary lateral incisor due to traumatic avulsion 6 months back. A concavity was found on the labial aspect of edentulous area. Serial transplanar images on CBCT revealed gross irregular radiolucency in place of labial cortical plate. Using CBCT, size of the required block was estimated, and mandibular symphyseal area was evaluated for the feasibility of harvesting a graft of suitable dimension. Onlay block graft was harvested from mandibular symphysis and placed at the edentulous site to augment the alveolar ridge. Implants were placed 5 months later and loaded successfully after osseointegration. After 1 year of followup, implant-based prosthesis is working well, without any complications.
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Liu X, He J. Ridge Augmentation and Concomitant Implant Placement in the Esthetic Zone Through One Surgical Site: A Clinical Report. J ORAL IMPLANTOL 2013; 41:310-3. [PMID: 23614854 DOI: 10.1563/aaid-joi-d-12-00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Xin Liu
- 1 Department of Oral Implant, Oral and Maxillofacial Center, Stomatologic Hospital & College, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, China
| | - Jiacai He
- 2 Oral and Maxillofacial Surgery, Stomatologic Hospital & College, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, China
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Full-arch vertical reconstruction of an extremely atrophic mandible with "box technique". A novel surgical procedure: a clinical and histologic case report. IMPLANT DENT 2013; 22:2-7. [PMID: 23287979 DOI: 10.1097/id.0b013e318278fa1c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a new augmentation procedure named "box technique" for bone reconstruction in a severely atrophic jaw with mandibular and mental nerve dehiscence. MATERIAL AND METHODS The first surgical box technique procedure was performed to augment the atrophic posterior area. Simultaneously, 2 implants were inserted into the interforaminal zone to stabilize the denture. After 6 months, 2 implants were positioned in the regenerated bone, and a second box technique procedure was performed to reconstruct the ridge in the area of fixture exposition. Six months after the second surgery, the patient was rehabilitated with a removable prosthesis retained on 4 implants. RESULTS The clinical and histologic analyses highlighted outstanding healing resulting from this vertical and horizontal allografting and included complete resorption of poly D,L-lactide meshes and substitution of the mineralized human bone allograft with an excellent quality new bone formation. CONCLUSIONS Results confirm the effectiveness of the technique, which needs a further case series study endorsing its reliability.
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Alveolar ridge augmentation for implant fixation: status review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:S179-89. [PMID: 23063396 DOI: 10.1016/j.oooo.2011.09.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 08/08/2011] [Accepted: 09/22/2011] [Indexed: 11/20/2022]
Abstract
This literature review was performed to illustrate and compare different alveolar ridge augmentation procedures before dental implant placement. The review was based on clinical and research studies listed in Pubmed. There is not enough evidence to support any single method as gold standard for any given condition, and choice seemed to be based on personal preferences. There is a lack of long-term survival data or success rates of grafting materials regarding donor and recipient sites. Although ridge splitting and distraction osteogenesis techniques eliminate donor site morbidity, circumvent the use of grafting materials, and reduce the operation time, some disadvantages and limitations should be considered. More studies are needed to compare the fate and characteristics of new bone obtained by these different procedures, as well as subsequent implant survival rates.
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Jensen OT, Ringeman JL, Cottam JR, Casap N. Orthognathic and osteoperiosteal flap augmentation strategies for maxillary dental implant reconstruction. Dent Clin North Am 2011; 55:813-846. [PMID: 21933734 DOI: 10.1016/j.cden.2011.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this article, five variations in orthognathic surgery procedures used to gain bone mass for implants are discussed: Le Fort I downgrafting, Le Fort I distraction, sub-Le Fort I interpositional sandwich grafting, segmental sandwich grafting, and the island osteoperiosteal flap approach.
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Affiliation(s)
- Ole T Jensen
- Implant Dentistry Associates of Colorado, 8200 East Belleview Avenue, Suite 520E, Greenwood Village, CO 80111, USA.
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Jensen OT, Ringeman JL, Cottam JR, Casap N. Orthognathic and Osteoperiosteal Flap Augmentation Strategies for Maxillary Dental Implant Reconstruction. Oral Maxillofac Surg Clin North Am 2011; 23:301-19, vi. [PMID: 21492803 DOI: 10.1016/j.coms.2011.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bone grafting by means of a tunnel dissection: predictable results using stem cells and matrix. IMPLANT DENT 2010; 19:280-7. [PMID: 20683284 DOI: 10.1097/id.0b013e3181e40166] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bone marrow aspirate has been shown to add stem cells, growth factors, and cytokines to bone graft matrices used in bone augmentation sites. The combination of bone marrow aspirate and resorbable scaffold material has a significant osteogenic capability that exceeds that of autogenous bone grafts. This article describes a subperiosteal tunneling technique for applying such grafts to defective sites. Treatment of 2 patients for whom the technique was used to graft 6 deficient sites is described. Histological results and histomorphometric analysis of bone core samples taken from 4 of the 6 grafting sites are also reported. Analysis of the 4 bone cores taken between 4 and 6 months showed a range of 34% to 45% of new bone.
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Le B, Rohrer MD, Prasad HS, Prassad HS. Screw "tent-pole" grafting technique for reconstruction of large vertical alveolar ridge defects using human mineralized allograft for implant site preparation. J Oral Maxillofac Surg 2010; 68:428-35. [PMID: 20116718 DOI: 10.1016/j.joms.2009.04.059] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 03/12/2009] [Accepted: 04/21/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of using titanium screws in combination with particulate human mineralized allograft, in a "tenting" fashion, to augment large vertical alveolar ridge defects for implant placement. MATERIALS AND METHODS This prospective case study evaluated augmentation in consecutive patients with large (>7 mm) vertical alveolar ridge defects. Vertical ridge augmentation was performed using mineralized allograft placed around titanium screws to tent out the soft tissue matrix. The ridges were clinically evaluated 4 to 5 months after augmentation, and implants were placed at that time. Bone cores were harvested from all patients for histologic evaluations. RESULTS Fifteen patients were treated in this prospective case study, and the mean vertical augmentation was 9.7 mm. Two patients had wound dehiscence resulting in loss of graft and requiring secondary grafting before implant placement. Five patients required 2-stage grafting procedures to achieve ideal ridge height before implant placement. Clinical evaluation of the grafted sites upon re-entry revealed uniform ridge anatomy. Histomorphometric analysis of 7 specimens revealed a mean bone content of 43%. A total of 32 implants were placed into grafted sites in 15 patients. All implants were integrated and successfully restored. Mean follow-up was 16.8 months after implant placement. CONCLUSIONS Tenting of the periosteum and soft tissue matrix with titanium screws maintains space and minimizes resorption of mineralized particulate allograft. This technique offers predictable functional and esthetic reconstruction of large vertical defects without the use of autogenous bone and is capable of osseointegration. More studies are needed to evaluate the stability of vertically grafted bone after long-term loading.
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Affiliation(s)
- Bach Le
- Department of Oral and Maxillofacial Surgery, USC School of Dentistry, Los Angeles, CA, USA.
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Cancellous and Cortical Microparticulate Allograft for Dental Implantation: An Experimental Study in Non-Human Primates. IMPLANT DENT 2009; 18:420-7. [DOI: 10.1097/id.0b013e3181ad18d6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alveolar cleft repair in adults using guided bone regeneration with mineralized allograft for dental implant site development: a report of 2 cases. J Oral Maxillofac Surg 2009; 67:1716-22. [PMID: 19615587 DOI: 10.1016/j.joms.2009.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 03/12/2009] [Accepted: 04/19/2009] [Indexed: 01/12/2023]
Abstract
Alveolar bone grafting is an integral part of the surgical management of oral clefts. The rationale behind alveolar cleft repair includes maxillary arch stabilization, closure of the oronasal fistula, nasal base support, nasolabial soft tissue reconstruction, and creation of bony support for tooth eruption or dental implant placement. Currently, the graft material of choice is autogenous bone graft from the anterior iliac crest. Nonetheless, autogenous bone grafting carries the significant risk of donor-site morbidity, leads to postoperative pain, and entails an additional operative cost. With the success of allograft bone material in implant site development, we explore the option of using human mineralized cancellous bone allograft in alveolar cleft patients. This article reports on the success of using mineralized human allograft to treat 2 adult patients with severe alveolar cleft defects. The repairs were accomplished with a guided bone regeneration technique without the use of any autogenous bone, with subsequent successful placement of endosseous implants. This opens up the possibility of avoiding harvesting iliac crest bone graft and its associated morbidities and expense by use of only mineralized allograft and a guided bone regeneration technique in an outpatient office setting.
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Esthetic Grafting for Small Volume Hard and Soft Tissue Contour Defects for Implant Site Development. IMPLANT DENT 2008; 17:136-41. [DOI: 10.1097/id.0b013e318174db99] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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