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Urban I, Sanz-Sánchez I, Monje A, Montero E. Complications and treatment errors in peri-implant hard tissue management. Periodontol 2000 2023; 92:278-298. [PMID: 37016554 DOI: 10.1111/prd.12472] [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: 04/22/2022] [Revised: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 04/06/2023]
Abstract
Bone augmentation procedures aim to regenerate the deficient alveolar ridge to properly place dental implants that are completely surrounded by bone. However, these are invasive and technically demanding surgeries that are not free of either complications or treatment errors. Careful patient selection and preparation is a mandatory process to reduce the rate of complications in bone regeneration procedures, irrespective of the technique used. It is important to assess the cost benefit of the intervention and to evaluate the potential impact on the patient's quality of life, especially in the elderly and medically compromised patients. Most common postoperative complications are wound dehiscences, which may be reduced, at least partially, by proper knowledge of the surgical technique and the craniofacial anatomy. Other complications that may appear are postoperative infections or nerve injuries. The aim of this narrative review is to summarize the best available scientific evidence on the incidence of complications, as well as the ideal strategies for their prevention and management. Depending on the severity of the complication, treatment approaches may vary and can include drug prescription or even surgical re-entries to remove exposed barrier membranes or contaminated bone grafts. Adequate prevention and proper management of complications associated with bone augmentation interventions are a requirement for clinicians carrying out these demanding procedures. A series of cases illustrating proper management of complications in different clinical scenarios is presented.
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Affiliation(s)
- Istvan Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
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Özer T, Başlarlı Ö, Aktaş A, Barış E, Ocak M. Effect of Locally Administered Denosumab on Bone Graft Healing in Rabbit Critical-Size Calvarial Defects. Indian J Orthop 2022; 56:1424-1430. [PMID: 35928658 PMCID: PMC9283553 DOI: 10.1007/s43465-022-00673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM Denosumab is a human monoclonal immunoglobulin G2 antibody developed from the ovarian cells of Chinese hamsters. We aimed to histomorphometrically and radiologically evaluate the effects of xenografts used with local denosumab on the healing of defect sites using rabbit skulls. MATERIALS AND METHODS Two 10-mm diameter critical-size defects were created in 16 rabbits. The defect areas were filled with xenografts and xenograft + 3 mg denosumab in the control and denosumab groups (DEN), respectively. We evaluated new bone, residual graft, soft tissue areas, and bone volume in 4- and 8-week study groups. RESULTS Histomorphometrically, there were no statistically significant differences between groups at both 4 and 8 weeks regarding residual graft, new bone, and soft tissue area (p > 0.05). The 4-week residual graft control group values were significantly higher than the 8-week values (p < 0.05). The soft tissue area was significantly greater in the 4-week compared with the 8-week DEN group (p < 0.05). The radiologically measured total bone volume was significantly greater in the 8-week specimens than in the 4-week specimens (p < 0.05). CONCLUSION In this study, denosumab used locally with bone grafts, showed no direct effect on new and total bone volume.
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Affiliation(s)
- Taha Özer
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Özgür Başlarlı
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Alper Aktaş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Emre Barış
- Department of Oral Pathology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Mert Ocak
- Vocational School of Health, Ankara University, Ankara, Turkey
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Starch-Jensen T, Deluiz D, Tinoco EMB. Horizontal Alveolar Ridge Augmentation with Allogeneic Bone Block Graft Compared with Autogenous Bone Block Graft: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2020; 11:e1. [PMID: 32377325 PMCID: PMC7191383 DOI: 10.5037/jomr.2020.11101] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/04/2020] [Indexed: 12/19/2022]
Abstract
Objectives The objective of the present systematic review was to test the hypothesis of no difference in implant treatment outcome after horizontal ridge augmentation with allogeneic bone block compared with autogenous bone block. Material and Methods A MEDLINE (PubMed), Embase and Cochrane Library search in combination with a hand-search of relevant journals was conducted including human studies published in English through March 13, 2019. Comparative and non-comparative studies evaluating horizontal ridge augmentation with allogeneic bone block were included. Cochrane risk of bias tool and Newcastle-Ottawa Scale were used to evaluate risk of bias. Results One comparative study with high quality and 12 non-comparative studies fulfilled the inclusion criteria. Considerable heterogeneity prevented meta-analysis from being performed. The comparative retrospective short-term study demonstrated no significant difference in implant treatment outcome between the two treatment modalities. Non-comparative long-term studies revealed high implant survival, gain in alveolar ridge width and bone regeneration with allogeneic bone block. However, non-comparative studies disclosed high incidence of complications including dehiscence, exposure of allogeneic bone block and partial or total loss of the grafts. Conclusions There seemed to be no difference in implant treatment outcome after horizontal ridge augmentation with allogeneic bone block compared with autogenous bone block. However, increased risk of complications was frequently reported with allogeneic bone block.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Daniel Deluiz
- Department of Periodontology, Rio de Janeiro State University, Rio de JaneiroBrazil
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Pérez-González F, Molinero-Mourelle P, Sánchez-Labrador L, Sáez-Alcaide LM, Limones A, Cortés-Bretón Brinkmann J, López-Quiles J. Assessment of clinical outcomes and histomorphometric findings in alveolar ridge augmentation procedures with allogeneic bone block grafts: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2020; 25:e291-e298. [PMID: 32040468 PMCID: PMC7103446 DOI: 10.4317/medoral.23353] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 12/09/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This systematic literature review aimed to evaluate the efficacy of allogeneic bone blocks for ridge augmentation by assessing block survival rates and subsequent implant survival, including post-surgical complications and histomorphometric analysis. MATERIAL AND METHODS An electronic and manual search among references, was conducted up to April 2019 by two independent authors. Inclusion criteria were: human clinical trials in which the outcomes of allogeneic bone block grafts were evaluated by means of their survival rates and subsequent implant success rates. RESULTS Seven articles fulfilled the inclusion criteria and were analyzed. A total of 323 allogeneic block grafts were monitored for a minimum of 12 months follow-up after surgery, of which thirteen (4.02%) failed. Regarding the cumulative implant survival rate, the weighted mean was 97.36%, computed from 501 implants. Histologic and histomorphometric analysis showed that allogeneic block grafts presented some clinical and microstructural differences in comparison with autologous block grafts. CONCLUSIONS Atrophic alveolar crest reconstruction with allogeneic bone block grafts would appear a feasible alternative to autologous bone block grafts, obtaining a low block graft failure rate, similar implant survival rate and fewer postoperative complications. Further investigations generating long term data are needed to confirm these findings.
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Affiliation(s)
- F Pérez-González
- Department of Conservative Dentistry and Orofacial Prosthodontics Faculty of Dentistry, Complutense University of Madrid, Spain Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
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Locally administrated single-dose teriparatide affects critical-size rabbit calvarial defects: A histological, histomorphometric and micro-CT study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:478-484. [PMID: 31530436 PMCID: PMC6938999 DOI: 10.1016/j.aott.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/08/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of teriparatide (PTH 1-34, rhPTH) on a rabbit defect model with local xenogen grafts histomorphometrically and radiologically. METHODS For this purpose, two 10 mm diameter critical-size defects were created in the calvaria of 16 rabbits. In the control group, the defect area was filled with a xenogen graft, while in the teriparatide group (PTH 1-34), a xenogen graft combination with 20 mcg teriparatide was used. For both 4 - week and 8 - week study groups, new bone, residual graft, and soft tissue areas were evaluated as well as bone volume histomorphometrically and radiologically. RESULTS Histomorphometrically, there was a significant difference in new bone area values at the 8th week (p < 0.05), but there was no significant difference between the 4 - week values (p > 0.05). There was no statistically significant difference between the groups at both 4 and 8 weeks (p > 0.05). In the radiologically measured total bone volume values, PTH1-34 group values were found to be significantly higher for both 4 - and 8 - weeks values compared to the control groups (p < 0.05). CONCLUSION In this study, rhPTH, which is used locally in defect areas to be repaired with bone grafts, increases both new bone volume and total bone volume.
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Procopio O, Trojan D, Frigo AC, Paolin A. Use of homologous bone for alveolar crest reconstruction in 483 patients with 5 years' outcomes post implantation. Oral Maxillofac Surg 2019; 23:353-363. [PMID: 31147787 PMCID: PMC6689316 DOI: 10.1007/s10006-019-00781-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/21/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical course of bone reconstruction of the alveolar crest using homologous fresh-frozen bone harvested from deceased donors. METHODS A retrospective survey was based on the Castelfranco Veneto Hospital database, in which 3264 clinical records with a primary or secondary diagnosis of alveolar atrophy were collected over a 10-year period. A random sample of 483 patients with at least 5 years' follow-up was included in the survey. Patients were contacted by telephone and administered a questionnaire with specific questions to build a significant sample. RESULTS Of the patients, 449 (93% of the sample) had an uneventful follow-up after surgery and 93.2% received at least one implant, with a mean of 3.4 implants per patient. At the time of the survey, 93% of the patients were wearing a dental prosthesis, 86.9% had not lost any implants, and 6.7% had lost at least one implant, while 6.4% still had implants but presented some clinical problems. Finally, patients were asked to provide an index score (1-10 points) on the therapy as a whole, i.e., bone graft, implants, and prostheses. A score of insufficient (up to 5 points) was given by 5.3% of patients, of sufficient (6 to 7 points) by 6.1%, and of good/very good (over 7) by 88.6%. CONCLUSIONS Homologous bone for alveolar crest reconstruction can be a valid alternative to autologous grafting if specific tissue limitations are considered when planning therapy. Creeping substitution is partial and slower than in autologous grafts, especially in cases where cortical bone is thick or volume graft is very large. The quality of soft tissue coverage and mucosa lining is also important, possibly due to slower tissue revascularization, so future implants should predictably be positioned primarily within the original host bone.
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Affiliation(s)
- Olindo Procopio
- Maxillofacial Surgery Unit, Castelfranco Veneto Hospital, Treviso, Italy
| | - Diletta Trojan
- Treviso Tissue Bank Foundation, Piazzale Ospedale, 1, Treviso, Italy.
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Adolfo Paolin
- Treviso Tissue Bank Foundation, Piazzale Ospedale, 1, Treviso, Italy
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Deluiz D, Delcroix GJR, D'Ippolito G, Grau-Monge C, Bonnin-Marquez A, Reiner T, Tinoco EMB, Amadeu T, Pires FR, Schiller PC. Human Bone Marrow-Derived Mesenchymal Stromal Cell-Seeded Bone Biomaterial Directs Fast and Superior Mandibular Bone Augmentation in Rats. Sci Rep 2019; 9:11806. [PMID: 31413279 PMCID: PMC6694159 DOI: 10.1038/s41598-019-48236-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/29/2019] [Indexed: 01/11/2023] Open
Abstract
Atrophic maxillary ridges present a challenge in the field of oral implantology. Autologous bone is still considered the gold standard grafting material, but the increased morbidity and surgical complications represent a major drawback for its use. The aim of this study was to assess the efficacy of an off-the-shelf cell-seeded bone biomaterial for mandibular bone augmentation, compared to its acellular counterpart. We used a rat model to test the osteogenic properties of bone marrow-derived mesenchymal stromal cells (MSCs)-seeded bone microparticles compared to acellular bone microparticles alone. Rats were euthanized at 4 and 8 weeks, and results analyzed using micro-CT imaging, histology (H&E, Masson’s Trichrome), histomorphometry and immunohistology (Tartrate-Resistant Acid Phosphatase-TRAP, Osteocalcin and human specific anti-mitochondria antibodies). Micro-CT analysis demonstrated that the cell-seeded biomaterial achieved significantly more bone volume formation at 4 weeks (22.75 ± 2.25 mm3 vs 12.34 ± 2.91 mm3, p = 0.016) and at 8 weeks (64.95 ± 5.41 mm3 vs 42.73 ± 10.58 mm3, p = 0.029), compared to the acellular bone microparticles. Histology confirmed that the cell-seeded biomaterial was almost completely substituted at 8 weeks, in opposition to the acellular biomaterial group. Immunohistochemical analysis showed a significantly higher number of TRAP and Osteocalcin positive cells at 4 weeks in the cell-seeded group compared to the acellular group, thereby demonstrating a higher rate of bone remodeling in the presence of MSCs. The grafted human cells remained viable and were detected up to at least 8 weeks, as observed using the human specific anti-mitochondria antibody. This off-the-shelf material available in unlimited quantities could therefore represent a significant advance in the field of mandibular bone augmentation by providing a larger volume of new bone formation in a shorter time.
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Affiliation(s)
- Daniel Deluiz
- Department of Periodontology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. .,Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA. .,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Gaëtan J-R Delcroix
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Gianluca D'Ippolito
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Department of Biomedical Engineering, College of Engineering, University of Miami, Miami, FL, USA
| | - Cristina Grau-Monge
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Bonnin-Marquez
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Teresita Reiner
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Eduardo M B Tinoco
- Department of Periodontology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Thaís Amadeu
- Department of Pathology and Laboratories, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fabio R Pires
- Department of Oral Pathology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paul C Schiller
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA. .,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA. .,Department of Biochemistry & Molecular Biology and Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
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Use of homologous bone for alveolar crest reconstruction in 483 patients with 5 years' outcomes post implantation. Oral Maxillofac Surg 2019. [PMID: 31147787 DOI: 10.1007/s10006-019-00781-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical course of bone reconstruction of the alveolar crest using homologous fresh-frozen bone harvested from deceased donors. METHODS A retrospective survey was based on the Castelfranco Veneto Hospital database, in which 3264 clinical records with a primary or secondary diagnosis of alveolar atrophy were collected over a 10-year period. A random sample of 483 patients with at least 5 years' follow-up was included in the survey. Patients were contacted by telephone and administered a questionnaire with specific questions to build a significant sample. RESULTS Of the patients, 449 (93% of the sample) had an uneventful follow-up after surgery and 93.2% received at least one implant, with a mean of 3.4 implants per patient. At the time of the survey, 93% of the patients were wearing a dental prosthesis, 86.9% had not lost any implants, and 6.7% had lost at least one implant, while 6.4% still had implants but presented some clinical problems. Finally, patients were asked to provide an index score (1-10 points) on the therapy as a whole, i.e., bone graft, implants, and prostheses. A score of insufficient (up to 5 points) was given by 5.3% of patients, of sufficient (6 to 7 points) by 6.1%, and of good/very good (over 7) by 88.6%. CONCLUSIONS Homologous bone for alveolar crest reconstruction can be a valid alternative to autologous grafting if specific tissue limitations are considered when planning therapy. Creeping substitution is partial and slower than in autologous grafts, especially in cases where cortical bone is thick or volume graft is very large. The quality of soft tissue coverage and mucosa lining is also important, possibly due to slower tissue revascularization, so future implants should predictably be positioned primarily within the original host bone.
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Özer T, Aktas A, Barıs E, Çelik HH, Vatansever A. Effects of local alendronate administration on bone defect healing. Histomorphometric and radiological evaluation in a rabbit model. Acta Cir Bras 2017; 32:781-795. [PMID: 29019595 DOI: 10.1590/s0102-865020170090000010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/18/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To performed a histomorphometric and radiological study to evaluate the effects of alendronate sodium administered locally in mandibular bone defects created in rabbits. METHODS Two circular defects 5 mm in diameter were created bilaterally in the mandibular corpus of 20 New Zealand rabbits (i.e., four defects per animal). Each defect received one of four treatments: no treatment (EC group), alendronate irrigation (AL group), autogenous bone grafting (AG group), or alendronate irrigation with autogenous bone grafting (AL+AG group). Histomorphometric and radiological assessments were conducted at 4 and 8 weeks after surgery. RESULTS Between-group comparisons of the new bone area, the value of the AL+AG group was significantly lower thanthe remaining three groups at 4 weeks postoperatively. In all groups, the new bone area was significantly larger at 8 weeks than at 4 weeks. The residual graft area at 4 and 8 weeks was significantly higher in the AL+AG group than in the AG group, although it was significantly smaller at 8 weeks than at 4 weeks in both these groups. CONCLUSION The use of alendronate sodium in conjunction with autogenous bone grafting improves the osteoconductive properties of the graft, enhances graft retention in the defect, and improves ossification.
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Affiliation(s)
- Taha Özer
- DDS, PhD, Department of Oral Surgery, Hacettepe University, Turkey. Scientific, intellectual, conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistics analysis; manuscript preparation and writing; final approval
| | - Alper Aktas
- DDS, PhD, Associate Professor, Department of Oral Surgery, Hacettepe University, Turkey. Scientific, intellectual, conception and design of the study; technical procedures; critical revision
| | - Emre Barıs
- DDS, PhD, Associate Professor, Department of Oral Pathology, Gazi University, Turkey. Acquisition of data, histopathological examinations, critical revision
| | - Hakan Hamdi Çelik
- MD, PhD, Department of Anatomy, Hacettepe University, Turkey. Acquisition of data, critical revision
| | - Alper Vatansever
- PhD, Department of Anatomy, Balıkesir University, Turkey. Acquisition of data, critical revision
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Silva ER, Ferraz EP, Neto ECM, Chaushu G, Chaushu L, Xavier SP. Volumetric Stability of Fresh Frozen Bone Blocks in Atrophic Posterior Mandible Augmentation. J ORAL IMPLANTOL 2017; 43:25-32. [DOI: 10.1563/aaid-joi-d-16-00095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fresh frozen bone allografts (FFB) have become an alternative for bone augmentation in the past decades, especially because of the absence of recent reports of disease transmission or immunologic reactions when it is used. The aim of this prospective controlled study is to evaluate volumetric changes of newly created bone following reconstruction of the atrophic posterior mandible. Twenty consecutive patients presenting for reconstruction of posterior mandibular alveolar bone ridge width ≤6.0 mm and/or height ≤6.0 who met all inclusion and exclusion criteria were included. FFB blocks were used. The main outcome variable investigated was bone volume dynamics. Vertical, horizontal, and 3-dimensional bone gain data were measured from computerized tomography scans. The main predictor variable was time evaluated at 3 points: immediately after surgery (T1), at implant placement (T2), and 1 year after functional loading (T3). Secondary outcome parameters evaluated were implant survival, histologic findings, and microtomographic morphometry. The study included 28 hemi-mandibles, 50 FFB bone blocks, and 15 female and 5 male patients (mean age, 51.8 years). Block and implant survival rates were 100% and 96%, respectively, after 31.75 months of follow-up. Vertical and horizontal bone gain at T2 was 5.15 and 6.42 mm, respectively. Volumetric resorption was 31% at T2, followed by an additional 10% reduction at T3. Histologic evaluation showed newly formed vital bone in intimate contact with the remaining FFB. Microtomography revealed 31.8% newly formed bone, 14.5% remaining grafted bone, and 53.7% connective tissue and bone marrow. Thus, FFB blocks may lead to new bone formation and consolidation, with satisfactory volumetric bone maintenance, allowing implant-supported rehabilitation with high success rates.
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Affiliation(s)
- Erick Ricardo Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, The School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
| | - Emanuela Prado Ferraz
- Department of Oral and Maxillofacial Surgery and Periodontology, The School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
| | - Evandro Carneiro Martins Neto
- Department of Oral and Maxillofacial Surgery and Periodontology, The School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel
| | - Liat Chaushu
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel
| | - Samuel Porfírio Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology, The School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
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Do Porous Titanium Granule Grafts Affect Bone Microarchitecture at Augmented Maxillary Sinus Sites? A Pilot Split-Mouth Human Study. IMPLANT DENT 2017. [PMID: 26200164 DOI: 10.1097/id.0000000000000275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this randomized controlled clinical study was to analyze the bone microarchitecture at augmented maxillary sinus sites by using different materials in patients to compare the effect of porous titanium granules as a sinus augmentation material with bone microstructural features. MATERIALS AND METHODS Eight subjects with bilateral atrophic posterior maxilla of residual bone height <4 mm included in this study and each patient was treated with bilateral sinus augmentation procedure using xenograft with equine origin (Apatos, Osteobiol; Tecnoss Dental) and xenograft (1 g) + porous titanium (1 g) granules (Natix; Tigran Technologies AB). Sixteen human bone biopsy samples were taken from patients receiving two-stage sinus augmentation therapy during implant installation and analyzed using microcomputerized tomography. Three-dimensional bone structural parameters were analyzed in details: tissue volume, bone volume, percentage of bone volume, bone surface and bone surface density, bone specific surface, trabecular thickness trabecular separation, trabecular number, trabecular pattern factor, structural model index, fractal dimension, and bone mineral density. RESULTS No statistically significant differences were found between groups according to bone structural parameters. CONCLUSIONS Porous titanium grafts may ensure a space for new bone formation in the granules, which may be a clinical advantage for long-term success.
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Deluiz D, Oliveira LS, Fletcher P, Pires FR, Tinoco JM, Tinoco EMB. Histologic and Tomographic Findings of Bone Block Allografts in a 4 Years Follow-up: A Case Series. Braz Dent J 2016; 27:775-780. [DOI: 10.1590/0103-6440201601100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/30/2016] [Indexed: 12/26/2022] Open
Abstract
Abstract The aim of this paper is to report histologic and tomographic findings of fresh frozen bone block allografts bearing dental implants in functional occlusion in a long-term follow-up. Four patients with implants functionally loaded for 4 years on augmented ridges requiring additional mucogingival surgery or implant placement were included in this case series. Cone-beam tomography scans were compared volumetrically between the baseline (first implant placement) and current images. Biopsies of the grafts were retrieved and sent to histological analysis. Volumetric reduction of the grafts varied from 2.1 to 7.7%. Histological evaluation demonstrated well-incorporated grafts with different degrees of remodeling. While data presented in this report are from a small sample size and do not allow definitive conclusions, the biopsies of the grafted sites were very similar to the host's native bone. Remodeling of the cortical portion of the allografts seems to take longer than the cancellous portion. The presence of unincorporated graft remains did not impair the implant success or the health of the surrounding tissues. This is the first time histologic and tomographic long term data of bone allograft have been made available in dentistry.
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Affiliation(s)
- Daniel Deluiz
- Universidade do Estado do Rio de Janeiro, Brazil; Pontifícia Universidade Católica, Brazil
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Deluiz D, Oliveira L, Fletcher P, Pires FR, Nunes MA, Tinoco EM. Fresh-Frozen Bone Allografts in Maxillary Alveolar Augmentation: Analysis of Complications, Adverse Outcomes, and Implant Survival. J Periodontol 2016; 87:1261-1267. [DOI: 10.1902/jop.2016.160155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Deluiz D, Santos Oliveira L, Ramôa Pires F, Reiner T, Armada L, Nunes MA, Muniz Barretto Tinoco E. Incorporation and Remodeling of Bone Block Allografts in the Maxillary Reconstruction: A Randomized Clinical Trial. Clin Implant Dent Relat Res 2016; 19:180-194. [DOI: 10.1111/cid.12441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/30/2016] [Accepted: 07/11/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel Deluiz
- Postdoctoral researcher, Department of Periodontology; State University of Rio de Janeiro; RJ, Rio de Janeiro Brazil
| | - Luciano Santos Oliveira
- Professor, Department of Implantology; Pontifical Catholic University of Rio de Janeiro; Rio de Janeiro RJ Brazil
| | - Fábio Ramôa Pires
- Professor, Department of Stomatology, Estácio de Sá University; Rio de Janeiro RJ Brazil
| | - Teresita Reiner
- Investigator, Geriatric Research, Education and Clinical Center - Bruce W. Carter Veterans Affairs Medical Center; Miami FL USA
| | - Luciana Armada
- Professor, Department of Endodontics, Estácio de Sá University; Rio de Janeiro RJ Brazil
| | - Marcus A. Nunes
- Professor, Department of Statistics, Federal University of Rio Grande do Norte; Natal RN Brazil
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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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16
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Rodella LF, Cocchi MA, Rezzani R, Procacci P, Hirtler L, Nocini P, Albanese M. Fresh frozen bone in oral and maxillofacial surgery. J Dent Sci 2015. [DOI: 10.1016/j.jds.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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17
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Dias RR, Sehn FP, de Santana Santos T, Silva ER, Chaushu G, Xavier SP. Corticocancellous fresh-frozen allograft bone blocks for augmenting atrophied posterior mandibles in humans. Clin Oral Implants Res 2014; 27:39-46. [DOI: 10.1111/clr.12509] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Rafael R. Dias
- Department of Oral and Maxillofacial Surgery and Periodontology; Ribeirão Preto Dental School; University of São Paulo; São Paulo Brazil
| | - Felipe P. Sehn
- Department of Oral and Maxillofacial Surgery and Periodontology; Ribeirão Preto Dental School; University of São Paulo; São Paulo Brazil
| | - Thiago de Santana Santos
- Department of Oral and Maxillofacial Surgery and Periodontology; Ribeirão Preto Dental School; University of São Paulo; São Paulo Brazil
| | - Erick R. Silva
- Department of Oral and Maxillofacial Surgery and Periodontology; Ribeirão Preto Dental School; University of São Paulo; São Paulo Brazil
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery; School of Dentistry; Tel Aviv University; Tel Aviv Israel
- Department of Oral and Maxillofacial Surgery; Rabin Medical Center; Petah Tikva Israel
| | - Samuel P. Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology; Ribeirão Preto Dental School; University of São Paulo; São Paulo Brazil
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18
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Pereira E, Messias A, Dias R, Judas F, Salvoni A, Guerra F. Horizontal Resorption of Fresh-Frozen Corticocancellous Bone Blocks in the Reconstruction of the Atrophic Maxilla at 5 Months. Clin Implant Dent Relat Res 2014; 17 Suppl 2:e444-58. [PMID: 25346211 PMCID: PMC4616242 DOI: 10.1111/cid.12268] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Reliable implant-supported rehabilitation of an alveolar ridge needs sufficient volume of bone. In order to achieve a prosthetic-driven positioning, bone graft techniques may be required. Purpose This prospective cohort study aims to clinically evaluate the amount of resorption of corticocancellous fresh-frozen allografts bone blocks used in the reconstruction of the severe atrophic maxilla. Materials and Methods Twenty-two partial and totally edentulous patients underwent bone augmentation procedures with fresh-frozen allogenous blocks from the iliac crest under local anesthesia. Implants were inserted into the grafted sites after a healing period of 5 months. Final fixed prosthesis was delivered ± 4 months later. Ridge width analysis and measurements were performed with a caliper before and after grafting and at implant insertion. Bone biopsies were performed in 16 patients. Results A total of 98 onlay block allografts were used in 22 patients with an initial mean alveolar ridge width of 3.41 ± 1.36 mm. Early exposure of blocks was observed in four situations and one of these completely resorbed. Mean horizontal bone gain was 3.63 ± 1.28 mm (p < .01). Mean buccal bone resorption between allograph placement and the reopening stage was 0.49 ± 0.54 mm, meaning approximately 7.1% (95% confidence interval: [5.6%, 8.6%]) of total ridge width loss during the integration period. One hundred thirty dental implants were placed with good primary stability (≥ 30 Ncm). Four implants presented early failure before the prosthetic delivery (96.7% implant survival). All patients were successfully rehabilitated. Histomorphometric analysis revealed 20.9 ± 5.8% of vital bone in close contact to the remaining grafted bone. A positive strong correlation (adjusted R2 = 0.44, p = .003) was found between healing time and vital bone percentage. Conclusions Augmentation procedures performed using fresh-frozen allografts from the iliac crest are a suitable alternative in the reconstruction of the atrophic maxilla with low resorption rate at 5 months, allowing proper stability of dental implants followed by fixed prosthetic rehabilitation.
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Affiliation(s)
- Eugénio Pereira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Messias
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ricardo Dias
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Fernando Judas
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Alexander Salvoni
- Faculty of Odontology and Medicine, São Leopoldo Mandic, Campinas, Brazil
| | - Fernando Guerra
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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19
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On the feasibility of utilizing allogeneic bone blocks for atrophic maxillary augmentation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:814578. [PMID: 25535616 PMCID: PMC4177739 DOI: 10.1155/2014/814578] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/02/2014] [Indexed: 01/11/2023]
Abstract
Purpose. This systematic review was aimed at assessing the feasibility by means of survival rate, histologic analysis, and causes of failure of allogeneic block grafts for augmenting the atrophic maxilla. Material and Methods. A literature search was conducted by one reviewer in several databases. Articles were included in this systematic review if they were human clinical trials in which outcomes of allogeneic bone block grafts were studied by means of survival rate. In addition other factors were extracted in order to assess their influence upon graft failure. Results. Fifteen articles fulfilled the inclusion criteria and subsequently were analyzed in this systematic review. A total of 361 block grafts could be followed 4 to 9 months after the surgery, of which 9 (2.4%) failed within 1 month to 2 months after the surgery. Additionally, a weighed mean 4.79 mm (95% CI: 4.51–5.08) horizontal bone gain was computed from 119 grafted sites in 5 studies. Regarding implant cumulative survival rate, the weighed mean was 96.9% (95% CI: 92.8–98.7%), computed from 228 implants over a mean follow-up period of 23.9 months. Histologic analysis showed that allogeneic block grafts behave differently in the early stages of healing when compared to autogenous block grafts. Conclusion. Atrophied maxillary reconstruction with allogeneic bone block grafts represents a reliable option as shown by low block graft failure rate, minimal resorption, and high implant survival rate.
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Correlation between density and resorption of fresh-frozen and autogenous bone grafts. BIOMED RESEARCH INTERNATIONAL 2014; 2014:508328. [PMID: 25050354 PMCID: PMC4094706 DOI: 10.1155/2014/508328] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/11/2014] [Indexed: 12/13/2022]
Abstract
Trial Design. This analysis compared the outcome of fresh-frozen versus autologous bone block grafts for horizontal ridge augmentation in patients with Cawood and Howell class IV atrophies. Methods. Seventeen patients received autologous grafts and 21 patients received fresh-frozen bone grafts. Patients underwent CT scans 1 week and 6 months after surgery for graft volume and density analysis. Results. Two autologous and 3 fresh-frozen grafts failed. Autologous and fresh-frozen grafts lost, respectively, 28% and 46% of their initial volume (P = 0.028). It is noteworthy that less dense fresh-frozen blocks lost more volume than denser grafts (61% versus 16%). Conclusions. According to these 6-month results, only denser fresh-frozen bone graft may be an acceptable alternative to autologous bone for horizontal ridge augmentation. Further studies are needed to investigate its behaviour at longer time points.
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