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Zhang Y, Wen G, Dong W. Clinical outcomes of narrow- and regular-diameter implants with bone augmentation in the anterior maxilla: a systematic review and meta-analysis. Clin Oral Investig 2024; 28:196. [PMID: 38443497 DOI: 10.1007/s00784-024-05588-4] [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: 12/06/2023] [Accepted: 02/25/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES To evaluate the clinical outcomes of narrow-diameter implants (NDIs) and regular-diameter implants (RDIs) with bone augmentation in the anterior maxilla, with implant survival rate (ISR) as the primary outcome. Additionally, secondary outcomes such as peri-implant marginal bone loss (MBL), pocket probing depth (PPD), mechanical complications, and biological complications were also considered. MATERIALS AND METHODS A thorough literature search was performed to identify randomized controlled trials and cohort studies comparing outcomes of NDIs and RDIs with bone augmentation in the anterior maxilla published up to February 2024. Only studies with a minimum follow-up period of 12 months were selected for analysis. Meta-analysis was performed if at least two articles with similar characteristics were available. RESULTS Of the 288 articles initially considered, 5 were included in the analysis, involving 282 NDIs and 100 RDIs. At the 36-month follow-up, no statistically significant differences in ISR, which ranged 93.8-100% for NDIs and were 100% for RDIs, were observed between the two groups (relative risk, 0.989; 95% confidence interval, 0.839-1.165; p = 0.896). Similarly, MBL and PPD did not differ significantly between the two groups. Soft tissue dehiscence was the most common complication found in RDIs. CONCLUSION The results indicate that NDIs yield clinical outcomes similar to those of RDIs with bone augmentation in the anterior maxilla over a 36-month follow-up period. CLINICAL RELEVANCE Considering the similar clinical outcomes, the shortened treatment duration and more rapid esthetic improvement associated with NDIs may render them preferrable to RDIs with bone augmentation, particularly in this esthetic zone.
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Affiliation(s)
- Yan Zhang
- School of Stomatology, North China University of Science and Technology, Tangshan, Hebei, 063210, China
| | - Guochen Wen
- School of Stomatology, North China University of Science and Technology, Tangshan, Hebei, 063210, China
| | - Wei Dong
- School of Stomatology, North China University of Science and Technology, Tangshan, Hebei, 063210, China.
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Perez A, Pierantozzi E, Di Felice R, Lombardi T. Clinical and Biological Validation of an Allogeneous Cancellous Bone Block for Alveolar Maxillary Ridge Reconstruction: A Case Series. Dent J (Basel) 2024; 12:42. [PMID: 38392246 PMCID: PMC10888231 DOI: 10.3390/dj12020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/07/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
This exploratory case series clinically and histologically investigated the performance of allogeneic cancellous freeze-dried bone allograft (FDBA) bone blocks (Maxgraft®) for the lateral augmentation of local alveolar defects in the posterior maxilla as part of two-staged implant therapy. Five patients receiving eight implants 5 months after block augmentation with a follow-up period of up to 3 years were documented and analyzed. Horizontal alveolar dimensions before and 5 months after block augmentation were quantified using CBCT. Radiographic marginal bone level changes were quantified at implant placement, loading, and 1 year post-placement. Graft integration and resorption were histologically qualitatively evaluated from core biopsies retrieved at implant placement. Block augmentations resulted in a pronounced horizontal median bone gain of 7.0 (5.5 to 7.8) mm. Marginal implant bone levels in block-augmented bone remained constant over the 1 year follow-up period. Block grafts appeared histologically well integrated. Histologic analysis also revealed signs of progressive resorption and new bone formation at the lateral aspects of the grafts. The results of this case series support using Maxgraft® cancellous FDBA blocks as suitable materials for the lateral augmentation of local alveolar defects.
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Affiliation(s)
- Alexandre Perez
- Unit of Oral Surgery and Implantology, Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Elena Pierantozzi
- Unit of Oral Surgery and Implantology, Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Roberto Di Felice
- Private Practice, Studio Roberto di Felice, Viale Buozzi 6, 63074 San Benedetto del Tronto, Italy
| | - Tommaso Lombardi
- Unit of Oral Medicine and Oral Maxillofacial Pathology, Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
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Urban IA, Montero E, Amerio E, Palombo D, Monje A. Techniques on vertical ridge augmentation: Indications and effectiveness. Periodontol 2000 2023; 93:153-182. [PMID: 36721380 DOI: 10.1111/prd.12471] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
Vertical ridge augmentation techniques have been advocated to enable restoring function and esthetics by means of implant-supported rehabilitation. There are three major modalities. The first is guided bone regeneration, based on the principle of compartmentalization by means of using a barrier membrane, which has been demonstrated to be technically demanding with regard to soft tissue management. This requisite is also applicable in the case of the second modality of bone block grafts. Nonetheless, space creation and maintenance are provided by the solid nature of the graft. The third modality of distraction osteogenesis is also a valid and faster approach. Nonetheless, owing to this technique's inherent shortcomings, this method is currently deprecated. The purpose of this review is to shed light on the state-of-the-art of the different modalities described for vertical ridge augmentation, including the indications, the step-by-step approach, and the effectiveness.
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Affiliation(s)
- Istvan A Urban
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eduardo Montero
- Department of Periodontics, Universidad Complutense de Madrid, Madrid, Spain
| | - Ettore Amerio
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Palombo
- Department of Periodontics, Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
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Esthetic Assessment following Ridge Augmentation, Late Implant Placement and Immediate Esthetic Reconstruction of the Atrophic Anterior Maxilla. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063689. [PMID: 35329376 PMCID: PMC8949589 DOI: 10.3390/ijerph19063689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/17/2022]
Abstract
Purpose: Evaluate the esthetic outcome of ridge augmentation using cancellous bone-block allografts, late implant placement, and immediate loading in the atrophic anterior maxilla, by PES (pink esthetic score) and WES (white esthetic score) indexes. Materials and Methods: Retrospective cohort study. Inclusion criteria were bone loss of at least 3 mm horizontally and 3 mm vertically according to preliminary CBCT; ridge augmentation using cancellous bone-block allografts; six months later the implant insertion and immediately loaded. PES-WES index was used for esthetic assessment of soft tissues surrounding the final implant-supported prosthesis (ISP). Results: All twenty-five successive individuals were included. The mean follow-up was 12.1 ± 56 months (range, 42−90 months). The mean PES index and WES index were 7 ± 1.74 (range: 5−10) and 8.4 ± 2.12 (range: 5−10), respectively. The mean total combination of PES index and WES index (PES/WES) was 15.3 ± 2.85 (range: 12−20). All ISPs had an overall score >12 (the defined threshold of clinical acceptability). Conclusions: Ridge augmentation in the atrophic anterior maxilla using cancellous bone-block allografts and immediate loading allows a stable esthetic result of the soft and hard tissues over the years (follow-up of 42−90 months).
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Blume O, Donkiewicz P, Palkovics D, Götz W, Windisch P. Volumetric Changes of a Customized Allogeneic Bone Block Measured by Two Image Matching Tools: Introduction of a Novel Assessment Technique for Graft Resorption. Acta Stomatol Croat 2022; 55:406-417. [PMID: 35001936 PMCID: PMC8734454 DOI: 10.15644/asc55/4/8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Objective The purpose of this case report was to present a method for the assessment of volumetric changes of bone blocks during healing and demonstrate its practicability by analysing the resorption of a pre-shaped allogeneic bone block used for the reconstruction of a complex maxillary defect. Materials and methods CBCT-scans of a 19-year-old male treated with an allogeneic bone block were recorded pre-OP, post-OP, and following six months of healing. Graft shrinkage was assessed via two image matching tools, namely coDiagnostiX® and Slicer. A biopsy specimen was harvested along the implant canal at the time of implantation. Results The osseous defect was successfully restored and advanced graft remodelling was found upon re-entry as confirmed by the histomorphometric and histologic analysis. The initial volumes of the graft determined via coDiagnostiX® and Slicer were 0.373 mL and 0.370 mL., respectively, while graft resorption after six months of healing was 0.011 mL (3.00%) and 0.016 mL (4.33%). Conclusions The avoidance of bone harvesting and reduction of invasiveness display an important issue in dentoalveolar restorations. However, before grafting materials can be considered a safe alternative, understanding their clinical performance, especially resorption stability, is pivotal. The present case report demonstrates a limited resorption of the allogeneic bone block and further emphasizes the practicability of determining bone resorption by the here introduced method. As our investigation comprises solely one subject, the results should be considered with care and substantiated by further studies.
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Affiliation(s)
- Oliver Blume
- Private Practice 'Dres. Back & Blume', Tal 13, 80331 Munich, Germany
| | - Phil Donkiewicz
- Department of Oral Surgery and Dental Emergency Care, Faculty of Health, School of Dentistry, Witten / Herdecke University, North RhineWestphalia, Germany
| | - Daniel Palkovics
- Department of Periodontology, Semmelweis University, Szentkirályi u. 47, 1088 Budapest, Hungary
| | - Werner Götz
- Department of Orthodontics, Laboratory for Basic Research in Oral Biology, University of Bonn, Germany
| | - Péter Windisch
- Department of Periodontology, Semmelweis University, Szentkirályi u. 47, 1088 Budapest, Hungary
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Survival Rates of Dental Implants in Autogenous and Allogeneic Bone Blocks: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121388. [PMID: 34946333 PMCID: PMC8705565 DOI: 10.3390/medicina57121388] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/11/2021] [Accepted: 12/14/2021] [Indexed: 12/17/2022]
Abstract
Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.
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Naishlos S, Zenziper E, Zelikman H, Nissan J, Mizrahi S, Chaushu G, Matalon S, Chaushu L. Esthetic Assessment Succeeding Anterior Atrophic Maxilla Augmentation with Cancellous Bone-Block Allograft and Late Restoration Loading. J Clin Med 2021; 10:jcm10204635. [PMID: 34682757 PMCID: PMC8541616 DOI: 10.3390/jcm10204635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Various conditions may lead to bony deficiency in the anterior maxilla. The present study evaluated esthetic (PES—pink esthetic score and WES—white esthetic score) results after augmentation of the anterior atrophic maxilla using cancellous bone-block allograft followed by implant placement and late (conventional) loading. Methods: Cohort study that included 33 patients with missing teeth in the upper anterior region characterized by extensive bone loss. Allogeneic cancellous bone-blocks were used for augmentation. Six months later, a dental implant was inserted. After a waiting time of an additional six-months, implant exposure and reconstruction were performed. The mean follow-up period was 62.93 ± 17.37 months (range 19–82 months). Results: The mean value of PES/WES was 17.8 ± 2.78. All patients had a PES/WES value above 12 (threshold value defined as clinically acceptable esthetics). The mean value of PES was 9.0 ± 1.79 and the mean value of WES was 8.8 ±1.84. Conclusions: Bone augmentation of the anterior atrophic maxilla using cancellous block-allograft and late loading supports achievement of a predictable esthetic result with long-term stability of soft and hard tissues around implant-supported reconstructions.
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Affiliation(s)
- Sarit Naishlos
- Department of Pedodontology, School of Dental Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel;
| | - Eran Zenziper
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel; (E.Z.); (H.Z.); (J.N.); (S.M.); (S.M.)
| | - Helena Zelikman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel; (E.Z.); (H.Z.); (J.N.); (S.M.); (S.M.)
| | - Joseph Nissan
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel; (E.Z.); (H.Z.); (J.N.); (S.M.); (S.M.)
| | - Shaked Mizrahi
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel; (E.Z.); (H.Z.); (J.N.); (S.M.); (S.M.)
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
- Correspondence:
| | - Shlomo Matalon
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel; (E.Z.); (H.Z.); (J.N.); (S.M.); (S.M.)
| | - Liat Chaushu
- Department of Periodontology and Implant Dentistry, School of Dental Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel;
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8
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Clinical performance of tooth root blocks for alveolar ridge reconstruction. Int J Oral Maxillofac Surg 2021; 51:680-689. [PMID: 34507879 DOI: 10.1016/j.ijom.2021.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/25/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022]
Abstract
This systematic literature review set out to investigate the clinical outcomes of autogenous tooth root blocks used for ridge augmentation: survival rates, block resorption, implant survival, post-surgical complications, and histology findings. This review followed PRISMA guidelines. An automated search was made in four databases, supplemented by a manual search for relevant articles published before December 2020. The quality of evidence provided was assessed with the Newcastle-Ottawa Quality Assessment Scale and the Joanna Briggs Institute Critical Appraisal tool. Seven articles fulfilled the inclusion criteria and underwent analysis. The articles included a total of 136 patients, who received 118 autogenous tooth root blocks and 26 autogenous bone blocks showing block survival rates of 99.15% and 100%, respectively. Tooth root blocks presented a mean bone gain that was similar to autologous bone blocks but showed less resorption. The implant survival rate was 98.32% for autogenous tooth root blocks. Reconstruction of alveolar crests by means of autogenous tooth root blocks appears to be a satisfactory option for single-tooth gaps and low grades of bone atrophy in terms of the survival of the bone block and the implants placed subsequently. More research providing long-term data is needed to confirm these findings.
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Tresguerres FGF, Tresguerres IF, Iglesias O, Leco I, Tamimi F, Torres J. The role of cortical perforations in allogeneic block grafting for lateral augmentation in maxilla: A randomized clinical trial. Clin Implant Dent Relat Res 2021; 23:530-542. [PMID: 34107553 DOI: 10.1111/cid.12996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The need of decortication on the recipient site remains unclear for bone regeneration. To our knowledge, there are no human clinical trials that studied the influence of decortication on cancellous allogeneic block grafting. PURPOSE The aim of the present study is to evaluate the influence of perforating the cortex of the recipient site on cancellous allogeneic block graft integration and revascularization in the maxilla. MATERIAL AND METHODS Twenty-six patients referred for lateral bone augmentation were included in this clinical trial. Patients received freeze-dried bone allograft cancellous blocks obtained from the iliac crest; cortical perforations of the recipient bed were performed in the test group while in the control group it was left intact. After a 4-month healing period another surgery was performed to place dental implants, and a bone biopsy was collected using a trephine. All samples underwent micro-CT scans, and were processed for histomorphometric and immunohistochemical analysis. Implant survival comparisons were made using a repeated measures analysis of variance (ANOVA) while all other variables were compared using the analysis of covariance (ANCOVA). RESULTS One hundred and nineteen implants were placed into 110 augmented sites. One hundred percent implant survival rate was reported during 24 months follow-up period. No differences were reported in bleeding on probing at 1 (5.6 vs 9%) and 2 years (13.2 vs 12.1%), probing pocket depth at 1 (3.4 ± 0.95 vs 3.6 ± 1.12 mm) and 2 years (3.8 ± 1.02 vs 4.1 ± 1.46 mm), and marginal bone loss at 1 (0.2 ± 0.52 vs 0.3 ± 0.57 mm) and 2 years (0.6 ± 0.91 vs 0.5 ± 0.87 mm). No statistically significant differences were found in the micro-CT and histomorphometric analysis in terms of newly formed bone (25.7 ± 11.2% vs 22.3 ± 9.7%), soft tissue (33.0 ± 14.7% vs 36.5 ± 15.7%), remnant allograft (39.3 ± 20.4% vs 41.2 ± 22.7%), and bone mineralization (57.2 ± 10.6% vs 53.8 ± 8.7%). Perforating the cortex of the recipient site had no significant effect on angiogenesis as shown by immunohistochemical analysis of CD34 positive blood vessels (39.21 ± 10.53/mm2 vs 34.16 ± 12.67/mm2 ). CONCLUSION Cancellous allogeneic bone block grafts are a clinically acceptable alternative for horizontal bone augmentation. Cortical perforations of the recipient site in the maxilla did not improve angiogenesis nor bone formation within the block graft.
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Affiliation(s)
- Francisco G F Tresguerres
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Isabel F Tresguerres
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Oscar Iglesias
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Isabel Leco
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Jesús Torres
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
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Tunkel J, de Stavola L, Kloss‐Brandstätter A. Alveolar ridge augmentation using the shell technique with allogeneic and autogenous bone plates in a split-mouth design-A retrospective case report from five patients. Clin Case Rep 2021; 9:947-959. [PMID: 33598278 PMCID: PMC7869406 DOI: 10.1002/ccr3.3626] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022] Open
Abstract
Atrophic alveolar ridges of five patients were augmented with allografts and autografts on opposite sites, followed by dental implantation. Both augmentation materials led to equivalent bone gains. Allografts did not compromise the clinical outcome.
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Affiliation(s)
- Jochen Tunkel
- private practice for oral surgeryBad OeynhausenGermany
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11
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Histomorphometrical Assessment of Sinus Augmentation Using Allograft (Particles or Block) and Simultaneous Implant Placement. Sci Rep 2020; 10:9046. [PMID: 32493960 PMCID: PMC7270087 DOI: 10.1038/s41598-020-65874-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 05/07/2020] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to compare the clinical, radiological and histomorphometrical outcome of simultaneous implant placement following augmentation of atrophic maxillary sinuses using allograft (block or particles). Consecutive patients with maxillary residual alveolar ridge height ≤3 mm, scheduled for sinus floor augmentation with simultaneous implant placement, were randomly included. Allograft bone-block or bone-particles served as grafting material. Simultaneously, dental implants were inserted. Biopsies were taken at second stage surgery (after 9 months) for histomorphometric evaluation. Initially 38 sinus augmentations (29 individuals) were allocated for the study. In 4 out of 21(19%) sinuses using particles it was impossible to stabilize the implants and a second stage insertion was preferred, leaving 34 sinuses for histomorphometric evaluation. The difference in the ability to perform simultaneous implant placement was statistically significant (p < 0.05). Ninety implants were inserted simultaneously. All implants osseointegrated. None of the implants was lost up to the end of follow-up time (Range 50–120 months, Mean 74.5 ± 13.5 months). Bone gain radiographically 12.3 ± 1 mm vs. 11.2 ± 1 mm (block vs. particles respectively) and new bone formation histomorphometrically 27.7 ± 15% vs. 32.1 ± 19% (block vs. particles respectively) showed no statistically significant differences between the two groups. Sinus augmentation using allograft (particles or block) and simultaneous implant placement is predictable. All outcome parameters are similar when sinus bone-blocks augmentation is compared to bone-particles augmentation (radiological new bone gain, implant survival, hisomorphometricly new bone formation) despite the ability to stabilize implants, when placed simultaneously with sinus augmentation. Blocks may be advisable when simultaneous implant placement is imperative in cases with residual alveolar bone height ≤3 mm.
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12
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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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13
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Reconstruction of a Unilateral Alveolar Cleft Using a Customized Allogenic Bone Block and Subsequent Dental Implant Placement in an Adult Patient. J Oral Maxillofac Surg 2019; 77:2127.e1-2127.e11. [DOI: 10.1016/j.joms.2019.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
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14
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G F Tresguerres F, Cortes ARG, Hernandez Vallejo G, Cabrejos-Azama J, Tamimi F, Torres J. Clinical and radiographic outcomes of allogeneic block grafts for maxillary lateral ridge augmentation: A randomized clinical trial. Clin Implant Dent Relat Res 2019; 21:1087-1098. [PMID: 31419002 DOI: 10.1111/cid.12834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/15/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND A main drawback of bone block graft surgery is the resorption occurring in early stages of healing. To our knowledge, there are no studies comparing outcomes of freeze-dried bone allograft (FDBA) blocks with different architecture. PURPOSE The aim of this work was to investigate different factors that can affect graft resorption and to compare the resorption rates of two different types of allogeneic blocks, corticocancellous and cancellous. MATERIALS AND METHODS A randomized clinical trial was designed. Twenty-eight patients referred for onlay bone augmentation prior to implant placement were included in the study. Preoperative computerized tomography (CT) was taken for all patients. Patients received FDBA blocks of either cancellous or corticocancellous bone obtained from the iliac crest. After a 4-month follow-up, postoperative CT was taken. Then, another surgery was performed, with the purpose to place dental implants. The aforementioned groups were compared for bone resorption and implant outcome using analysis of covariance (ANCOVA) and repeated ANOVA measures, respectively. Demographic data, trabecular bone density, and graft sites were also analyzed. RESULTS A total of 93 implants were placed in the augmented bone sites over 28 patients. A 100% survival rate was achieved during a mean follow-up period of 24 months in both groups. Higher bone resorption rate was found with cancellous bone grafts (29.2% ± 2.6) compared with corticocancellous grafts (19.3% ± 2.3). Moreover, higher resorption rates in patients with lower bone density (<185 Hounsfield Units) (31.7% ± 3.1) and smokers (26.39% ± 2.3) were observed when compared with patients with higher bone density (>185 Hounsfield Units) (16.8% ± 2.1) and nonsmokers (22.1% ± 2.3), respectively. CONCLUSION Within the limitations of this study, these findings indicate that both corticocancellous and cancellous FDBA grafts constitute a clinical acceptable alternative for bone reconstruction, although cancellous grafts present higher resorption rates. Moreover, host factors such as patient's low bone density and smoking habits may also increase graft resorption rates.
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Affiliation(s)
- Francisco G F Tresguerres
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Arthur R G Cortes
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Sao Paulo, Brazil
| | - Gonzalo Hernandez Vallejo
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Jatsue Cabrejos-Azama
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Quebec
| | - Jesusis Torres
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain
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Urban IA, Montero E, Monje A, Sanz-Sánchez I. Effectiveness of vertical ridge augmentation interventions: A systematic review and meta-analysis. J Clin Periodontol 2019; 46 Suppl 21:319-339. [DOI: 10.1111/jcpe.13061] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/15/2018] [Accepted: 01/06/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Istvan A. Urban
- Department of Implant Dentistry; University of Loma Linda; Loma Linda California
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Alberto Monje
- Department of Periodontology; School of Dentistry; International University of Catalonia; Barcelona Spain
- Department of Oral Surgery and Stomatology; ZMK School of Dentistry; University of Bern; Bern Switzerland
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
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16
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Bone Augmentation and Simultaneous Implant Placement with Allogenic Bone Rings and Analysis of Its Purification Success. MATERIALS 2019; 12:ma12081291. [PMID: 31010149 PMCID: PMC6515040 DOI: 10.3390/ma12081291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 01/13/2023]
Abstract
The main objective of this manuscript was to demonstrate the use of freeze-dried bone allografts (FDBA) by means of a technique of simultaneous bone augmentation and implant placement (“Bone Ring Technique”) in different indications, i.e., ridge reconstruction and sinus floor elevation procedure with a maxillary bone height of less than 4 mm. Moreover, cases with an up to 3-year follow-up were chosen to analyze the techniques of mid-term clinical success. Finally, the purification success of the FDBA was analyzed by means of established scanning electron microscopic (SEM) and histological methods. The FBDA bone ring was applied in three different patients and indications and presented; the healing success was analyzed on the basis of radiographical and clinical images. For analysis of the purification of the allogeneic bone, previously established histological methods and scanning electron microscopy (SEM) were applied. All analyzed patient cases showed that the FDBA-based bone ring was fully integrated into newly built alveolar bone. Furthermore, the observations revealed that the three-dimensional bone reconstructions in maxilla and mandible were stable within the observational period of up to 3 years. Altogether, the present data show that the application of the Bone Ring Technique using the FDBA rings allows for successful regeneration of alveolar bone with a predictable clinical outcome, functionality and esthetics. Moreover, the material analyses showed that the allogeneic bone tissue was free of cells or cell remnants, while the (ultra-) structure of the bone matrix has been retained. Thus, the biological safety of the FDBA has been confirmed.
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17
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Kothiwale S, Bhimani R, Kaderi M, Ajbani J. Comparative study of DFDBA and FDBA block grafts in combination with chorion membrane for the treatment of periodontal intra-bony defects at 12 months post surgery. Cell Tissue Bank 2019:10.1007/s10561-018-09744-5. [PMID: 30740620 DOI: 10.1007/s10561-018-09744-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
The goal of periodontal therapy is to prevent periodontal disease progression and to regenerate lost periodontal tissues. Various bone grafts are used alone or in combination with other treatment modalities for periodontal therapy. In literature no reports are presented with block allografts in the treatment of intrabony defects in periodontitis. Hence the study aimed to evaluate and compare clinically and radiographically freeze dried bone and demineralized freeze dried bone block allografts with chorion membrane in intra-bony defects at 12 months post-surgery. Eighteen intra-bony defects (9 intra patient pairs) in 9 patients with chronic periodontitis were randomly assigned to group 1 (FDBA + Chorion membrane) and group 2 (DFDBA + Chorion membrane) for periodontal therapy. Clinical and radiographic (RVG) measurements were made at base line and 12 months. Data obtained was subjected to statistical analysis. At 12 months on intra-group comparison both the groups showed statistically significant improvement in the plaque and gingival indices with reduction in the mobility, probing pocket depth and gain in clinical attachment (p value < 0.001). Radiographs showed significant bone fill and increased bone density (p value < 0.001). On inter-group comparison no statistical difference were observed at 12 months in clinical parameters and bone fill among both the groups. However, group 1 (FDBA) showed increase in the bone density which was statistically significant (p value < 0.001). The use of the FDBA and DFDBA block allografts showed significant improvement in the periodontal prognosis of teeth with intra-bony defects. Within the limitation of the present study, both the groups showed similar results with significant increase in bone density in FDBA group.
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Affiliation(s)
- Shaila Kothiwale
- Department of Periodontics, KAHE'S KLE V.K. Institute of Dental Sciences, KAHER (KLE University), Nehru Nagar, Belagavi, 590010, India.
| | - Rishi Bhimani
- Department of Periodontics, KAHE'S KLE V.K. Institute of Dental Sciences, KAHER (KLE University), Nehru Nagar, Belagavi, 590010, India
| | - Murtaza Kaderi
- Department of Periodontics, KAHE'S KLE V.K. Institute of Dental Sciences, KAHER (KLE University), Nehru Nagar, Belagavi, 590010, India
| | - Jyoti Ajbani
- Department of Periodontics, KAHE'S KLE V.K. Institute of Dental Sciences, KAHER (KLE University), Nehru Nagar, Belagavi, 590010, India
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Use of Bone Marrow Aspirate Concentrate (BMAC) Associated with Hyperbaric Oxygenation Therapy in Maxillary Appositional Bone Reconstruction. A Randomized Clinical Trial. Symmetry (Basel) 2018. [DOI: 10.3390/sym10100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objectives: The objective of this study was to evaluate bone reconstruction using xenograft alone and associated with bone marrow aspirate concentrate (BMAC) and hyperbaric oxygen therapy. Material and Methods: Twenty-four maxillary edentulous patients were randomly assigned into three groups: Control group (CG)—xenograft bone alone (n = 8); Group 1 (G1)—xenogeneic bone block combined with BMAC (n = 8), and Group 2 (G2)—xenogeneic bone block combined with BMAC and hyperbaric oxygenation (n = 8). Bone biopsies were harvested 6 months after grafting. Vital Mineralized Tissue (VMT), Non-vital Mineralized Tissue (NVMT), and Non-Mineralized Tissue (NMT) were measured. Computed tomography was also performed on three occasions T0 (preoperative), T4 (4 months postoperative), and T8 (8 months postoperative). The difference between T4 and T8 values with respect to T0 was used to determine the thickness level gain after 4 and 8 months, respectively. Results: The tomographic evaluation did not show significant differences between the groups either at 4 or at the 8 months postoperatively. Regarding the histomorphometric analysis, CG had the lowest percentages of VMT (36.58 ± 9.56%), whereas G1 and G2 had similar results (55.64 ± 2.83% and 55.30 ± 1.41%, respectively). Concerning NMT and NVMT levels, the opposite was observed, with CG levels of 51.21 ± 11.54% and 11.16 ± 2.37%, G1 of 39.76 ± 11.48% and 3.65 ± 0.87%, and G2 of 40.3 ± 11.48% and 4.10 ± 0.87%, respectively. Conclusions: The use of bone block xenograft associated with BMAC resulted in a significant increase of bone neoformation when compared to the xenograft alone, though hyperbaric oxygenation did not enhance the results.
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Hattingh A, Hommez G, De Bruyn H, Huyghe M, Vandeweghe S. A prospective study on ultra-wide diameter dental implants for immediate molar replacement. Clin Implant Dent Relat Res 2018; 20:1009-1015. [PMID: 30255544 DOI: 10.1111/cid.12666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/13/2018] [Accepted: 06/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although wide diameter implants are well documented, little is known about ultra-wide diameter implants (>6 mm). This study evaluates the clinical outcome of ultra-wide diameter implants, placed in molar extraction sockets. MATERIALS AND METHODS Ultra-wide diameter implants (7-9 mm) were placed immediately after molar extraction in a 1-stage protocol, without raising a flap or using any bone grafts. After 4 months, the implant was loaded with a single screw-retained crown. Bone loss was evaluated using peri-apical radiographs. Plaque and bleeding were recorded. Crown and papilla dimensions were measured and compared with the contra-lateral tooth. RESULTS Fifty-one patients (36 male and 15 female), mean ages 61 years old, were treated with 26 implants in the maxilla and 25 implants in the mandible. The majority had a thick (#19) or medium (#31) biotype. After a mean-follow-up period of 23 months, the mean bone level was located 1.16 mm apical of the implant-abutment junction (SD 0.42, range 0.00-2.45) while the actual bone remodeling associated with socket healing resulted in a mean coronal movement of the bone level of 0.15 mm. The mean insertion torque was 116 Ncm (SD 53, range 10-250). There were no differences in papilla height (P = .55), crown length (P = .32), zenith (P = .84), and bucco-palatal dimensions (P = .38). There was a significant difference in the mesio-distal dimension (P = .01). Mean probing depth was 2.59 mm at the implant and 2.23 mm at the contra-lateral tooth (P = .001). There was significantly more plaque at the tooth compared to the implant (P = .01), but there was no significant difference in terms of bleeding on probing (P = .08). Patient satisfaction was high with 72.5% of the patients experiencing no problems at all. CONCLUSIONS Ultra-wide diameter implants have a predictable outcome, demonstrating very little bone loss. Papilla and crown dimensions were comparable to the contra-lateral natural tooth.
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Affiliation(s)
- André Hattingh
- Research Cluster Periodontology, Oral Implantology, Removable and Implant Prosthodontics, Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Private Practice for Periodontology and Oral Implantology, United Kingdom
| | - Geert Hommez
- Research Cluster Periodontology, Oral Implantology, Removable and Implant Prosthodontics, Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hugo De Bruyn
- Research Cluster Periodontology, Oral Implantology, Removable and Implant Prosthodontics, Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marie Huyghe
- Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stefan Vandeweghe
- Research Cluster Periodontology, Oral Implantology, Removable and Implant Prosthodontics, Dental School, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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20
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Giesenhagen B, Martin N, Donkiewicz P, Perić Kačarević Ž, Smeets R, Jung O, Schnettler R, Barbeck M. Vertical bone augmentation in a single-tooth gap with an allogenic bone ring: Clinical considerations. J ESTHET RESTOR DENT 2018; 30:480-483. [PMID: 30070751 DOI: 10.1111/jerd.12392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The main objective of this case report is to introduce a one-stage bone block augmentation with a cylindrical freeze-dried bone allograft (FDBA) and simultaneous implantation for the reconstruction of a single-tooth bone defect. CLINICAL CONSIDERATIONS The report describes this method on the basis of radiographical and clinical images derived from a single patient. CONCLUSIONS The report demonstrates the time-saving and successful application of this treatment concept, which has the potential to increase patient satisfaction and comfort. CLINICAL SIGNIFICANCE The application of the presented technique enabled a prosthetic rehabilitation of the extracted tooth about 3 months earlier as compared to the conventional procedure, while demonstrating no compromises regarding clinical outcome, functionality and esthetics.
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Affiliation(s)
| | | | | | - Željka Perić Kačarević
- Department of anatomy histology and embryology, Faculty of dental medicine and health, University of Osijek, Osijek, Croatia
| | - Ralf Smeets
- Department of Oral Maxillofacial Surgery, Division for Regenerative Orofacial Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ole Jung
- Department of Oral Maxillofacial Surgery, Division for Regenerative Orofacial Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Mike Barbeck
- Department of Oral Maxillofacial Surgery, Division for Regenerative Orofacial Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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21
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Blume O, Back M, Born T, Smeets R, Jung O, Barbeck M. Treatment of a bilaterally severely resorbed posterior mandible due to early tooth loss by Guided Bone Regeneration using customized allogeneic bone blocks: A case report with 24 months follow-up data. J ESTHET RESTOR DENT 2018; 30:474-479. [PMID: 29920915 DOI: 10.1111/jerd.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The use of allogeneic bone grafts for alveolar ridge reconstruction has become an often-discussed alternative to augmentation procedures using autografts. Nevertheless, there still is a lack of literature concerning long-time experiences of allografts for alveolar ridge reconstruction. Especially the results of the use of allogeneic bone blocks for mandible reconstructions need to be further investigated. CLINICAL CONSIDERATIONS In this case report, we present the use of customized allogenic bone blocks in Guided Bone Regeneration (GBR) procedures for severely deficient mandibulary bones, the implantation after a healing period of 5 month and the 24-month follow-up data. CONCLUSIONS Customized allogeneic bone blocks seem to be a successful alternative to augmentations with autologous bone blocks reconstructing highly resorbed mandibulary alveolar ridges, showing highest volume stability and no signs of bone resorption after implant loading. CLINICAL SIGNIFICANCE The application of customized allogeneic bone blocks has shown to be a successful augmentation technique even compared with with autologous bone blocks reconstructing highly resorbed mandibulary alveolar ridges demonstrating no compromises regarding clinical outcome, functionality and esthetics.
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Affiliation(s)
| | | | | | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, Hamburg, Germany
| | - Ole Jung
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, Hamburg, Germany
| | - Mike Barbeck
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, Hamburg, Germany
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Fretwurst T, Gad LM, Steinberg T, Schmal H, Zeiser R, Amler AK, Nelson K, Altmann B. Detection of major histocompatibility complex molecules in processed allogeneic bone blocks for use in alveolar ridge reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:S2212-4403(18)30054-3. [PMID: 29571656 DOI: 10.1016/j.oooo.2018.01.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/14/2017] [Accepted: 01/20/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Because processed allogenic bone blocks contain remnants of cells and other organic material, the present study examined the putative presence of major histocompatibility complex (MHC) molecules in protein extracts derived from processed allogeneic bone blocks. STUDY DESIGN Protein content and the immunogenic potential of 3 different processed allografts (Osteograft, DIZG, Berlin, Germany; Caput femoris, DIZG, Berlin, Germany; Human Spongiosa, Charité Tissue Bank, Berlin, Germany) were assessed by protein extraction and analysis of the presence of MHC class 1 and 2 molecules prior to grafting. MHC concentration was measured by using enzyme-linked immunosorbent assay. RESULTS Protein content in the allograft materials varied between 0.87 and 1.61 µg protein/mg. In the allograft Human Spongiosa, no MHC was detected, whereas in the allogeneic bone blocks Osteograft and Caput femoris MHC 1 (0.04-0.037 ng/mg graft material) and in Osteograft MHC class 2 molecules were detectable. CONCLUSIONS The results of the present study suggest that despite thorough processing, a potential antigenicity of allografts is not eliminated. MHC molecules in allografts may sensitize the immune system.
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Affiliation(s)
- Tobias Fretwurst
- Department of Oral and Craniomaxillofacial Surgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Lames M Gad
- Department of Oral and Craniomaxillofacial Surgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thorsten Steinberg
- Department of Oral Biotechnology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Robert Zeiser
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna-K Amler
- Department of Oral and Craniomaxillofacial Surgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katja Nelson
- Department of Oral and Craniomaxillofacial Surgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brigitte Altmann
- Department of Oral and Craniomaxillofacial Surgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lee JS, Lee JS, Kang MH, Jung UW, Choi SH, Cho KS. Proof-of-concept study of vertical augmentation using block-type allogenic bone grafts: A preclinical experimental study on rabbit calvaria. J Biomed Mater Res B Appl Biomater 2018; 106:2700-2707. [PMID: 29411504 DOI: 10.1002/jbm.b.34087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/26/2017] [Accepted: 01/20/2018] [Indexed: 12/22/2022]
Abstract
This study aimed to quantify the healing following vertical augmentation of allogenic bone blocks with/without recombinant human bone morphogenetic protein-2 (rhBMP-2) on rabbit calvaria. Experiments were performed using allogenic bone blocks which were grafted bilaterally with or without rhBMP-2 on 20 rabbit calvaria, and these animals were divided to four groups according to the use of rhBMP-2 and healing periods (2 and 8 weeks; n = 10 in each group). Onlay-type bone blocks (8 mm in diameter and 5 mm high) were fixed with a self-tapping screw after removing the cortex in the control group, and the same protocol was applied with the addition of soaking the bone blocks with rhBMP-2 for 15 min in the test group. Radiographic and histologic analyses were performed after 2 or 8 weeks to evaluate the volumetric stability and bone regeneration within the grafted area. The radiographic analysis revealed that the height of the allogenic bone block decreased but its volume was maintained from 2 to 8 weeks in both the control and test groups. The histologic results demonstrated a statistically significant increase in new bone area in the test group, especially in the lower region adjacent to the preexisting calvarial floor. The amount of newly formed bone in all regions of the augmented bone blocks in both the control and test groups was greater at 8 weeks than at 2 weeks. In conclusion, the vertically grafted allogenic bone block maintained its volume with new bone formation, and this was accelerated by the addition of rhBMP-2. These findings indicate that allogenic bone block soaked with rhBMP-2 could be a useful candidate biomaterial for vertical augmentation. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2700-2707, 2018.
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Affiliation(s)
- Ji-Sun Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Myung-Hun Kang
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Seong-Ho Choi
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kyoo-Sung Cho
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
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Shahmohammadi R, Moeintaghavi A, Radvar M, Ghanbari H, Saghravanian N, Aghayan S, Sarvari S. Clinical and histological evaluation of increase in the residual ridge width using mineralized corticocancellous block allografts: A pilot study. J Dent Res Dent Clin Dent Prospects 2018; 11:229-235. [PMID: 29354249 PMCID: PMC5768955 DOI: 10.15171/joddd.2017.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 08/20/2017] [Indexed: 11/09/2022] Open
Abstract
Background. Lateral ridge augmentation is conventionally accomplished by means of autogenous bone grafts. However, due to its complications, the application of autogenous bone graft substitutes, e.g. mineralized corticocancellous allograft, is ecommended. Methods. In the present study, twelve patients were included, with insufficient alveolar ridge widths in the designated sites for dental implant placement. During the primary surgery, mineralized corticocancellous block allografts were fixed in deficient sites with titanium screws and resorbable collagen membranes were used to cover the blocks. After a period of six months, a flap was raised and variations in ridge width values was measured. Finally, a micro-biopsy was obtained from the sites for histologic investigation prior to preparing them for subsequent implant placement. Results. All the applied blocks were incorporated into the underlying bone except for one. A statistically significant difference was seen between the average ridge widths before placing the allografts compared with that of implant placement stage (2.62±1.02 mm vs. 7.75±1.63 mm, respectively). Vital bone tissue was detected in all the histological specimens obtained from the interface of blocks and the underlying bone. Conclusion. The results suggest that mineralized corticocancellous block allografts might be used as scaffolds for bone growth and ridge width augmentation.
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Affiliation(s)
- Reza Shahmohammadi
- Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Moeintaghavi
- Dental Material Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Radvar
- Dental Material Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Ghanbari
- Department of Periodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrollah Saghravanian
- Oral and Maxillofacial Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shabnam Aghayan
- Department of Periodontics, Dental Branch, Islamic Azad University (Tehran), Tehran, Iran
| | - Sara Sarvari
- Mashhad University of Medical Sciences, Mashhad, Iran
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25
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Venet L, Perriat M, Mangano FG, Fortin T. Horizontal ridge reconstruction of the anterior maxilla using customized allogeneic bone blocks with a minimally invasive technique - a case series. BMC Oral Health 2017; 17:146. [PMID: 29216869 PMCID: PMC5721474 DOI: 10.1186/s12903-017-0423-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/12/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Different surgical procedures have been proposed to achieve horizontal ridge reconstruction of the anterior maxilla; all these procedures, however, require bone replacement materials to be adapted to the bone defect at the time of implantation, resulting in complex and time-consuming procedures. The purpose of this study was to describe how to use a 3D printed hardcopy model of the maxilla to prepare customized milled bone blocks, to be adapted on the bone defect areas using a minimally invasive subperiosteal tunneling technique. METHODS Cone beam computed tomography (CBCT) images of the atrophic maxilla of six patients were acquired and modified into 3D reconstruction models. Data were transferred to a 3D printer and solid models were fabricated using autoclavable nylon polyamide. Before the surgery, freeze-dried cortico-cancellous blocks were manually milled and adapted on the 3D printed hardcopy models of the maxillary bone, in order to obtain customized allogeneic bone blocks. RESULTS In total, eleven onlay customized allogeneic bone grafts were prepared and implanted in 6 patients, using a minimally invasive subperiosteal tunneling technique. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. The patients did not demonstrate adverse events such as inflammation, dehiscence or flap re-opening during the recovery period; however, one patient experienced scaffold resorption, which was likely caused by uncontrolled motion of the removable provisional prosthesis. Following a 6 month healing period, CBCT was used to assess graft integration, which was followed by insertion of implants into the augmented areas. Prosthetic restorations were placed 4 months later. CONCLUSIONS These observations suggest that customized bone allografts can be successfully used for horizontal ridge reconstruction of the anterior maxilla: patients demonstrated reduced morbidity and decreased total surgery time. Further studies on a larger sample of patients, with histologic evaluation and longer follow-up are needed to confirm the present observations.
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Affiliation(s)
- Laurent Venet
- Department of oral surgery, Hospices Civils de Lyon, Lyon, France
| | - Michel Perriat
- Department of oral surgery, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Fortin
- Department of Oral Surgery, Dental School of Lyon, University Claude Bernard, Lyon 1, 6-8 rue Guillaume Paradin, 69007, Lyon, France. .,UJF-Grenoble 1 / CNRS / TIMC-IMAG UMR 5525, F-38041, Grenoble, France.
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Nissan J, Kolerman R, Chaushu L, Vered M, Naishlos S, Chaushu G. Age-related new bone formation following the use of cancellous bone-block allografts for reconstruction of atrophic alveolar ridges. Clin Implant Dent Relat Res 2017; 20:4-8. [PMID: 29194937 DOI: 10.1111/cid.12560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/07/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND An age-related decrease in the number of osteogenic progenitor cells may compromise bone augmentation. PURPOSE Histomorphometrical assessment of age-related new bone formation, following atrophic alveolar ridge reconstruction, using cancellous bone-block allografts. MATERIAL AND METHODS Ninety-three consecutive patients (58 females and 35 males) were referred for implant-supported restoration of 122 severe atrophic alveolar ridges. Alveolar ridge deficiency locations were classified as anterior maxilla (n = 58), posterior maxilla (n= 32), and posterior mandible (n = 32). A bony deficiency of at least 3 mm horizontally and up to 3 mm vertically according to computerized tomography (CT) in the posterior mandible and anterior maxilla, served as inclusion criteria. In the posterior maxilla, a residual alveolar ridge up to 4 mm vertically according to CT served as inclusion criteria. Augmentation was performed by the use of cancellous bone-block allografts. Bone biopsies (9-month posterior maxilla, 4 months anterior maxilla and posterior mandible) of young (≤40 years) versus older (>40 years) patients were histomorphometrically evaluated. RESULTS In the posterior maxilla, no statistically significant histomorphometric differences were noted. While at the anterior maxilla and posterior mandible, statistically significant more newly formed bone was found in young versus older individuals, respectively (38.6% vs 19.8%, P = 0.04 and 69% vs 31%, P = .05). CONCLUSION New bone formation following residual alveolar ridge bone grafting is age-related. Longer bone consolidation and healing time may be recommended for older individuals.
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Affiliation(s)
- Joseph Nissan
- Department of Oral Rehabilitation, School of Dental Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Roni Kolerman
- Department of Periodontology, School of Dental Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Liat Chaushu
- Department of Periodontology, School of Dental Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Marilena Vered
- Department of Oral Pathology, School of Dental Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Sarit Naishlos
- Department of Pedodontology, School of Dental Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Gavriel Chaushu
- Department of Oral & Maxillofacial Surgery, School of Dental Medicine, Tel Aviv University, Tel-Aviv, Israel
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Bone Augmentation Using Allogeneic Bone Blocks With Recombinant Bone Morphogenetic Protein-2. IMPLANT DENT 2017; 26:826-831. [DOI: 10.1097/id.0000000000000693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report. MATERIALS 2017; 10:ma10101213. [PMID: 29065477 PMCID: PMC5667019 DOI: 10.3390/ma10101213] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022]
Abstract
The objective of this case report is to introduce a customized CAD/CAM freeze-dried bone allograft (FDBA) block for its use in Guided Bone Regeneration (GBR) procedures for severely deficient maxillary bones. Additionally, a special newly developed remote incision technique is presented to avoid wound dehiscence. The results show optimal integration behavior of the FDBA block after six months and the formation of new vital bone. Thus, the results of the present case report confirm the use of the customized CAD/CAM bone block for augmentation of complex defects in the maxillary aesthetic zone as a successful treatment concept.
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Ahmadi RS, Sayar F, Rakhshan V, Iranpour B, Jahanbani J, Toumaj A, Akhoondi N. Clinical and Histomorphometric Assessment of Lateral Alveolar Ridge Augmentation Using a Corticocancellous Freeze-Dried Allograft Bone Block. J ORAL IMPLANTOL 2017; 43:202-210. [PMID: 28326892 DOI: 10.1563/aaid-joi-d-16-00042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Horizontal ridge augmentation with allografts has attracted notable attention because of its proper success rate and the lack of disadvantages of autografts. Corticocancellous block allografts have not been adequately studied in humans. Therefore, this study clinically and histomorphometrically evaluated the increase in ridge width after horizontal ridge augmentation using corticocancellous block allografts as well as implant success after 12 to 18 months after implantation. In 10 patients receiving implants (3 women, 7 men; mean age = 45 years), defective maxillary alveolar ridges were horizontally augmented using freeze-dried bone allograft blocks. Ridge widths were measured before augmentation, immediately after augmentation, and ∼6 months later in the reentry surgery for implantation. This was done at points 2 mm (A) and 5 mm (B) apically to the crest. Biopsy cores were acquired from the implantation site. Implant success was assessed 15.1 ± 2.7 months after implantation (range = 12-18 months). Data were analyzed using Friedman and Dunn tests (α = 0.05). At point A, ridge widths were 2.77 ± 0.37, 8.02 ± 0.87, and 6.40 ± 0.66 mm, respectively, before surgery, immediately after surgery, and before implantation. At point B, ridge widths were 3.40 ± 0.39, 9.35 ± 1.16, and 7.40 ± 1.10 mm, respectively, before surgery, immediately after surgery, and before implantation. The Friedman test showed significant increases in ridge widths, both at point A and point B (both P = .0000). Postaugmentation resorption was about 1.5-2 mm and was statistically significant at points A and B (P < .05, Dunn). The percentage of newly formed bone, residual graft material, and soft tissue were 33.0% ± 11.35% (95% confidence interval [CI] = 24.88%-41.12%), 37.50% ± 19.04% (95% CI = 23.88%-51.12%), and 29.5%, respectively. The inflammation was limited to grades 1 or zero. Twelve to 18 months after implantation, no implants caused pain or showed exudates or pockets. Radiographic bone loss was 2.0 ± 0.7 mm (range = 1-3). It can be concluded that lateral ridge augmentation with corticocancellous allograft blocks might be successful both clinically and histologically. Implants might have a proper clinical success after a minimum of 12 months.
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Affiliation(s)
- Roya Shariatmadar Ahmadi
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Ferena Sayar
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Vahid Rakhshan
- 2 Department of Dental Anatomy, Dental Faculty, Islamic Azad University, Tehran, Iran
| | - Babak Iranpour
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Jahanfar Jahanbani
- 3 Oral Pathology Department, Dental Branch Tehran, Islamic Azad University, Tehran, Iran
| | | | - Nasrin Akhoondi
- 5 Department of Mathematics, South Tehran Branch, Islamic Azad University, Tehran, Iran
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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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De Ponte FS, Cutroneo G, Falzea R, Rizzo G, Catalfamo L, Favaloro A, Vermiglio G, Runci M, Centofanti A, Anastasi G. Histochemical and morphological aspects of fresh frozen bone: a preliminary study. Eur J Histochem 2016; 60:2642. [PMID: 28076936 PMCID: PMC5178803 DOI: 10.4081/ejh.2016.2642] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 11/12/2016] [Accepted: 11/17/2016] [Indexed: 11/23/2022] Open
Abstract
Bone graft are used in dentistry for the reconstruction of severely atrophic jaws. Fresh frozen bone has no osteogenic property but it has osteoconductive and osteoinductive properties because its matrix contains growth factors such as vascular endothelial growth factor. The purpose of the present study was to evaluate morphological and protein expression characteristics of fresh frozen bone before graft and after six months of graft in patients who needed maxillary reconstruction. After 6 month of graft we observed the presence of viable bone as evidenced by full osteocyte lacunae and by the presence of RANKR, osteocalcin positive cells and vascular endothelial growth factor. In conclusion, our findings show that the fresh frozen bone after six month of graft is for the most part viable bone, encouraging its use as an alternative to autogenous bone for reconstructing maxillary bone defects prior to implant.
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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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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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Troeltzsch M, Troeltzsch M, Kauffmann P, Gruber R, Brockmeyer P, Moser N, Rau A, Schliephake H. Clinical efficacy of grafting materials in alveolar ridge augmentation: A systematic review. J Craniomaxillofac Surg 2016; 44:1618-1629. [PMID: 27622971 DOI: 10.1016/j.jcms.2016.07.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/22/2016] [Accepted: 07/29/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the efficacy of grafting materials in lateral and vertical ridge augmentations. MATERIALS AND METHODS A systematic review of the literature on the clinical use of grafting materials of the years 1995 to April 2015 was conducted using electronic search of PubMed and Cochrane libraries and hand search of eight print journals. A total of 184 papers were included, comprising 6182 patients. Parameters evaluated were observation period [months], bone formation [histologic area%], defect fill [%], horizontal and vertical gain [mm], loss of augmented volume [mm], complication rate [%], and implant survival rate [%]. Results are expressed as weighted means ± SD. RESULTS Results were obtained after a weighted mean observation period of 27.4 months (range 3-168 months). Bone formation in the augmented areas varied from 33.2 ± 14.9% for allogeneic grafts to 56.0 ± 25.6% for mixtures of autogenous and other grafting materials. Defect fill in dehiscence defects ranged from 51.0 ± 13.6% (synthetic) to 85.8 ± 13.4% (xenogeneic) for the different materials, with an overall weighted mean of 79.8 ± 18.7%. Weighted mean horizontal gain for all particulate grafting materials was 3.7 ± 1.2 mm, with variation between 2.2 ± 1.2 mm (synthetic) and 4.5 ± 1.0 mm (mixtures of autogenous bone with allogeneic/xenogeneic grafting material) without statistical significance. Weighted overall mean vertical gain was 3.7 ± 1.4 mm. Vertical gain was substantially higher when space-making barrier materials such as titanium meshes were used; however this was also associated with strong increase in complication rate. Block grafts achieved higher horizontal gain by approximately 1 mm. The use of block grafts achieved significantly increased vertical gain compared to particulate material only when autogenous block grafts from extraoral donor sites were used. CONCLUSION Horizontal and vertical gain by 3.7 mm on average can be achieved using particulate materials. This can be increased by using titanium meshes. Substantial vertical gains beyond this dimension require the use of extraoral bone block grafts.
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Affiliation(s)
- Markus Troeltzsch
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany.
| | - Matthias Troeltzsch
- Department of Maxillofacial Surgery, Ludwig - Maximilians - University of Munich, Germany
| | - Philipp Kauffmann
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Rudolph Gruber
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Phillipp Brockmeyer
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Norman Moser
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Anna Rau
- Department of Anesthesiology, University of Goettingen, Germany
| | - Henning Schliephake
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
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Draenert FG, Kämmerer PW, Berthold M, Neff A. Complications with allogeneic, cancellous bone blocks in vertical alveolar ridge augmentation: prospective clinical case study and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:e31-43. [DOI: 10.1016/j.oooo.2016.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/25/2016] [Indexed: 12/31/2022]
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Pelegrine AA, Teixeira ML, Sperandio M, Almada TS, Kahnberg KE, Pasquali PJ, Aloise AC. Can bone marrow aspirate concentrate change the mineralization pattern of the anterior maxilla treated with xenografts? A preliminary study. Contemp Clin Dent 2016; 7:21-6. [PMID: 27041895 PMCID: PMC4792049 DOI: 10.4103/0976-237x.177112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate bony reconstruction of the atrophic anterior maxilla using particulate grafts with or without autologous bone marrow aspirate concentrate (BMAC). Materials and Methods: Eight patients with atrophy of the anterior maxilla due to teeth loss were selected and split into groups according to the type of material used: Control Group (CG) (n = 4) - particulate xenograft only and Test Group (TG) (n = 4) - a combination of particulate xenograft and BMAC. Both groups received a collagen membrane to cover the xenograft. After 4 months, during implant placement, a sample of bone was removed from the graft area using a 2 mm diameter trephine bur. The specimens were fixed and preserved for histomorphometric evaluation, which included the following parameters: Mineralized tissue (MT) and non-MT (NMT). Cone beam computed tomography was performed at 3 time intervals to measure bone thickness: (1) Before grafting, (2) 4 months and (3) 8 months postgrafting, using localized bone gain (mm) as the outcome variable. Results: Tomographic analysis revealed bone gain in CG of 3.78 ± 1.35 mm and 4.34 ± 1.58 mm at 4 and 8 months, respectively. TG showed an increase of 3.79 ± 0.52 mm and 4.09 ± 1.33 mm after 4 and 8 months, respectively. Histomorphometric analysis revealed that, for CG, MT- and NMT-related values were 52.3% ± 16.78% and 47.70% ± 5.55%, respectively, whereas for TG, they were 65.04% ± 20.98% and 34.96 ± 10.38, respectively. Conclusion: Although radiographic bone gain appeared similar between the groups, the use of BMAC obtained via the BMAC® method revealed an increased mineralization trend in the anterior maxilla. It must be highlighted, however, that this is a preliminary study with a relatively small sample population and further studies with larger sample sizes are needed to verify these results.
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Affiliation(s)
- André Antonio Pelegrine
- Department of Implantology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | | | - Marcelo Sperandio
- Department of Implantology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Thiago Sousa Almada
- Department of Implantology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Karl Erik Kahnberg
- Department of Oral Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Paulo José Pasquali
- Department of Implantology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Antonio Carlos Aloise
- Department of Implantology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
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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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38
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Al-Abedalla K, Torres J, Cortes ARG, Wu X, Nader SA, Daniel N, Tamimi F. Bone Augmented With Allograft Onlays for Implant Placement Could Be Comparable With Native Bone. J Oral Maxillofac Surg 2015; 73:2108-22. [DOI: 10.1016/j.joms.2015.06.151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 02/08/2023]
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Abstract
BACKGROUND The loss of teeth, whether it is from trauma or pathology, is accompanied by a concomitant loss of the surrounding alveolar bone. Khoury introduced a new method for grafting ridge defects in 2007. This technique involved using thin cortical plates harvested from the ramus, and in a 'sandwich' type manner, interposed these bone plates with cancellous bone harvested from the same site. Although this has shown success, the technique suffers from similar disadvantages of most harvesting techniques, i.e. a need for a second surgical site, and donor site morbidity. In this case presentation, we report the use of an allograft bone plate in a similar manner as was previously described by Khoury, to reconstruction lost alveolar bone in order to facilitate the correct three dimensional (3D) placement of dental implants. CASE DESCRIPTION A 53-year-old female presented for the restoration of her missing dentition in her upper jaw. The cone bean computed tomography (CBCT) revealed a large horizontal bony defect in the region of the upper anterior teeth, with minimal remaining bone. Using bone fixation screws, the bone plates were fixed to the buccal defect and the space between the plate and the existing palatal bone wall was then filled using a combination of autograft bone scrapings and xenograft bone particles. Six months after the initial surgery, the grafted sites were surgically re-entered and showed a marked increase in ridge width. CONCLUSION Evidence exists for the use of bone allografts for a variety of alveolar bone augmentation procedures. The case presented outlines another use for this versatile biomaterial. CLINICAL SIGNIFICANCE Bone harvesting for large alveolar defects is invariably associated with increased morbidity and an increased risk of postoperative complications. The above technique described by the author, may be used as a suitable alternative to reconstruct these defects, without harvesting bone from a second surgical site.
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Affiliation(s)
- Mogammad Thabit Peck
- Consultant Specialist, Department of Oral Medicine and Periodontology, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa, Phone: +2721 937 3128, e-mail:
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40
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Checchi V, Felice P. The Inlay Technique With an Allograft Block Used for the Rehabilitation of an Atrophic Posterior Mandible: A Case Report. Clin Adv Periodontics 2015; 5:68-74. [DOI: 10.1902/cap.2013.130040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/04/2013] [Indexed: 11/13/2022]
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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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42
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Benic GI, Hämmerle CHF. Horizontal bone augmentation by means of guided bone regeneration. Periodontol 2000 2014; 66:13-40. [DOI: 10.1111/prd.12039] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/18/2022]
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Fretwurst T, Spanou A, Nelson K, Wein M, Steinberg T, Stricker A. Comparison of four different allogeneic bone grafts for alveolar ridge reconstruction: a preliminary histologic and biochemical analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:424-31. [PMID: 25183228 DOI: 10.1016/j.oooo.2014.05.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/14/2014] [Accepted: 05/16/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Allograft material for alveolar ridge reconstruction is quite promising and appears to be as equally successful as bone autograft material. The aim of the present study was to compare four different allogeneic bone grafts in terms of their histologic structure and DNA content before grafting. STUDY DESIGN Four allograft specimens from different suppliers were analyzed histologically, and the DNA content was analyzed before clinical use of the allografts. RESULTS Organic tissue remnants were detected in all of the evaluated samples. In the present samples adipocytes, fibroblasts, osteocytes, and chondrocytes were identified and DNA isolation and purification was possible. CONCLUSION Demineralized freeze-dried allogeneic bone transplants can stimulate new bone formation and are a viable alternative to bone autograft material. However, the well-tolerated use of allograft material in regard to our findings should be further investigated.
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Affiliation(s)
- Tobias Fretwurst
- Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany.
| | | | - Katja Nelson
- Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany
| | - Martin Wein
- Department of Oral Biotechnology, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany
| | - Thorsten Steinberg
- Department of Oral Biotechnology, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany
| | - Andres Stricker
- Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Hugstetter Straße 55, D-79106, Freiburg, Germany
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Ferraz EP, Rosa AL, de Oliveira PT, Santos TS, Reino DM, Pontes CB, Xavier SP. Clinical, Histological and Cellular Evaluation of Vertico-Lateral Maxillary Reconstruction Associating Alveolar Osteogenic Distraction and Fresh-Frozen Bone Allograft. J ORAL IMPLANTOL 2013; 41:326-31. [PMID: 24175910 DOI: 10.1563/aaid-joi-d-13-00102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Emanuela Prado Ferraz
- 1 Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Adalberto Luiz Rosa
- 1 Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Paulo Tambasco de Oliveira
- 2 Department of Morphology, Stomatology and Basic Pathology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Thiago Santana Santos
- 1 Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Danilo Maeda Reino
- 1 Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Cássio Barros Pontes
- 3 Department of Prosthodontics, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Samuel Porfírio Xavier
- 1 Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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Kolerman R, Nissan J, Tal H. Combined osteotome-induced ridge expansion and guided bone regeneration simultaneous with implant placement: a biometric study. Clin Implant Dent Relat Res 2013; 16:691-704. [PMID: 23350624 DOI: 10.1111/cid.12041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the long-term outcome of a single-step ridge expansion osteotome procedure and implant placement combined with guided bone regeneration in patients presenting narrow maxillary alveolar ridges. MATERIALS AND METHODS During the period 1999 to 2010, 41 patients aged 19 to 77 years (18 males; 23 females) suffering from partial or full edentulism associated with horizontal resorption of the maxillary ridges (2.5-5 mm) were treated using the combined ridge expansion and guided bone-regeneration techniques to obtain an improved bony base for implant placement. Implant survival, bone width measurements, clinical and radiologic implant success, and clinical complications were recorded and analyzed. RESULTS Achievement of primary stability of the implant was impossible at six sites; these were recorded as failures. In the remaining 35 patients, one hundred sixteen endosseous titanium implants were simultaneously placed. Follow-up time varied between 6 and 144 months (mean 52.4); of these, 36% were followed up for periods of time longer than 60 months. Implant diameter and lengths varied between 3.3 to 4.8 and 12 to 16 mm, respectively. In the 35 successful procedures (one hundred sixteen implants), the overall implant survival rate was 100%. An average gain in ridge width was 3.5 ± 0.93 (p < .0001) and an average enlargement of the buccal bone was 1.91 ± 0.6 (p < .0001). The mean vertical mesial bone loss was 1.81 mm ± 1.07 (ranging from 0.3 to 4.2 mm), and the mean vertical distal bone loss was 1.74 mm ± 1.12 (ranging from 0.4 to 4.5 mm). In eight patients (32%), at least one implant presented bone loss of ≥3 mm. CONCLUSIONS Within the limitations of this study, we suggest that the combined osteotome-induced ridge expansion and guided bone regeneration simultaneous with implant placement is a reliable procedure with reduced morbidity and may offer an alternative in suitable situations.
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Affiliation(s)
- Roni Kolerman
- Department of Periodontology and Dental Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Krasny M, Krasny K, Kamiński A, Zadurska M, Piekarczyk P, Fiedor P. Evaluation of safety and efficacy of radiation-sterilized bone allografts in reconstructive oral surgery. Cell Tissue Bank 2012; 14:367-74. [PMID: 23239267 PMCID: PMC3732757 DOI: 10.1007/s10561-012-9348-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 11/03/2012] [Indexed: 02/07/2023]
Abstract
Bone grafting allows reconstruction of the atrophied or destroyed alveolar process. In orthopaedics and traumatology allogeneic grafting has been used to restore defects of osseous tissue for over 60 years. In order to improve safety of the graft recipient, sterilized allogeneic grafts have been use. The aim of the study was to assess the direct and long-term outcomes following augmentation of atrophied alveolar processes with the use of radiation-sterilized allogeneic bone grafts. Sixty-eight patients were surgically treated between 2004 and 2011: 29 underwent open sinus floor elevation, post-extraction alveoli augmentation was performed in 16 subjects and 23 underwent reconstruction of the atrophied alveolar process. Augmentation of bone defects used bone granulate in 63 patients and bone blocks stabilized with titanium screws in 5 patients. PRF membranes collected from the patient’s blood were also used in all the procedures. In each of the cases optimal dimensions of the alveolar process were obtained allowing embedment of BIOMET 3I dental implant/-s. In all the patients the defects were successfully restored with implant-supported prostheses. Radiation-sterilized allogeneic bone grafts proved to be safe and effective for the patients and manageable for the surgeon constituting a good alternative to autogeneic material.
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Affiliation(s)
- Marta Krasny
- Department of Orthodontics, Warsaw Medical University, ul. Nowogrodzka 59, 02-006, Warsaw, Poland.
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Nissan J, Gross O, Mardinger O, Ghelfan O, Sacco R, Chaushu G. Post-traumatic implant-supported restoration of the anterior maxillary teeth using cancellous bone block allografts. J Oral Maxillofac Surg 2011; 69:e513-8. [PMID: 21982693 DOI: 10.1016/j.joms.2011.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/12/2011] [Accepted: 08/12/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To prospectively evaluate the outcome of dental implants placed in the post-traumatic anterior maxilla after ridge augmentation with cancellous freeze-dried block bone allografts. MATERIALS AND METHODS Patients presenting with a history of anterior dentoalveolar trauma with bony deficiencies in the sagittal (≥3 mm) and vertical (<3 mm) planes according to computed tomography were included. The recipient sites were reconstructed with cancellous bone block allografts. After 6 months of healing, implants were placed. The primary outcomes of interest were 1) bone measurements taken before grafting, at the time of implant placement, and at stage 2 operations; 2) implant survival; and 3) complications. RESULTS The sample was composed of 20 consecutive patients with a mean age of 25 ± 7 years. We used 28 cancellous allogeneic bone blocks, and 31 implants were inserted. Of the 31 implants, 12 were immediately restored. The mean follow-up was 42 ± 15 months. Graft and implant survival rates were 92.8% and 96.8%, respectively. Mean bone gain in the sagittal and vertical planes was 5 ± 0.5 mm horizontally and 2 ± 0.5 mm (P < .001). Successful restoration was achieved in all patients with fixed implant-supported prostheses. Soft tissue complications occurred in 7 patients (35%). Complications after cementation of the crowns were seen in 3 implants (9.6%). All implants remained clinically osseointegrated at the end of the follow-up examination. There was no crestal bone loss around the implants beyond the first implant thread. CONCLUSION Cancellous block allograft can be used successfully for post-traumatic implant-supported restoration in the anterior maxilla.
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Affiliation(s)
- Joseph Nissan
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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