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De Angelis P, Cavalcanti C, Manicone PF, Liguori MG, Rella E, De Rosa G, Palmieri A, D’Addona A. A Comparison of Guided Bone Regeneration vs. the Shell Technique Using Xenogeneic Bone Blocks in Horizontal Bone Defects: A Randomized Clinical Trial. Dent J (Basel) 2024; 12:137. [PMID: 38786535 PMCID: PMC11120356 DOI: 10.3390/dj12050137] [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: 12/14/2023] [Revised: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
In cases of severe horizontal atrophy, implant placement requires bone reconstruction procedures. The aim of this randomized controlled trial is to compare the outcomes of bone augmentation with simultaneous implant placement using the shell technique to the outcomes of guided bone regeneration (GBR) in cases of severely horizontal bone atrophy. This study was designed as a monocentric, parallel-group, randomized controlled trial with a six-month follow-up. Among the primary outcomes of this study, peri-implant bone regeneration and peri-implant bone defect closure were selected. Forty-four patients were recruited and equally divided between two groups. In the GRB group, a horizontal regeneration of 2.31 ± 0.23 mm was observed opposed to a horizontal regeneration of 2.36 ± 0.17 mm in the shell group (p = 0.87). A volumetric increase was observed in both groups, with an increase of 0.30 ± 0.12 cm3 in the GBR group and an increase of 0.39 ± 0.09 cm3 in the shell group, highlighting a significant difference between the two groups (p = 0.02). In conclusion, bone augmentation with simultaneous implant placement using the shell technique or guided bone regeneration in horizontal bone atrophy are both predictable therapeutic options.
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Affiliation(s)
- Paolo De Angelis
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Oral Surgery, and Implantology Unit, Department of Head and Neck, A. Gemelli University Hospital Foundation (IRCCS) Catholic University of the Sacred Heart, 00168 Rome, Italy; (P.D.A.); (C.C.); (P.F.M.); (G.D.R.); (A.P.); (A.D.)
| | - Camilla Cavalcanti
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Oral Surgery, and Implantology Unit, Department of Head and Neck, A. Gemelli University Hospital Foundation (IRCCS) Catholic University of the Sacred Heart, 00168 Rome, Italy; (P.D.A.); (C.C.); (P.F.M.); (G.D.R.); (A.P.); (A.D.)
| | - Paolo Francesco Manicone
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Oral Surgery, and Implantology Unit, Department of Head and Neck, A. Gemelli University Hospital Foundation (IRCCS) Catholic University of the Sacred Heart, 00168 Rome, Italy; (P.D.A.); (C.C.); (P.F.M.); (G.D.R.); (A.P.); (A.D.)
| | | | - Edoardo Rella
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Oral Surgery, and Implantology Unit, Department of Head and Neck, A. Gemelli University Hospital Foundation (IRCCS) Catholic University of the Sacred Heart, 00168 Rome, Italy; (P.D.A.); (C.C.); (P.F.M.); (G.D.R.); (A.P.); (A.D.)
| | - Giuseppe De Rosa
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Oral Surgery, and Implantology Unit, Department of Head and Neck, A. Gemelli University Hospital Foundation (IRCCS) Catholic University of the Sacred Heart, 00168 Rome, Italy; (P.D.A.); (C.C.); (P.F.M.); (G.D.R.); (A.P.); (A.D.)
| | - Alberto Palmieri
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Oral Surgery, and Implantology Unit, Department of Head and Neck, A. Gemelli University Hospital Foundation (IRCCS) Catholic University of the Sacred Heart, 00168 Rome, Italy; (P.D.A.); (C.C.); (P.F.M.); (G.D.R.); (A.P.); (A.D.)
| | - Antonio D’Addona
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Oral Surgery, and Implantology Unit, Department of Head and Neck, A. Gemelli University Hospital Foundation (IRCCS) Catholic University of the Sacred Heart, 00168 Rome, Italy; (P.D.A.); (C.C.); (P.F.M.); (G.D.R.); (A.P.); (A.D.)
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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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Wang J, Luo Y, Qu Y, Man Y. Horizontal ridge augmentation in the anterior maxilla with in situ onlay bone grafting: a retrospective cohort study. Clin Oral Investig 2022; 26:5893-5908. [PMID: 35583662 DOI: 10.1007/s00784-022-04547-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/08/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to introduce a digitally guided in situ autogenous onlay grafting technique and compare its effectiveness with the conventional (ex situ) onlay technique in augmenting horizontal bone defects of the anterior maxilla. MATERIALS AND METHODS This retrospective cohort study included 24 patients who had received autogenous onlay bone grafts combined with guided bone regeneration (GBR) in the anterior maxilla. Fourteen patients were recruited into the in situ onlay grafting group (EG), and 10 were recruited into the ex situ onlay group (CG), defined by the donor sites. The clinical parameters, radiographic changes, micro-CT, and histological processes were evaluated after a mean follow-up period of 1.7 years. RESULTS The horizontal bone width reflected significant bone modeling over time (p < 0.001) in the first 6 months. Multivariable analysis showed that the treatment modality (grouping) was a critical factor positively associated with vertical bone height alteration. However, neither the alteration rate of horizontal bone width nor the bone volume was associated with the treatment modality. The number of periosteal screws per graft positively affected horizontal contour maintenance (p < 0.05). No significant differences were observed between the groups in the clinical parameters (complications, success rate, and peri-implant parameters). The micro-CT and histological outcomes were similar between the groups. CONCLUSION Despite the limitations of this study, in situ onlay grafting combined with GBR was an effective and reliable approach for horizontal bone augmentation in the anterior maxilla and appeared to demonstrate better stability in vertical bone remodeling. CLINICAL RELEVANCE This study introduces a modified and minimally invasive technique of onlay grafting for horizontal bone augmentation. This in situ onlay grafting demonstrates superior stability in vertical bone remodeling. The trial registration number is ChiCTR2100054683.
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Affiliation(s)
- Jing Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, Renmin Nan Road, Chengdu, 610041, Sichuan, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yilin Luo
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, Renmin Nan Road, Chengdu, 610041, Sichuan, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yili Qu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, Renmin Nan Road, Chengdu, 610041, Sichuan, China.,Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Man
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, Renmin Nan Road, Chengdu, 610041, Sichuan, China. .,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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