Volumetric assessment of changes in the alveolar ridge dimension following guided bone regeneration using a combination freeze-dried bone allograft with collagen membrane or novel resorbable scaffold: A prospective two-center clinical trial.
Journal of periodontology
BACKGROUND:The aim of this study was to examine osseous changes following lateral bone augmentation using a novel scaffold (OV) alone and compare it to combination therapy using freeze-dried bone allograft (FDBA) and resorbable collagen membrane (FDBA/CM). METHODS:Thirty patients completed this 9-months prospective two-center cohort clinical trial. Before surgery and 9-months re-entry, linear measurements were performed, and impressions taken. Cone-beam computed tomography (CBCT) were done at baseline and 9 months. DICOM slice data were converted into volumetric images using 3D Slicer. Following 3D volumetric image construction, pre- and post-op Standard Triangle Language files were superimposed and volumetric data were extracted for a 10-mm region of interest. Linear measurements were compared similarly. RESULTS:Baseline clinical parameters were similar in both groups (4.22 and 4.53 mm for OV and FDBA/CM at -2 mm, respectively). Following treatment, vertical distance from the stent had changed minimally (-0.36 and -0.12 mm, respectively). Similarly, lateral bone gain ranged from 0 to 0.4 mm, for both groups. To the contrary, the CBCT measurements showed a significantly greater increase in horizontal width in the control at -2 mm (0.95 ± 0.2 mm) compared with -0.62 mm for the OV (P = 0.000). Similar changes were observed at -5 mm (0.63 and -0.41 mm, respectively, P = 0.01). Sites volume had increased from 266 ± 149 mm to 360 ± 138 mm (P = 0.001) for FDBA/CM with negligible changes for OV (from 334 to 335 mm , P = 0.952). these between-group changes being statistically significant (P = 0.023). CONCLUSION:FDBA/CM yielded better albeit moderate increase in the volume of the edentulous ridge, while OV scaffolds failed to produce similar results.
10.1002/JPER.21-0006
Alveolar ridge augmentation using anodized implants coated with Escherichia coli-derived recombinant human bone morphogenetic protein 2.
Huh Jung-Bo,Park Chan-Kyung,Kim Se-Eun,Shim Kyung-Mi,Choi Kyung-Hee,Kim Sun-Jong,Shim June-Sung,Shin Sang-Wan
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics
OBJECTIVE:The aim of this study was to examine the effect of Escherichia coli-derived recombinant human bone morphogenetic protein 2 (ErhBMP-2) coated onto anodized implant to stimulate local bone formation, including osseointegration and the vertical augmentation of the alveolar ridge. STUDY DESIGN:Six young male adult beagle dogs were used. A crestal area was leveled on both sides of each test subject by removing minimal cortical bone using a round bur and without exposing cancellous bone. After a 2-month healing period, 3 anodized implants (length 8 mm, diameter 4 mm; Cowellmedi, Busan, Korea) were placed 5 mm into the mandibular alveolar ridge in either side. Each animal received 6 implants that were either coated with ErhBMP-2 (0.75 or 1.5 mg/mL concentration; Cowellmedi) or uncoated. This was performed using a randomized split-mouth design. A total of 36 implants were used for this study. Twelve noncoated implants were used as control, and 24 BMP-coated implants were used as our experimental group, which was further divided into 2 groups of 12 implants each with different BMP concentration of 0.75 and 1.5 mg/mL. Radiologic examinations were performed immediately after implant placement and 4 and 8 weeks after implant placement. The amount of bone augmentation was evaluated by measuring the distance from the uppermost point of the cover screw to the marginal bone. Implant stability quotient (ISQ) values were measured immediately after surgery and 8 weeks after implant placement. Statistical analysis was performed using one-way analysis of variance (SPSS version 17.0) and multiple-comparison tests. Statistical significance was established at the 95% confidence level. RESULTS:Implants coated with ErhBMP-2 at 0.75 mg/mL (BMP 0.75 group) and 1.5 mg/mL (BMP 1.5 group) exhibited significant vertical bone formation compared with the control group (mean ± SD): 0.88 ± 0.94 versus 0.60 ± 0.64 versus -0.52 ± 0.64 mm, respectively; P < .05. There was a significant difference between the 3 groups in bone level change (P < .05). The BMP 0.75 and BMP 1.5 groups exhibited significant changes in ISQ compared with the control group: 8.17 ± 8.31 versus 11.50 ± 9.02 versus 2.17 ± 7.61, respectively; P < .05. CONCLUSION:Within the limits of this study, the ErhBMP-2 coating on an anodized implant may stimulate vertical bone augmentation, which significantly increases implant stability on completely healed alveolar ridges.
10.1016/j.tripleo.2010.09.063
Use of rhBMP-2/β-TCP for Interpositional Vertical Grafting Augmentation: 5.5-Year Follow-up Clinically and Histologically.
Zétola André,do Valle Marisa,Littieri Sahara,Baumgart Dieter,Gapski Ricardo
Implant dentistry
PURPOSE:This case report documented long-term results using rh-BMP-2/β-tricalcium phosphate (TCP) for vertical grafting augmentation. MATERIALS AND METHODS:A 58-year-old patient with extreme atrophy of the left posterior mandible was treated with rh-BMP-2/β-TCP for vertical bone augmentation. At the time of implant placement, bone biopsy was performed for histological evaluation. RESULTS:Seven months after surgery, CT scan demonstrated approximately 8 mm of bone gain height. The histological results revealed a newly formed vital bone tissue, predominantly lamellar with variable density. Remaining bone ceramic surrounded by newly formed bone tissue or connective tissue was observed. The bone levels remained unchanged during the entire period treatment (5.5 years). CONCLUSION:This technique has demonstrated a potential for reconstruction of atrophic sites when vertical bone gain is desirable. Moreover, the bone gain has shown long-term maintenance without resorption. Future long-term prospective clinical trials are needed to confirm these findings.
10.1097/ID.0000000000000245
The use of intraorally harvested autogenous block grafts for vertical alveolar ridge augmentation: a human study.
Proussaefs Periklis,Lozada Jaime
The International journal of periodontics & restorative dentistry
This study presents a clinical, radiographic, laboratory, and histologic/histomorphometric analysis of the use of mandibular block autografts for vertical alveolar ridge augmentation. Twelve patients were included in the study. The autogenous block autografts were fixated at the recipient sites with screws, and a mixture of autogenous bone marrow and inorganic bovine mineral (Bio-Oss) was used at the periphery. At re-entry surgery, all the grafts appeared well incorporated at the recipient sites. Radiographic measurements revealed an average of 5.75 +/- 1.29 mm vertical ridge augmentation at 1 month after surgery and 4.75 +/- 1.29 mm at 4 to 6 months after surgery. This indicated 17.4% resorption. Laboratory volumetric measurements revealed an average of 0.84 +/- 0.34 mL of alveolar ridge augmentation 1 month after surgery and 0.71 +/- 0.28 mL at 6 months postoperatively. The resorption rate according to the laboratory volumetric measurements was 15.5%. Linear laboratory measurements revealed 5.92 +/- 1.38 mm of vertical ridge augmentation 1 month postoperatively and 4.08 +/- 1.01 mm at 4 to 6 months after surgery. Histologic evaluation of the block autografts indicated signs of active remodeling activity in 10 of the 12 specimens. In one case the block graft became exposed and infected, and in another case the block autograft became dislodged during implant placement surgery. Histomorphometric analysis of the peripheral particulate bone indicated bone present at 33.99% +/- 8.82% of the graft surface, while 42.43% +/- 11.06% of the area was occupied by fibrous tissue and 23.89% +/- 9.12% was made up of residual Bio-Oss particles. Residual Bio-Oss particles were in tight contact with newly formed bone along 58.57% +/- 15.22% of their perimeter.
Vertical bone augmentation procedures: basics and techniques in dental implantology.
Draenert F G,Huetzen D,Neff A,Mueller W E G
Journal of biomedical materials research. Part A
An appropriate bony situation is essential for dental implant placement and bony support of soft tissues (pink esthetic). Loss of teeth often results in complex horizontal and vertical alveolar ridge defects. They demand advanced bone augmentation techniques for reconstruction. We present the different techniques and materials used in complex bone augmentation. Clinical cases show the application of the methods in the clinical setting. We present current techniques and materials used in complex bone augmentations. Clinical cases show the application of the methods in the clinical setting. Applied techniques include stabilized-guided bone regeneration (GBR), autologous local block augmentation, modified techniques such as Gellrich shell technique including piezosurgery, pelvic bone blocks, complex materials such as graft-derived bone blocks and their unique handling problems. Successful basic principles are reduction of cortical bone healing due to long remodeling time and possible late loss; extended application of materials with interconnecting porous system and particulate material resulting in fast healing analogous to cancellous bone; mechanical stabilization of the augmentation to allow bony healing in vertical defect situations. GBR and autologous bone blocks with minimal cortical thickness and a high volume of particulated material are most favorable techniques.
10.1002/jbm.a.34812
Outcomes of alveolar segmental 'sandwich' osteotomy with interpositional particulate allograft for severe vertical defects in the anterior maxilla and mandible.
Chan C,Mirzaians A,Le B T
International journal of oral and maxillofacial surgery
The purpose of this study was to report the outcomes of interpositional osteotomy with mineralized allograft in the treatment of alveolar vertical defects in preparation for implant placement. Thirteen defects (11 maxillary and two mandibular) were treated with osteotomy segments ranging in length from two to five missing teeth. The segments were positioned 5-7 mm coronally, with the gap space filled with allograft and then fixated with titanium hardware. Vertical bone augmentation was analyzed by superimposing pre- and post-surgical cone beam computed tomography images and stratified based on the length and number of missing teeth in each edentulous segment. The mean vertical bone gain was 3.7 ± 1.6 mm in the area of greatest vertical defect and the mean length of the transport segment was 20.5 ± 8.1 mm. These segments represented two-, three-, four-, or five-tooth edentulous sites; the mean vertical bone gain for these segments was 1.7 ± 0.5 mm, 3.8 ± 1.0 mm, 4.6 ± 0.9 mm, and 6.7 ± 0.0 mm, respectively. Stability of vertical height gain was found to be directly proportional to the span length of the osteotomy segment, with the largest five-tooth segment achieving the greatest gain. Vertical bone gain in two-tooth segments was minimal, indicating a moderate amount of resorption.
10.1016/j.ijom.2021.06.004
Clinical and Histologic Evaluations of Porcine-Derived Collagen Matrix Membrane Used for Vertical Soft Tissue Augmentation: A Case Series.
Puisys Algirdas,Zukauskas Saulius,Kubilius Ricardas,Barbeck Mike,Razukevičius Dainius,Linkevičiene Laura,Linkevičius Tomas
The International journal of periodontics & restorative dentistry
This case series aimed to clinically and histologically evaluate porcine-derived membrane used for vertical thickening of thin soft tissues. Twenty porcine-derived collagen membranes and bone-level implants were placed in 20 patients. After 2 months, thickened soft tissues were measured and biopsy samples were harvested. All xenografts healed successfully. The average thickness of thin soft tissue before vertical thickening was 1.65 ± 0.36 mm, while tissue thickness increased to 3.45 ± 0.52 mm after the procedure (P < .001); the mean thickness increase was 1.8 ± 0.13 mm. Histologic analysis showed complete integration of the graft and no differences (P = .4578) in vascularization between the host (39.74 ± 17.15 vessels/mm) and graft (30.43 ± 11.26 vessels/mm). It can be concluded that porcine-derived membrane can be used for vertical soft tissue thickening with substantial gain in tissue height.
10.11607/prd.4097
Retrospective study of alveolar ridge preservation compared with no alveolar ridge preservation in periodontally compromised extraction sockets.
Lee Jungwon,Yun Junseob,Kim Jung-Ju,Koo Ki-Tae,Seol Yang-Jo,Lee Yong-Moo
International journal of implant dentistry
BACKGROUND:To minimize alveolar bone resorption, alveolar ridge preservation (ARP) has been proposed. Recently, interest in improving the feasibility of implant placement has gradually increased, especially in situations of infection such as periodontal and/or endodontic lesions. The aim of this study was to investigate if ARP improves feasibility of implant placement compared with no ARP in periodontally compromised sites. Secondary endpoints were the necessity of bone graft at the time of implant placement and implant failure before loading at ARP compared with no ARP. MATERIAL AND METHODS:This retrospective study was performed using dental records and radiographs obtained from patients who underwent tooth extraction due to chronic periodontal pathology. Outcomes including the feasibility of implant placement, horizontal bone augmentation, vertical bone augmentation, sinus floor elevation, total bone augmentation at the time of implant placement, and implant failure before loading were investigated. Multivariable logistic regression analysis was performed to examine the influence of multiple variables on the clinical outcomes. RESULTS:In total, 418 extraction sites (171 without ARP and 247 with ARP) in 287 patients were included in this study. The ARP group (0.8%) shows significantly lower implant placement infeasibility than the no ARP group (4.7%). Horizontal and vertical bone augmentations were significantly influenced by location and no ARP. Total bone augmentation was significantly influenced by sex, location, and no ARP. CONCLUSION:ARP in periodontally compromised sites may improve the feasibility of implant placement. In addition, ARP attenuate the severity of the bone augmentation procedure.
10.1186/s40729-021-00305-2
Vertical-guided bone regeneration with a titanium-reinforced d-PTFE membrane utilizing a novel split-thickness flap design: a prospective case series.
Windisch Peter,Orban Kristof,Salvi Giovanni E,Sculean Anton,Molnar Balint
Clinical oral investigations
OBJECTIVES:To evaluate the feasibility of a newly proposed minimally invasive split-thickness flap design without vertical-releasing incisions for vertical bone regeneration performed in either a simultaneous or staged approach and to analyze the prevalence of adverse events during postoperative healing. MATERIALS AND METHODS:Following preparation of a split-thickness flap and bilaminar elevation of the mucosa and underlying periosteum, the alveolar bone was exposed over the defects, vertical GBR was performed by means of a titanium-reinforced high-density polytetrafluoroethylene membrane combined with particulated autogenous bone (AP) and bovine-derived xenograft (BDX) in 1:1 ratio. At 9 months after reconstructive surgery, vertical and horizontal hard tissue gain was evaluated based on clinical and radiographic examination. RESULTS:Twenty-four vertical alveolar ridge defects in 19 patients were treated with vertical GBR. In case of 6 surgical sites, implant placement was performed at the time of the GBR (simultaneous group); in the remaining 18 surgical, sites implant placement was performed 9 months after the ridge augmentation (staged group). After uneventful healing in 23 cases, hard tissue fill was detected in each site. Direct clinical measurements confirmed vertical and horizontal hard tissue gain averaging 3.2 ± 1.9 mm and 6.5 ± 0.5 mm respectively, in the simultaneous group and 4.5 ± 2.2 mm and 8.7 ± 2.3 mm respectively, in the staged group. Additional radiographic evaluation based on CBCT data sets in the staged group revealed mean vertical and horizontal hard tissue fill of 4.2 ± 2.0 mm and 8.5 ± 2.4 mm. Radiographic volume gain was 1.1 ± 0.4 cm. CONCLUSION:Vertical GBR consisting of a split-thickness flap and using titanium-reinforced non-resorbable membrane in conjunction with a 1:1 mixture of AP+BDX may lead to a predictable vertical and horizontal hard tissue reconstruction. CLINICAL RELEVANCE:The used split-thickness flap design may represent a valuable approach to increase the success rate of vertical GBR, resulting in predicable hard tissue regeneration, and favorable wound healing with low rate of membrane exposure.
10.1007/s00784-020-03617-6
Ridge Augmentation Using Customized Allogeneic Bone Block: A 3-Year Follow-up of Two Case Reports.
Landsberg Cobi,Moses Ofer
The International journal of periodontics & restorative dentistry
A variety of surgical techniques and grafting materials for the purpose of ridge augmentation have been developed during the last three decades. Recently, the use of customized allogeneic bone blocks, prepared by CAD/CAM techniques, has been introduced. This new augmentation technology may significantly reduce surgical time and improve donor-recipient fit and adaptation. However, promising clinical and histologic results have been published in only a few short-term case reports. The 3-year follow-ups of these two case reports may provide more clinical data on the use of the customized bone blocks for horizontal and vertical ridge augmentation in the posterior mandible.
10.11607/prd.3354
Growth factor-mediated vertical mandibular ridge augmentation: a case report.
Guze Kevin A,Arguello Emilio,Kim David,Nevins Myron,Karimbux Nadeem Y
The International journal of periodontics & restorative dentistry
Posterior vertical alveolar ridge deficiencies are challenging defects to treat predictably and often require autogenous bone-harvesting procedures. Traditional treatment modalities, eg, guided bone regeneration, distraction osteogenesis, and autogenous grafts, present with a number of potential complications and limited success when used to restore vertical ridge height. Recent advances in recombinant growth factor technology may provide viable, alternative therapies for the treatment of significant alveolar ridge deficiencies. This proof-of-principle case report examines the utility and effectiveness of using a composite graft of freeze-dried bone allograft and recombinant human platelet-derived growth factor BB in conjunction with an overlying titanium mesh to regenerate well-vascularized bone in a significant posterior mandibular ridge defect prior to implant placement. The important role of the overlying periosteum as a possible key source of osteogenic cells during growth factor-enhanced regenerative procedures is emphasized.
10.11607/prd.1518
Guided bone regeneration in staged vertical and horizontal bone augmentation using platelet-rich fibrin associated with bone grafts: a retrospective clinical study.
Amaral Valladão Carlos Alberto,Freitas Monteiro Mabelle,Joly Julio Cesar
International journal of implant dentistry
BACKGROUND:The use of guided bone regeneration (GBR) for vertical and horizontal bone gain is a predictable approach to correct the bone defects before implant installation; however, the use of different protocols is associated with different clinical results. It is suggested that platelet-rich fibrin (PRF) could improve the outcomes of regenerative procedures. Thus, this study aimed to describe the bone gain associated with GBR procedures combining membranes, bone grafts, and PRF for vertical and horizontal bone augmentation. MATERIALS AND METHODS:Eighteen patients who needed vertical or horizontal bone regeneration before installing dental implants were included in the study. The horizontal bone defects were treated with a GBR protocol that includes the use of a mixture of particulate autogenous and xenogenous grafts in the proportion of 1:1, injectable form of PRF (i-PRF) to agglutinate the graft, an absorbable collagen membrane covering the regenerated region, and leukocyte PRF (L-PRF) membrane covering the GBR membrane. The vertical bone defects were treated with the same grafted mixture protected by a titanium-reinforced non-resorbable high-density polytetrafluoroethylene (d-PTFE-Ti) membrane and covered by L-PRF. The bone gain was measured using a cone-beam computed tomography at baseline and after a period of 7.5 (± 1.0) months. RESULTS:All patients underwent surgery to install implants after this regenerative protocol. The GBR produces an increase in bone thickness (p < 0.001) and height (p < 0.005) after treatment, with a bone gain of 5.9 ± 2.4 for horizontal defects and 5.6 ± 2.6 for vertical defects. In horizontal defects, the gain was higher in the maxilla than in mandible (p = 0.014) and in anterior than the posterior region (p = 0.033). No differences related to GBR location were observed in vertical defects (p > 0.05). CONCLUSION:GBR associated with a mixture of particulate autogenous and xenogenous grafts and i-PRF is effective for vertical and horizontal bone augmentation in maxillary and mandibular regions, permitting sufficient bone gain to future implant placement. TRIAL REGISTRATION:REBEC, RBR-3CSG3J . Date of registration-19 July 2019, retrospectively registered. http://www.ensaiosclinicos.gov.br/rg/RBR-3csg3j/.
10.1186/s40729-020-00266-y
Vertical Bone Augmentation with GBR Pocket Technique: Surgical Procedure and Preliminary Results.
The journal of contemporary dental practice
AIM:Nowadays, guided bone regeneration (GBR) is a predictable technique in both vertical and horizontal bone defects treatment. GBR Pocket Technique is an original surgical approach adopted in order to reduce the invasiveness of traditional procedures. The aim of this work is to describe the surgical procedure of GBR Pocket Technique in vertical bone augmentation and to compare the clinical outcomes of this technique with the results reported in literature of vertical bone augmentation and crestal bone remodeling achieved after 1 year after implants insertion. MATERIALS AND METHODS:Twenty-eight patients were recruited for this study and received 28 GBR procedures in the posterior region due to vertical and horizontal defects. A 50/50 mixture of autologous bone component and heterologous bone of equine origin was then made with the use of a bone scraper tunnel with internal reservoir. A PTFE-d membrane with titanium reinforcement was then fixed to the residual bone structure with screws in order to maintain the graft in place. Radiographic checks were made before graft procedures and implants insertion, then 6 months later and 1 year after implants placement. RESULTS:The average bone augmentation after surgery seems to be aligned, or even better, than the average reported in literature with alternative surgical approach; in addition, the mean crestal remodeling after 1 year and the rate of complications are aligned with other previous surgical techniques with a vertical bone augmentation of 8.78 mm ± SD 2.39 and a bone remodeling after 1 year of 0.59 mm ± SD 0.29. CONCLUSIONS:The advantages of this technique are preservation of blood circulation and consequently risk of flap necrosis, dehiscence, and graft exposure. This technique also reduces mucosal healing times even if it takes longer surgical time. CLINICAL SIGNIFICANCE:GBR Pocket Technique is the use of a minimal-invasive surgical wound to reduce patient morbidity and compliance.
Ridge augmentation in implant dentistry.
Kim Young-Kyun,Ku Jeong-Kui
Journal of the Korean Association of Oral and Maxillofacial Surgeons
In patients with insufficient bone height and width, the successful placement of dental implants is difficult with regards to maintaining an ideal pathway and avoiding important anatomical structures. Vertical and/or horizontal ridge augmentation may be necessary using various bone substitute materials and bone graft procedures. However, effective one-wall reconstruction has been challenging due to its poor blood supply and insufficient graft stability. In this paper, the authors summarize current evidence-based literature based on the author's clinical experience. Regarding bone substitutes, it is advantageous for clinicians to select the types of bone substitutes including autogenous bone. The most important consideration is to minimize complications through principle-based ridge augmentation surgery. Ridge augmentation should be decided with complete consent of the patients due to the possible disadvantages of surgery, complications, and unpredictable prognosis.
10.5125/jkaoms.2020.46.3.211
Autogenous bone ring for vertical bone augmentation procedure with simultaneous implant placement: A systematic review of histologic and histomorphometric outcomes in animal studies.
Gaikwad Amit M,Joshi Amruta A,Padhye Ashvini M,Nadgere Jyoti B
The Journal of prosthetic dentistry
STATEMENT OF PROBLEM:The performance of the autogenous bone ring (ABR) technique used for the vertical bone augmentation procedure has not yet been determined. PURPOSE:The purpose of this systematic review was to investigate whether the ABR technique for the vertical bone augmentation procedure with simultaneous implant placement enhances the histologic and histomorphometric outcomes in surgically created bone defects in animal models. MATERIAL AND METHODS:An electronic search of 3 databases, Medline/PubMed, Science Direct, Lilacs, and a manual search of a reference list of relevant studies were performed. Only animal studies regarding vertical bone augmentation by using the ABR technique with simultaneous implant placement in surgically created bone defects were included in the review. The SYstematic Review Center for Laboratory Animal Experimentation tool was used to determine the risk of bias assessment, and the quality of included studies was assessed by using the Animal Research: Reporting in Vivo Experiments guidelines. RESULTS:Five studies were included in the qualitative analysis based on the inclusion and exclusion criteria. One study comparing the ABR technique with the bovine and biphasic ring reported a high percentage of bone area and bone implant contact of the ABR at 5 weeks of osseointegration. Similar histologic findings were reported in another study at 4 months of healing, but contrasting data were reported at 8 months. Another study reported an increase in the percentage of bone area and bone implant contact of the ABR technique from 3 months to 6 months of osseointegration. Two studies reported an increase in the percentage of bone area, and 1 study reported a decrease in the mean of bone implant contact, both with simultaneous and staged implant procedures. CONCLUSION:Based on the limited available studies, the use of the ABR technique for the vertical bone augmentation procedure with simultaneous implant placement presented optimal histologic and histomorphometric outcomes in surgically created bone defects in animal models. However, the results of the current review are not sufficiently robust to support the use of the ABR technique for vertical bone augmentation in humans.
10.1016/j.prosdent.2020.09.001
Vertical Alveolar Ridge Augmentation by Distraction Osteogenesis.
Mohanty Rajat,Kumar N Nanda,Ravindran C
Journal of clinical and diagnostic research : JCDR
INTRODUCTION:Compromised alveolar ridge in vertical and horizontal dimension is a common finding in patients visiting practitioners for dental prosthesis. Various treatment modalities are available for correction of deficient ridges among which alveolar distraction osteogenesis is one. AIM:To study the efficacy of alveolar distraction osteogenesis in augmentation of alveolar ridges deficient in vertical dimension. MATERIALS AND METHODS:Ten patients aged 16 to 46 years with deficient alveolar ridge underwent ridge augmentation in 11 alveolar segments using the distraction osteogenesis method. For each patient a custom made distraction device was fabricated. The device was indigenously manufactured with SS-316 (ISO 3506). RESULTS:The vertical bone gain reached more than 10mm without the use of bone transplantation. Certain complications like incorrect vector of distraction, paresthesia, pain and loss of transport segment were encountered during the course of the study. CONCLUSION:Alveolar vertical distraction osteogenesis is a reliable and predictable technique for both hard and soft tissue genesis. Implant placement is feasible with primary stability in neogenerated bone at the level of the distracted areas.
10.7860/JCDR/2015/15976.6993
Ridge Augmentation in a Site of a Previous Implant Failure Using Tenting Screws With Allograft and Collagen Membrane.
Shariff Jaffer A,Gurpegui Abud Daniela,Dave Anjali K,Tarnow Dennis P
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)
Rehabilitation of a severely resorbed mandibular posterior ridge with implants poses a challenge to the clinician. Several techniques to address this challenge have been described in the literature. This case report describes the successful vertical and horizontal bone augmentation of a site of a previous implant failure with severe vertical and horizontal ridge deficiencies using tenting screws, cortico-cancellous particulate bone allograft, and a resorbable collagen membrane. A bone core was obtained at the time of implant placement, 8 months postoperatively, and histological findings showed the highest concentration of lamellar bone at the apical third; a 50-50% graft and lamellar bone proportion in the middle third; and a higher concentration of bone allograft at the coronal third of the bone core. Successful implant placement was achieved at the site. This case report demonstrates the effective use of tenting screws for vertical and horizontal bone augmentation and consequent implant placement in a severely resorbed ridge in the posterior mandible.
Alveolar Ridge Augmentation Around Exposed Mandibular Dental Implant With Histomorphometric Analysis.
Clinical advances in periodontics
INTRODUCTION:Alveolar ridge augmentation either before or during implant placement is a predictable procedure under certain conditions. A major complication during the healing phase is incision line opening and membrane exposure, which may result in reduced bone gain and reduced implant survival. This case report describes alveolar bone regeneration around three dental implants despite membrane exposure that developed during healing post-surgically. CASE PRESENTATION:A 72-year-old female presented requesting dental implants to replace tooth numbers 18, 19, and 20. A cone-beam computed tomography (CBCT) scan showed loss of horizontal and vertical ridge dimensions. All implants were placed with a variable degree of implant thread exposure on their buccal surfaces, ranging from 3 to 4.5 mm. Simultaneous bone grafting was performed using freeze dried bone allograft and deproteinized bovine bone mineral that was covered by a d-PTFE membrane that was secured with tacking screws. Primary closure was obtained, and flaps were sutured. Three weeks post-surgically, membrane exposure occurred. Exposure was monitored and patient was instructed to follow strict oral hygiene instructions around the exposed membrane. Membrane exposure gradually increased without infection and was removed at 16 weeks. Membrane removal revealed dense fibrous tissues covering all implant surfaces. At the second stage surgery, new bone was seen covering all the implants coronal to the cover screws. A trephine core biopsy specimen revealed significant new bone formation and connective tissue around any residual grafted bone. CONCLUSION:d-PTFE membrane exposure does not necessarily lead to adverse healing outcomes for alveolar ridge augmentation if handled properly with close patient follow-up.
10.1002/cap.10090
Histologic and Clinical Evaluation of Ridge Augmentation of Extraction Sockets with Severe Bone Defects: A Clinical Prospective Study.
The International journal of oral & maxillofacial implants
PURPOSE:To primarily evaluate the dimensional changes of bone and soft tissue following ridge augmentation in compromised molar regions. The secondary objective was to evaluate the histologic composition of augmented sites. MATERIALS AND METHODS:The study included 27 patients who underwent augmentation of extraction sites with grafts covered by a collagen membrane. CBCT was taken immediately after augmentation (T2) and after 8 months of healing, before implant placement (T3). The width and height of the extraction sites were recorded at extraction (T1) and reentry surgery (T4). A histomorphometric analysis was performed. Data were evaluated in terms of bone crest level, implant survival rates, and change in mucogingival junction. RESULTS:According to clinical measurement, horizontal and vertical bone gain was 10.15 ± 1.00 mm and 8.80 ± 1.86 mm, respectively. Radiographic measurement showed that the horizontal width changes were 1.46 ± 0.52 mm, 0.98 ± 1.29 mm, and 1.29 ± 0.82 mm, respectively, at 1, 3, and 5 mm apical to the crestal level. Vertical bone change was 2.34 ± 0.90 mm in the center of the socket. Histomorphometric analysis showed that percentages of mineralized bone, nonmineralized tissue, and bone substitute were 32.31% ± 13.25%, 25.36% ± 12.24%, and 42.34% ± 9.54%, respectively. The mucogingival junction shift was 0.6 ± 1.1 mm. Implant survival rates and crestal bone resorption were 100% and 0.78 ± 0.58 mm, respectively, after 1 year of loading. CONCLUSION:Ridge augmentation can be performed successfully to manage extraction sockets. Membrane coverage combined with primary wound closure could be conducive to new bone regeneration and peri-implant tissue health.
10.11607/jomi.9651
A Case Series of Vertical Ridge Augmentation Using a Nonresorbable Membrane: A Multicenter Study.
Mendoza-Azpur Gerardo,Gallo Pier,Mayta-Tovalino Frank,Alva Renato,Valdivia Erick
The International journal of periodontics & restorative dentistry
Vertical ridge augmentation (VRA) using titanium-reinforced dense polytetrafluorethylene (d-PTFE) membranes has been associated with promising clinical outcomes. This retrospective multicenter case series was prepared for the purpose of identifying the elements that contribute to the predictability of this surgical technique. VRA procedures were carried out in 35 patients (13 male and 22 female) with an age range of 43 to 76 years. The average bone gain was 5.44 mm. In the Kaplan-Meier estimates of cumulative survival calculated at 15 months, membrane exposure (P = .045) was a predictor for VRA.
10.11607/prd.3538
Long-term outcomes of implants placed after vertical alveolar ridge augmentation in partially edentulous patients: a 10-year prospective clinical study.
Roccuzzo Mario,Savoini Matteo,Dalmasso Paola,Ramieri Guglielmo
Clinical oral implants research
AIM:The aim of this study was to evaluate the long-term clinical results around non-submerged implants placed after vertical alveolar ridge augmentation. MATERIAL AND METHODS:The original population consisted of two groups of partially edentulous patients (Clinical Oral Implants Research, 15, 2004, 73; Clinical Oral Implants Research, 18, 2007, 286), receiving a total of 82 implants, after a vertical bone augmentation of at least 4 mm. Following cementation of the fixed dental prostheses, patients were asked to follow an individualized supportive periodontal therapy (SPT) program for an appropriate clinical and radiographic follow-up. RESULTS:At the 10-year examination, seven of the 41 patients were lost to follow-up. During SPT, additional antibiotic and/or surgical therapy was necessary in 18 implants, and four of these implants were removed for biological complications. The overall implant survival rate was 94.1%. The mean interproximal bone loss (BL) was 0.58 ± 0.57 mm. CONCLUSIONS:The results of this study confirmed that implants, placed after vertical augmentation and followed by an adequate SPT, offer predictable long-term results. Nevertheless, patients whose bone atrophy was consequence of a previous history of periodontitis presented a statistically significant greater BL.
10.1111/clr.12941
A Titanium Mesh and Particulate Allograft for Vertical Ridge Augmentation in the Posterior Mandible: A Pilot Study.
Chan Hsun-Liang,Benavides Erika,Tsai Ching-Yu,Wang Hom-Lay
The International journal of periodontics & restorative dentistry
This preliminary study was designed to test the clinical efficacy of a modified Ti-mesh combined with particulate allograft for vertical ridge augmentation (VRA). Five healthy patients with vertical ridge deficiency in the posterior mandible were recruited. Preoperative width of the keratinized mucosa (KM) and mucosal thickness (MT) were measured. Cone beam computed tomography (CBCT) scans were taken preoperatively, immediately, and 5 months after VRA. The amount of vertical bone gain was measured on CBCT scans. Bone core biopsies were taken for histomorphometric examinations. The mean ± standard deviation KM on the facial and lingual sides was 3.9 ± 1.7 mm and 3.3 ± 1.3 mm, respectively. The mean thickness of the flaps, measured at the facial, lingual, and crestal sites, was 2.9 ± 0.8 mm, 1.8 ± 0.8 mm, and 3.2 ± 1.2 mm, respectively. The mean vertical gain was 3.4 ± 1.9 mm when only the sites with the greatest vertical defect in each subject were studied. Histometric analysis of the bone cores revealed that percentages of the soft tissue, residual allograft, and new bone were 42.2% ± 10.0%, 25.2% ± 13.5%, and 32.6% ± 4.9%. The use of a Ti-mesh and particulate allograft may be a viable option for vertical augmentation of sites with slight to moderate ridge deficiency.
10.11607/prd.1980
Vertical ridge augmentation using the modified shell technique--a case series.
Stimmelmayr Michael,Beuer Florian,Schlee Markus,Edelhoff Daniel,Güth Jan-Frederik
The British journal of oral & maxillofacial surgery
Vertical defects of the alveolar crest often restrict the placement of implants. The outcome of vertical augmentation is unpredictable so we aimed to develop a technique that has predictable results. We used autogenous grafts trimmed to shells less than 1mm thick to rebuild the vertical dimensions of the alveolar ridge. The shells were fixed with microscrews and the vertical space between the shell and the residual bone was filled with autogenous particulate bone. Vertical dimensions before and after augmentation were measured and descriptive statistics calculated. A total of 17 patients (10 female, 7 male, mean (SD) age 46 (17) years) had 18 sites augmented (2 sites in one patient). In 2 cases the wound dehisced and healing was by secondary intention. The rest healed uneventfully. The mean (SD) vertical defect was 4.7 (1.4) mm and mean (SD) resorption during consolidation was 0.5 (0.7) mm. All 30 previously planned implants were placed, and none failed during the first year. Loading was monitored for a mean (SD) period of 14.6 (10.5) months. The technique showed promising results and could be an alternative to procedures that use extraoral donor sites.
10.1016/j.bjoms.2014.08.009
Overlay Analysis of Cone-Beam Computed Tomography Volumes Acquired before and after Horizontal Alveolar Ridge Augmentation.
Pfaff Aaron S,Bumpers April P,Swenson Dane T,Ange Brittany L,Wikesjö Ulf M E,Johnson Thomas M
Medical journal (Fort Sam Houston, Tex.)
OBJECTIVE:The objective of this study was to illustrate the efficacy of a novel imaging analysis technology to capture horizontal and vertical dimensional changes following horizontal alveolar ridge augmentation (HRA). METHODS:Cone-beam computed tomography (CBCT) volumes from 65 HRA sites in 57 patients were available for evaluation, employing a three-dimensional analysis software to overlay preoperative and post-augmentation CBCT volumes. Horizontal and vertical alveolar ridge dimensional (HRD/VRD) changes were recorded considering a panel of patient-, site-, and procedure-related explanatory variables. RESULTS:VRD changes ranged from -2.9 to 3.0 mm, more than half anterior sites losing alveolar ridge height. Mean HRD increase at the 3- and 5-mm levels apical to the alveolar crest amounted to 2.3±1.6 and 2.4±1.3 mm, respectively, membrane fixation and non-resorbable membrane use associated with significantly greater gains. CONCLUSIONS:To date, studies reporting dimensional changes following HRA predominantly rely on serial in situ orofacial caliper recordings omitting vertical alterations. The protocol employed in this study allows simultaneous HRD and VRD evaluations and assures baseline and post-augmentation recordings are made at the same alveolar ridge position. Compared with in situ recording, CBCT overlay analysis may achieve a more complete characterization of dimensional changes following HRA.
Three-Dimensional Vertical Alveolar Ridge Augmentation in the Posterior Maxilla: A 10-year Clinical Study.
Khoury Fouad,Hanser Thomas
The International journal of oral & maxillofacial implants
PURPOSE:The aim of this clinical study was to evaluate the long-term outcome of the split bone block (SBB) technique for vertical bone augmentation in the posterior maxilla in combination with sinus floor elevation using a tunneling approach. MATERIALS AND METHODS:Patients were treated for extensive vertical and horizontal alveolar bone defects without simultaneous implant placement and followed up for at least 10 years postoperatively. Autogenous bone blocks were harvested from the mandibular retromolar area following the MicroSaw protocol. The harvested bone blocks were split longitudinally according to the SBB technique. Implants were inserted and exposed after every 3 months, and prosthetic restoration was performed. RESULTS:One hundred forty-two consecutively treated patients, 154 grafted sites, and 356 inserted implants were documented. Minimal graft exposure (1 to 3 mm) 4 to 8 weeks postoperatively was documented in two sites; infection of the grafted area occurred in one other case. The mean preoperative clinical vertical defect was 7.8 ± 3.9 mm, and the mean horizontal width was 3.1 ± 2.2 mm. Postoperatively, the mean vertical gained dimension was 7.6 ± 3.4 mm (maximum: 13 mm), and the mean width was 8.3 ± 1.8 mm. Implants could be inserted in all sites, with additional local small augmentation in 21 cases. The amount of maximum vertical bone resorption was 0.21 ± 0.18 mm after 1 year, 0.26 ± 0.21 mm after 3 years, 0.32 ± 0.19 mm after 5 years, and 0.63 ± 0.32 mm after 10 years. As part of a total patient dropout of 16.9%, four implants were lost within 10 years. The mean vertically gained bone was stable at 6.82 ± 0.28 mm (maximum: 12 mm). The resorption rate after 10 years was 8.3%. CONCLUSION:The described tunneling flap approach allows a hermetic soft tissue closure, characterized by a reduction of dehiscence and a secure bone graft healing. The combination of thin autogenous bone blocks and bone particles according to the SBB technique allows an acceleration of transplant revascularization, and thus, of graft regeneration, allowing a shortening of the patient treatment time as well as long-term three-dimensional volumetric bone stability.
10.11607/jomi.6869
Bioactivating a bone substitute accelerates graft incorporation in a murine model of vertical ridge augmentation.
Chen Jinlong,Yuan Xue,Li Zhijun,Bahat Daniel J,Helms Jill A
Dental materials : official publication of the Academy of Dental Materials
OBJECTIVE:Compared to autologous bone grafts, allogeneic bone grafts integrate slowly, which can adversely affect clinical outcomes. Here, our goal was to understand the molecular mechanisms underlying graft incorporation, and then test clinically feasible methods to accelerate this process. METHODS:Wild-type and transgenic Wnt "reporter" mice were used in a vertical ridge augmentation procedure. The surgery consisted of tunneling procedure to elevate the maxillary edentulous ridge periosteum, followed by the insertion of bone graft. Micro-computed tomographic imaging, and molecular/cellular analyses were used to follow the bone graft over time. Sclerostin null mice, and mice carrying an activated form of β-catenin were evaluated to understand how elevated Wnt signaling impacted edentulous ridge height and based on these data, a biomimetic strategy was employed to combine bone graft particles with a formulation of recombinant WNT protein. Thereafter, the rate of graft incorporation was evaluated. RESULTS:Tunneling activated osteoprogenitor cell proliferation from the periosteum. If graft particles were present, then osteoprogenitor cells attached to the matrix and gave rise to new bone that augmented edentulous ridge height. Graft particles alone did not stimulate osteoprogenitor cell proliferation. Based on the thicker edentulous ridges in mice with amplified Wnt signaling, a strategy was undertaken to load bone graft particles with WNT; this combination was sufficient to accelerate the initial step of graft incorporation. SIGNIFICANCE:Local delivery of a WNT protein therapeutic has the potential to accelerate graft incorporation, and thus shorten the time to when the graft can support a dental implant.
10.1016/j.dental.2020.06.003
Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft.
Navarro Cuéllar Carlos,Ochandiano Caicoya Santiago,Navarro Cuéllar Ignacio,Valladares Pérez Salvador,Fariña Sirandoni Rodrigo,Antúnez-Conde Raúl,Díez Montiel Alberto,Sánchez Pérez Arturo,López López Ana María,Navarro Vila Carlos,Salmerón Escobar José Ignacio
Journal of clinical medicine
Double-barrel flap, vertical distraction and iliac crest graft are used to reconstruct the vertical height of the fibula. Twenty-four patients with fibula flap were reconstructed comparing these techniques (eight patients in each group) in terms of height of bone, bone resorption, implant success rate and the effects of radiotherapy. The increase in vertical bone with vertical distraction, double-barrel flap and iliac crest was 12.5 ± 0.78 mm, 18.5 ± 0.5 mm, and 17.75 ± 0.6 mm, ( < 0.001). The perimplant bone resorption was 2.31 ± 0.12 mm, 1.23 ± 0.09 mm and 1.43 ± 0.042 mm ( < 0.001), respectively. There were significant differences in vertical bone reconstruction and bone resorption between double-barrel flap and vertical distraction and between iliac crest and vertical distraction ( < 0.001). The study did not show significant differences in implant failure ( = 0.346). Radiotherapy did not affect vertical bone reconstruction ( = 0.125) or bone resorption ( = 0.237) but it showed higher implant failure in radiated patients ( = 0.015). The double-barrel flap and iliac crest graft showed better stability in the height of bone and less bone resorption and higher implant success rates compared with vertical distraction. Radiation therapy did not affect the vertical bone reconstruction but resulted in a higher implant failure.
10.3390/jcm10010101
Vertical ridge augmentation (VRA) with Ti-reinforced d-PTFE membranes or Ti meshes and collagen membranes: 1-year results of a randomized clinical trial.
Cucchi Alessandro,Vignudelli Elisabetta,Fiorino Antonino,Pellegrino Gerardo,Corinaldesi Giuseppe
Clinical oral implants research
OBJECTIVES:The aim of this study was to evaluate hard and soft tissues around implants placed in posterior mandible 1 year after vertical ridge augmentation (VRA). MATERIALS AND METHODS:40 patients with vertical defects were enrolled and treated according to the study protocol. Patients were randomly divided into two study groups: reinforced PTFE membranes (group A) and titanium meshes plus collagen membranes (group B). All patients received simultaneous implants which were evaluated after prosthetic restoration at baseline and after 1 year, using the following parameters: peri-implant bone levels (PBLs), interproximal bone peaks (IBPs), pocket probing depth (PPD), bleeding on probing (BoP), plaque index (mPI), gingival index (mGI), keratinized tissue thickness/width (tKT and wKT), and fornix depth (FD). Statistical analysis was performed to investigate any statistically significant differences and/or correlations (p = .05). RESULTS:30 patients were completely followed up according to the study protocol. After 1 year, implants showed a change in PBL from 0.12 to 0.76 mm, with marginal bone loss of 0.67 and 0.61 mm for group A and group B, respectively, without significant differences (p > .9337). The estimated difference between treatments for the change from baseline in PBL was -0.05 (95% CI -0.27 to 0.16). Statistical analysis revealed strong correlations between PBL and IBP (p < .0001). However, no significant differences were observed for PPD, mPI, mGI, tKT, wKT, and FD (p > .05). CONCLUSION:The results indicate that GBR treatment with titanium meshes plus collagen membranes (Group B) compared to reinforced PTFE membranes does not appear to be inferior or superior in terms of PBL change. In both groups, hard and soft tissues were stable after 1 year of follow-up, with a peri-implant bone loss less than 1.0 mm in the first year (study registered at ClinicalTrials.gov NCT04332679).
10.1111/clr.13673
Vertical ridge augmentation using a porous composite of uncalcined hydroxyapatite and poly-DL-lactide enriched with types 1 and 3 collagen.
Akino Norio,Tachikawa Noriko,Miyahara Takayuki,Ikumi Reo,Kasugai Shohei
International journal of implant dentistry
BACKGROUND:Previous studies have shown that porous composite blocks containing uncalcined hydroxyapatite (u-HA; 70 wt%) with a scaffold of poly-DL-lactide (PDLLA, 30 wt%) are biodegradable, encourage appropriate bone formation, and are suitable for use as a bone substitute in vertical ridge augmentation. The present study aimed to accelerate osteogenesis in vertical ridge formation by adding types 1 and 3 collagen to the u-HA/PDLLA blocks and assessing the effect. MATERIAL AND METHODS:The bone substitute in the present study comprised porous composite blocks of u-HA (70 wt%) with a PDLLA (27-29 wt%) scaffold and enriched with types 1 and 3 collagen (1.7 ~ 3.4 wt%). The control blocks were composed of u-HA (70 wt%) and PDLLA (30 wt%). The materials were formed into 8-mm diameter, 2-mm high discs and implanted onto the cranial bones of six rabbits. The animals were sacrificed 4 weeks after implantation, and histological and histomorphometrical analyses were performed to quantitatively evaluate newly formed bone. RESULTS:New bone formation occurred with both block types, showing direct contact with the original bone. Mean ± standard deviation bone formation was significantly greater in the experimental blocks (25.6% ± 4.8%) than in the control blocks (17.0% ± 4.7%). CONCLUSIONS:Histological and histomorphometrical observations indicated that new bone was formed with both block types. The u-HA/PDLLA block with types 1 and 3 collagen is a more promising candidate for vertical ridge augmentation than the u-HA/PDLLA alone block.
10.1186/s40729-019-0167-5
Vertical and horizontal ridge augmentation using customized CAD/CAM titanium mesh with versus without resorbable membranes. A randomized clinical trial.
Clinical oral implants research
OBJECTIVES:The aim was to evaluate the role of resorbable membranes applied over customized titanium meshes related to soft tissue healing and bone regeneration after vertical/horizontal bone augmentation. MATERIALS AND METHODS:Thirty patients with partial edentulism of the maxilla/mandible, with vertical/horizontal reabsorption of the alveolar bone, and needing implant-supported restorations, were randomly divided into two groups: Group A was treated using only custom-made meshes (Mesh-) and Group B using custom-made meshes with cross-linked collagen membranes (Mesh+). Data collection included surgical/technical and healing complications, "pseudo-periosteum" thickness, bone density, planned bone volume (PBV), regenerated bone volume (RBV), regeneration rate (RR), vertical bone gain (VBG), and implant survival in regenerated areas. Statistical analysis was performed between the two study groups using a significance level of α = .05. RESULTS:Regarding the healing complications, the noninferiority analysis proved to be inconclusive, despite the better results of group Mesh+ (13%) compared to group Mesh- (33%): estimated value -1.13 CI-95% from -0.44 to 0.17. Superiority approach confirmed the absence of significant differences (p = .39). RBV was 803.27 mm and 843.13 mm , respectively, and higher RR was observed in group Mesh+ (82.3%) compared to Mesh- (74.3%), although this value did not reach a statistical significance (p = .44). All 30 patients completed the study, receiving 71 implants; 68 out of them were clinically stable and in function. CONCLUSION:The results showed that customized meshes alone do not appear to be inferior to customized meshes covered by cross-linked collagen membranes in terms of healing complication rates and regeneration rates, although superior results were observed in group Mesh+compared to group Mesh- for all variables.
10.1111/clr.13841
Vertical ridge augmentation feasibility using unfixed collagen membranes and particulate bone substitutes: A 1- to 7-year retrospective single-cohort observational study.
Clinical implant dentistry and related research
AIM:To determine whether vertical ridge augmentation (VRA) can be obtained through guided bone regeneration (GBR) using exclusively resorbable collagen membranes and particulate bone substitutes without additional stabilization. MATERIALS AND METHODS:This study retrospectively examined 22 participants who underwent VRA with staged or simultaneous implant placement. The vertical defects of all participants were filled with particulate bone substitutes and covered with resorbable collagen membranes. The augmented sites were stabilized with unfixed collagen membranes and the flap without any additional fixation. The augmented tissue height was assessed using cone-beam computed tomography at baseline, immediately after surgery, and at annual follow-ups. RESULTS:The vertical bone gain of the 22 augmented sites amounted to 6.48 ± 2.19 mm (mean ± SD) immediately after surgery and 5.78 ± 1.72 mm at 1- to 7-year follow-up. Of the 22 augmented sites, 18 exhibited changes of less than 1 mm, while the other 4 showed changes of greater than 1 mm. Histological observation of three representative cases revealed new bone apposition on the remaining material. CONCLUSION:The present findings indicate that GBR procedures using exclusively collagen membranes and particulate biomaterials without any additional fixation are feasible options for VRA.
10.1111/cid.13084
Dimensional alterations following vertical ridge augmentation using collagen membrane and three types of bone grafting materials: A retrospective observational study.
Park Yun-Ho,Choi Seong-Ho,Cho Kyoo-Sung,Lee Jung-Seok
Clinical implant dentistry and related research
BACKGROUND:Various biomaterials have been introduced for vertical ridge augmentation to replace autogenous block bone grafting. PURPOSE:This retrospective study radiographically evaluated dimensional alterations of the vertically augmented alveolar ridge using collagen membrane and 3 types of materials: autogenous bone block, allogenous bone block, and particulated bone substitute. MATERIALS AND METHODS:The electronic medical records of 32 patients who received vertical ridge augmentation using 3 types of materials were searched: 9 for autogenous bone block, 12 for allogenous bone block, and 11 for particulated bone substitutes. The vertical bone gain, progression of bone resorption, and peri-implant marginal bone loss after prosthetic loading were measured on follow-up radiographs. RESULTS:The alveolar ridge was vertically augmented by 5.13 ± 1.61, 4.54 ± 2.48, and 3.90 ± 0.85 mm (mean ± standard deviation) after grafting with autogenous bone block, allogenous bone block, and particulated bone substitute, respectively. The radiographic vertical height of the augmented ridge that received autogenous bone block reduced continuously during the first year but was stable thereafter. Sites that received allogenous bone block or particulated bone substitute exhibited dimensional shrinkage for up to 1.5 years postsurgery. However, the peri-implant marginal bone loss did not exceed 1 mm throughout the observational periods in all groups. CONCLUSIONS:The clinical findings of this study suggest that the alveolar ridge can be vertically augmented using either allogenous bone block or particulated bone substitute. However, they require a longer healing period to ensure dimensional stability compared to the autogenous bone block.
10.1111/cid.12502
One-Stage Vertical Ridge Augmentation and Dental Implantation With Allograft Bonerings: Results 1 Year After Surgery.
Nord Thomas,Yüksel Orcan,Grimm Wolf-Dieter,Giesenhagen Bernd
The Journal of oral implantology
The aim of this study was to analyze the success rate of dental implants and the graft shrinkage rate after vertical ridge augmentation and simultaneous implantation with an allograft bonering. Fifty-one patients (81 augmentations and simultaneous implantations) were included. The bonering technique followed a standardized protocol. The alveolar ridge was prepared using a congruent trephine, and depending on the defect size, an allograft bonering with an outer diameter of 6-7 mm was placed. The height of the bonering was trimmed with a diamond disc to the required length. The average height of vertical augmentation was 5.5 mm. Implants were inserted through the bonering into the native bone of alveolar ridge. After 6 months, dental implants were exposed, and dental prosthetics were placed. Of 81 implants placed with the bonering technique, two failed during a 12-month follow-up, corresponding to a success rate of 97.5%. One year after surgery, the allograft bonering exhibited an average vertical graft shrinkage rate of 8.6%. In conclusion, the allograft bonering technique was associated with a favorable outcome, and in cases with large vertical defects, both treatment time and donor site morbidity could be reduced.
10.1563/aaid-joi-D-18-00257
Microstructural volumetric analysis of vertical alveolar ridge augmentation using autogenous tooth roots.
Parvini Puria,Schwarz Frank,Hüfner Mira Kristin,Rauch Nicole,Nienkemper Manuel,Becker Kathrin
Clinical implant dentistry and related research
BACKGROUND:To volumetrically assess the bone microstructure following vertical alveolar ridge augmentation using differently conditioned autogenous tooth roots (TR) and second-stage implant placement. MATERIALS AND METHODS:The upper premolars were bilaterally extracted in n = 4 beagle dogs and randomly assigned to either autoclavation (TR-A) or no additional treatment (TR-C). Subsequently, TR were used as block grafts for vertical alveolar ridge augmentation in both lower quadrants. At 12 weeks, titanium implants were inserted and left to heal 3 weeks. Microcomputed tomography was used to quantify bone volume per tissue volume (BV/TV), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp) at vestibular (v) and oral (o) aspects along the implant and in the augmented upper half of the implant, respectively. RESULTS:Median BV/TV [TR-C: 51.33% (v) and 70.42% (o) vs TR-A: 44.05% (v) and 64.46% (o)], Tb.th [TR-C: 0.22 mm (v) and 0.27 mm (o) vs TR-A: 0.23 mm (v) and 0.29 mm (o)] and Tb.Sp [TR-C: 0.26 mm (v) and 0.13 mm (o) vs TR-A: 0.29 μm (v) and 0.15 mm (o)] values were comparable in both groups. CONCLUSION:Both TR-C and TR-A grafts were associated with a comparable bone microstructure within the grafted area.
10.1111/cid.12947
Vertical Ridge Augmentation With a Honeycomb Structure Titanium Membrane: A Technical Note for a 3-Dimensional Curvature Bending Method.
Ishikawa Tomohiro,Ueno Daisuke
The Journal of oral implantology
Guided bone regeneration is the most commonly used technique for vertical ridge augmentation (VRA), and it is popular because it is less invasive and highly formative. Since the augmented site is exposed to external pressure, it is preferable to support the membrane using a framework to maintain the shape of the VRA. Recently, a titanium framework-reinforced ultrafine titanium membrane was developed by laser processing technology. The technique allows microperforations to be made (φ20 μm) into a titanium membrane, which is expected to prevent fibrous tissue ingrowth from outside the membrane. In addition, significant bone regeneration was confirmed on ridge defects in previous animal studies. However, the membrane tends to crumple during the bending process, because it is very thin (20 nμm); thus, the bending procedures are technically sensitive. Since this titanium honeycomb membrane was first approved for clinical use in Japan, no international clinical reports have been published. The purpose of this case report is to describe a technical note for a 3-dimensional curvature bending method in VRA using the newly developed honeycomb structure titanium membrane.
10.1563/aaid-joi-D-20-00262
Vertical Ridge Gain with Various Bone Augmentation Techniques: A Systematic Review and Meta-Analysis.
Hameed Muhammad Hasan,Gul Meisha,Ghafoor Robia,Khan Farhan Raza
Journal of prosthodontics : official journal of the American College of Prosthodontists
PURPOSE:The aim of this systematic review was to determine the most effective alveolar augmentation technique for vertical bone gain. MATERIALS AND METHODS:A systematic search to select clinical trials and retrospective studies done on patients with reduced vertical bone height was conducted. The intervention of interest was autogenous block graft done compared to procedures such as distraction osteogenesis (DO), particulate grafting, block plus particulate grafting with titanium mesh, and tent pole technique in systematically healthy adult patients age 18 and older. The following electronic databases were explored: PubMed, CINAHL, and Dental and Oral Science. A supplementary manual search of published full-text articles from January 2005 to December 2017 was done using Google Scholar. Grey literature was also sought using greylit.org. The review protocol was registered at the Prospero registry (CRD # 42017072432). The risk of bias of the included studies was assessed using EPOC criteria. Meta-analysis was performed using Review Manager for studies with quantitative data on mean values of vertical bone gain and bone resorption achieved with various bone augmentation techniques. Random effect model was used. Heterogeneity among studies was evaluated using the I statistic. RESULTS:A total of 2322 articles were found. After excluding the irrelevant papers, only 8 papers were finally selected for the detailed evaluation. Of these 8, 5 were clinical trials, and 3 were retrospective studies. Four studies were on DO, 2 on particulate grafting, 1 on autogenous block grafting plus particulate grafting, and 1 on tent pole grafting. The control group in all studies were autogenous block graft. Meta-analysis revealed no significant difference between DO and autogenous block grafting for vertical bone gain (mean difference 0.82 [-1.28, 2.91]). Similarly, no significant difference was observed in the 2 techniques for bone resorption (mean difference 0.38 [-0.23, 0.99]). CONCLUSIONS:DO was not superior to autogenous block grafting for vertical bone augmentation. Both techniques were associated with a number of complications. There was no difference in the bone resorption observed in the 2 techniques. No conclusive results can be drawn on other techniques on account of limited data.
10.1111/jopr.13028
Vertical ridge augmentation (VRA) with the use of a cross-linked resorbable membrane, tenting screws, and a combination grafting technique: a report of three cases.
Quintessence international (Berlin, Germany : 1985)
OBJECTIVE:The purpose of the present study was to present vertical ridge augmentation (VRA) with the use of cross-linked resorbable membrane, tenting screws, and a combination grafting technique. REPORT:Three cases are presented. Case 1: A 67-year-old ASA II patient required VRA at the areas of the mandibular left second premolar and first molar. Flap management was performed with the use of periosteal release on the buccal aspect and 23 mm of mylohyoid muscle release on the lingual aspect. VRA was completed with the use of four self-tapping tenting screws, and 1:1 mix of anorganic bovine bone matrix (ABBM) and particulate mineralized bone allograft. A cross-linked resorbable membrane was placed over the buccal and lingual aspect, and a double line of suturing was performed to secure the tension-free closure. Twelve months postoperatively, 4 mm of VRA was confirmed with CBCT. Two implants were placed with >35 Ncm primary stability. Case 2: A 64-year-old ASA I patient required VRA at the area of the maxillary first premolar. Flap management was performed with the use of periosteal release on the buccal aspect and VRA was performed with a 9-mm self-tapping screw, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Twelve months postoperatively, VRA of 6.2 mm on the buccal aspect and 7.9 mm on the lingual aspect were confirmed with CBCT. An implant was placed with > 35 Ncm primary stability in combination with horizontal ridge augmentation. Case 3: A 70-year-old ASA II patient required horizontal and VRA at the area of the mandibular left canine. Following extraction, a lateral pedicle sliding flap was completed to enhance the soft tissue volume of the site. After 6 weeks, flap management was performed with the use of buccal periosteal release, VRA was completed with two self-tapping screws, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Eight months postoperatively there was 5.3 mm of bone regeneration on the vertical dimension and 3.9 mm on the horizontal dimension. An implant was placed with primary stability of 45 Ncm. CONCLUSION:Successful VRA can be achieved with proper flap management to achieve tension-free closure, a cross-linked collagen membrane, tenting screws, and a combination grafting technique. The VRA ranged from 4.0 to 7.9 mm.
10.3290/j.qi.a45424
Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study.
Cucchi Alessandro,Bianchi Alessandro,Calamai Paolo,Rinaldi Lisa,Mangano Francesco,Vignudelli Elisabetta,Corinaldesi Giuseppe
BMC oral health
BACKGROUND:One of the most recent innovations in bone augmentation surgery is represented by computer-aided-design/computer-aided-manufacturing (CAD/CAM) customized titanium meshes, which can be used to restore vertical bone defects before implant-prosthetic rehabilitations. The aim of this study was to evaluate the effectiveness/reliability of this technique in a consecutive series of cases. METHODS:Ten patients in need of bone augmentation before implant therapy were treated using CAD/CAM customized titanium meshes. A digital workflow was adopted to design virtual meshes on 3D bone models. Then, Direct Metal Laser Sintering (DMLS) technology was used to produce the titanium meshes, and vertical ridge augmentation was performed according to an established surgical protocol. Surgical complications, healing complications, vertical bone gain (VBG), planned bone volume (PBV), lacking bone volume (LBV), regenerated bone volume (RBV), average regeneration rate (RR) and implant success rate were evaluated. RESULTS:All augmented sites were successfully restored with definitive implant-supported fixed partial dentures. Measurements showed an average VBG of 4.5 ± 1.8 mm at surgical re-entry. Surgical and healing complications occurred in 30% and 10% of cases, respectively. Mean values of PBV, LBV, and RBV were 984, 92, and 892 mm, respectively. The average RR achieved was 89%. All 26 implants were successfully in function after 1 year of follow-up. CONCLUSIONS:The results of this study suggest that the bone augmentation by means of DMLS custom-made titanium meshes can be considered a reliable and effective technique in restoring vertical bone defects.
10.1186/s12903-020-01205-4
Influence of autoclavation on the efficacy of extracted tooth roots used for vertical alveolar ridge augmentation.
Schwarz Frank,Mihatovic Ilja,Popal-Jensen Ingela,Parvini Puria,Sader Robert
Journal of clinical periodontology
OBJECTIVES:To assess the influence of autoclavation on the efficacy of extracted tooth roots (TR) used for vertical alveolar ridge augmentation and two-stage osseointegration. MATERIAL AND METHODS:Maxillary premolars were randomly assigned to either autoclavation (TR-A) or were left untreated (TR-C) and used as block grafts for vertical alveolar ridge augmentation in both lower quadrants (n = 4 beagle dogs). At 12 weeks, titanium implants were inserted and left to heal for 3 weeks. Histological analyses considered vertical bone gain (BD-BC), augmented area (AA) and bone-to-implant contact (BIC) at vestibular (v) and oral (o) aspects. RESULTS:Both TR-C and TR-A (exposures n = 3) grafts were associated with a replacement resorption and marked vertical bone gain. Median BD-BC (TR-C: 1.45 [v] to 1.62 mm [o] versus TR-A: 0.97 [v] to 1.79 mm [o]) and AA (TR-C: 0.64 [v] to 2.36 mm [o] versus TR-A: 0.22 [v] to 2.36 mm [o]) values were comparable in both groups. V BIC (TR-C: 49.32 [v] to 52.97% [o] versus TR-A: 25.34 [v] to 46.11% [o]) values were significantly higher in the TR-C group. CONCLUSIONS:Both TR-C and TR-A grafts equally supported vertical alveolar ridge augmentation; however, osseointegration was partially facilitated in the TR-C group.
10.1111/jcpe.13090
Effectiveness of the bone ring technique and simultaneous implant placement for vertical ridge augmentation: a systematic review.
Sáez-Alcaide Luis Miguel,Brinkmann Jorge Cortés-Bretón,Sánchez-Labrador Luis,Pérez-González Fabián,Molinero-Mourelle Pedro,López-Quiles Juan
International journal of implant dentistry
BACKGROUND:Dimensional changes after dental extraction frequently lead to situations in which bone augmentation procedures are required prior to dental implant placement. Bone ring technique (BRT) has been described as a one-stage approach to restore vertical alveolar ridge defects, in which an autogenous or allogeneic cortico-cancellous bone block graft is stabilized with a dental implant inserted simultaneously. The objective of this systematic review was to evaluate the clinical performance of BRT. MATERIALS AND METHODS:This review was conducted according to PRISMA guidelines. An electronic search was conducted in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. RESULTS:Sixteen studies with a total of 186 patients treated with 219 bone rings bocks were included in the review. The studies showed a mean bone gain of 4.94 mm, mean bone resorption of 0.83 mm, and mean marginal bone loss of 0.57 mm after a mean follow-up period of 13.35 months. A mean bone ring survival rate of 97.26% and implant survival rate of 94.97% were recorded. CONCLUSIONS:BRT would appear to be an adequate alternative technique for restoring single vertical alveolar ridge defects with simultaneous dental implant placement. However, further studies comparing this technique with other vertical ridge augmentation procedures in different clinical scenarios are needed to confirm the present results.
10.1186/s40729-020-00280-0
Histomorphometrical assessment of vertical alveolar ridge augmentation using extracted tooth roots in the canine.
Parvini Puria,Schliephake Carla,Al-Maawi Sarah,Schwarz Katrin,Sader Robert,Ghanaati Shahram,Schwarz Frank
Clinical oral investigations
OBJECTIVES:To histomorphometrically evaluate the influence of autoclavation on the efficacy of extracted tooth roots (TR) used for vertical alveolar ridge augmentation. MATERIALS AND METHODS:Upper premolars were randomly assigned to either autoclavation (TR-A) or an untreated control group (TR-C) and used as block grafts for vertical alveolar ridge augmentation in both lower quadrants (n = 4 beagle dogs). Tissue biopsies were obtained after 15 weeks of submerged healing. Histological analyses considered gain in ridge height (GRH), augmented area (AA), and the proportion of mineralized (MT) and non-mineralized tissue (NMT). RESULTS:TR-C and TR-A grafts were commonly associated with a complete replacement resorption and a marked gain in ridge height. Significant differences between groups were noted for mean GRH [TR-C: 2.35 ± 0.55 vs. TR-A: 2.46 ± 0.21 mm] and AA [TR-C: 11.88 ± 4.31 vs. TR-A: 8.65 ± 1.59 mm] values. Within AA, both groups revealed a comparable distribution of mean MT and NMT values. The linear regression analysis pointed to a significant correlation between NMT and AA values. CONCLUSIONS:Both TR-C and TR-A grafts supported vertical alveolar ridge augmentation; however, GRH was improved in the TR-A group. CLINICAL RELEVANCE:TR grafts may serve as a potential alternative for vertical alveolar ridge augmentation.
10.1007/s00784-019-02960-7
Clinical, Radiographic, and Histomorphometric Evaluation of a Vertical Ridge Augmentation Procedure Using a Titanium-Reinforced Microporous Expanded Polytetrafluoroethylene Membrane: A Prospective Case Series with 1-Year Follow-Up.
Ji Jung-Gu,Yu Jung-A,Choi Seong-Ho,Lee Dong-Woon
Materials (Basel, Switzerland)
Vertical ridge augmentation for long-term implant stability is difficult in severely resorbed areas. We examined the clinical, radiological, and histological outcomes of guided-bone regeneration using novel titanium-reinforced microporous expanded polytetrafluoroethylene (MP-ePTFE) membranes. Eighteen patients who underwent implant placement using a staged approach were enrolled (period: 2018-2019). Vertical ridge augmentation was performed in areas with vertical bone defects ≥4 mm. Twenty-six implant fixtures were placed in 14 patients. At implant placement six fixtures had relatively low stability. On cone-beam computed tomography, the average vertical changes were 4.2 ± 1.9 (buccal), 5.9 ± 2.7 (central), and 4.4 ± 2.8 mm (lingual) at six months after vertical ridge augmentation. Histomorphometric analyses revealed that the average proportions of new bone, residual bone substitute material, and soft tissue were 34.91 ± 11.61%, 7.16 ± 2.74%, and 57.93 ± 11.09%, respectively. Stable marginal bone levels were observed at 1-year post-loading. The residual bone graft material area was significantly lower in the exposed group ( = 0.003). There was no significant difference in the vertical height change in the buccal side between immediately after the augmentation procedure and the implant placement reentry time ( = 0.371). However, all implants functioned well regardless of the exposure during the observation period. Thus, vertical ridge augmentation around implants using titanium-reinforced MP-ePTFE membranes can be successful.
10.3390/ma14143828
[Application of β-TCP for bone defect restore after the mandibular third molars extraction: A splitmouth clinical trial].
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
OBJECTIVE:To evaluate the effect of bone defect regeneration and the periodontal status of the second molars after mandibular third molars extraction using β-tertiary calcium phosphate (β-TCP) in the test side compared with the spontaneously healed side. To the bone defect of mandibular second molars as a result of surgical removal of impacted mandibular third molars is a common phenomenon, many research shows that the mandibular second molars alveolar bone regeneration was about 1.5 mm and the periodontal pocket >7 mm was greater than 43.3% after mandibular third molars extraction. There has been significant progress researches in the repair of bone defect after the third molar removal, and bone graft filling was one of the effective methods. The bone graft substitutes include autogenous bone, allograft bone, xenograft bone and synthetic bone. METHODS:A split mouth, randomized clinical study was designed. Fifteen patients with mandibular third molars in the same jaw planned to be extracted were enrolled in the study. One of the sockets of each patient was randomly selected and filled with easy-graftTMCLASSIC (test group). The contralateral socket was left to heal spontaneously (control group). cone beam computed tomography (CBCT) scans were performed the day after the extraction and after 6 months. The horizontal dimensional changes of the sockets were recorded. The newly formed bone volume in the bone was analyzed by CBCT, and the probing depth (PD) was recorded. Student's t test was used to evaluate the difference between the two groups for each parameter, and the P value lower than 0.05 was considered to be statistically significant. RESULTS:Fifteen patients (30 sockets) completed the flow-up, and all the 30 sockets healed uneventfully. After 6 months' healing, the new bone volume fraction of the test group was 63.3%±2.2%, while the new bone volume fraction of the control group was 50.1%±1.9%. The vertical dimensional increment of the test group was (5.53±0.39) mm, while the vertical change of the control group was (1.53±0.27) mm. The distal buccal site PD of the second molar was (3.0±0.7) mm in the test group, and (6.5±0.8) mm in the control group. Statistically significant differences were detected between the two groups. CONCLUSION:The randomized controlled clinical trial showed that the application of β-TCP for bone defect repair after the mandibular third molars extraction resulted in more vertical bone regeneration and less probing depth when compared with what was spontaneously healed.
Effect of Different Membranes on Vertical Bone Regeneration: A Systematic Review and Network Meta-Analysis.
BioMed research international
This study is aimed at performing a systematic review and a network meta-analysis of the effects of several membranes on vertical bone regeneration and clinical complications in guided bone regeneration (GBR) or guided tissue regeneration (GTR). We compared the effects of the following membranes: high-density polytetrafluoroethylene (d-PTFE), expanded polytetrafluoroethylene (e-PTFE), crosslinked collagen membrane (CCM), noncrosslinked collagen membrane (CM), titanium mesh (TM), titanium mesh plus noncrosslinked (TM + CM), titanium mesh plus crosslinked (TM + CCM), titanium-reinforced d-PTFE, titanium-reinforced e-PTFE, polylactic acid (PLA), polyethylene glycol (PEG), and polylactic acid 910 (PLA910). Using the PICOS principles to help determine inclusion criteria, articles are collected using PubMed, Web of Science, and other databases. Assess the risk of deviation and the quality of evidence using the Cochrane Evaluation Manual, and GRADE. 27 articles were finally included. 19 articles were included in a network meta-analysis with vertical bone increment as an outcome measure. The network meta-analysis includes network diagrams, paired-comparison forest diagrams, funnel diagrams, surface under the cumulative ranking curve (SUCRA) diagrams, and sensitivity analysis diagrams. SUCRA indicated that titanium-reinforced d-PTFE exhibited the highest vertical bone increment effect. Meanwhile, we analyzed the complications of 19 studies and found that soft tissue injury and membrane exposure were the most common complications.
10.1155/2022/7742687
Vertical ridge augmentation using guided bone regeneration (GBR) in three clinical scenarios prior to implant placement: a retrospective study of 35 patients 12 to 72 months after loading.
Urban Istvan A,Jovanovic Sascha A,Lozada Jaime L
The International journal of oral & maxillofacial implants
PURPOSE:The aims of the current study were to: (1) evaluate the results of vertical guided bone regeneration (GBR) with particulate autogenous bone grafts, (2) determine clinically and radiographically the success and survival rates of 82 implants placed in such surgical sites after prosthetic loading for 12 to 72 months, and (3) compare defects that were treated simultaneously with sinus augmentation and vertical GBR to other areas of the jaw treated with vertical GBR only. MATERIALS AND METHODS:Eighty-two implants were inserted in 35 patients with 36 three-dimensional vertical bone defects. The patients were divided into three groups: single missing teeth (group A), multiple missing teeth (group B), and vertical defects in the posterior maxilla only (group C). All group C subjects were treated simultaneously with sinus and vertical augmentations. All patients were treated with vertical ridge augmentation utilizing titanium-reinforced polytetrafluoroethylene (e-PTFE) membranes and particulated autografts. After removal of the e-PTFE membrane, all sites received a collagen membrane. RESULTS:At membrane removal, mean vertical augmentation was 5.5 mm (+/-2.29 mm). Mean combined crestal remodeling was 1.01 mm (+/-0.57 mm) at 12 months, which remained stable through the 6-year follow-up period. There were no statistically significant differences between the three groups in mean marginal bone remodeling. One defect had a bone graft complication (2.78%, 95% CI: 0.00%, 8.15%). The overall implant survival rate was 100% with a cumulative success rate of 94.7%. CONCLUSIONS:(1) Vertical augmentation with e-PTFE membranes and particulated autografts is a safe and predictable treatment; (2) success and survival rates of implants placed in vertically augmented bone with the GBR technique appear similar to implants placed in native bone under loading conditions; (3) success and failure rates of implants placed into bone regenerated simultaneously with sinus and vertical augmentation techniques compare favorably to those requiring only vertical augmentation.
Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration.
Jepsen Søren,Schwarz Frank,Cordaro Luca,Derks Jan,Hämmerle Christoph H F,Heitz-Mayfield Lisa J,Hernández-Alfaro Federico,Meijer Henny J A,Naenni Nadja,Ortiz-Vigón Alberto,Pjetursson Bjarni,Raghoebar Gerry M,Renvert Stefan,Rocchietta Isabella,Roccuzzo Mario,Sanz-Sánchez Ignacio,Simion Massimo,Tomasi Cristiano,Trombelli Leonardo,Urban Istvan
Journal of clinical periodontology
BACKGROUND AND AIMS:Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects. MATERIAL AND METHODS:The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures. RESULTS:A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla. CONCLUSIONS:The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications.
10.1111/jcpe.13121
Horizontal ridge augmentation with a collagen membrane and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 25 patients.
Urban Istvan A,Nagursky Heiner,Lozada Jaime L,Nagy Katalin
The International journal of periodontics & restorative dentistry
This prospective case series evaluated the use of a resorbable natural collagen membrane with a mixture of autogenous bone and anorganic bovine bone-derived mineral (ABBM) for lateral ridge augmentation and subsequent implant placement. A mixture (1:1) of particulated autogenous bone and ABBM was used for lateral ridge augmentation and covered with a resorbable, natural collagen bilayer membrane to treat knife-edge ridges and prepare them for implant placement. Ridge measurements were obtained pre- and postsurgery, complications recorded, and biopsy specimens examined histologically. Seventy-six implants were placed in 25 patients with 31 knife-edge ridge surgical sites. One defect had a bone graft complication (3.2%; exact 95% confidence interval: 0.1%, 16.7%). Clinical measurements revealed an average of 5.68 mm (standard deviation [SD] = 1.42 mm) of lateral ridge augmentation after a mean 8.9-month (SD = 2.1 months) graft healing period. Clinically, all treated ridges were sufficient in width for subsequent implant placement. All implants survived with an average follow-up of 20.88 months (SD = 9.49 months). Histologic analysis of nine surgical sites showed that ABBM was connected with a dense network of newly formed bone with varying degrees of maturation. Histomorphometric analysis demonstrated that autogenous bone represented a mean of 31.0% of the specimens, ABBM 25.8%, and marrow space 43.2%. The treatment of horizontally deficient alveolar ridges with the guided bone regeneration technique using autogenous bone mixed with ABBM and a natural collagen resorbable barrier membrane can be regarded as successful. Implant success and survival need to be confirmed with long-term follow-up examinations.
10.11607/prd.1407
Vertical ridge augmentation with titanium-reinforced, dense-PTFE membranes and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 19 patients.
Urban Istvan A,Lozada Jaime L,Jovanovic Sascha A,Nagursky Heiner,Nagy Katalin
The International journal of oral & maxillofacial implants
PURPOSE:This prospective case series evaluated the use of a new titanium-reinforced nonresorbable membrane (high-density polytetrafluoroethylene), in combination with a mixture of anorganic bovine bone-derived mineral (ABBM) and autogenous particulated bone, for vertical augmentation of deficient alveolar ridges. MATERIALS AND METHODS:A mixture of ABBM and autogenous particulated bone was used for vertical ridge augmentation and covered with a new titanium-reinforced nonresorbable membrane. Ridge measurements were obtained before and after the procedure, complications were recorded, and biopsy specimens were taken for histologic examination. RESULTS:Twenty vertical ridge augmentation procedures were carried out in 19 patients. All treated defect sites exhibited excellent bone formation, with an average bone gain of 5.45 mm (standard deviation 1.93 mm). The healing period was uneventful, and no complications were observed. Eight specimens were examined histologically; on average, autogenous or regenerated bone represented 36.6% of the specimens, ABBM 16.6%, and marrow space 46.8%. No inflammatory responses or foreign-body reactions were noted in the specimens. CONCLUSION:The treatment of vertically deficient alveolar ridges with guided bone regeneration using a mixture of autogenous bone and ABBM and a new titanium-reinforced nonresorbable membrane can be considered successful.
10.11607/jomi.3346
Mandibular Regional Anatomical Landmarks and Clinical Implications for Ridge Augmentation.
Urban Istvan A,Monje Alberto,Wang Hom-Lay,Lozada Jaime,Gerber Gabor,Baksa Gabor
The International journal of periodontics & restorative dentistry
Mandibular ridge augmentation via guided bone regeneration in the atrophic mandible is considered one of the most challenging scenarios for implant-supported oral rehabilitation. Uneventful wound healing has clearly demonstrated its impact on the final regenerative outcome. Soft tissue management must be precise and adequate to attain flap-free wound closure. Accordingly, it demands exhaustive insight and expertise to avoid damaging the neighboring structures. The cadaver study described herein discusses the mandibular morphologic landmarks (ie, musculature, vascularization, innervation, and salivary glands) necessary to safely perform regenerative procedures in the atrophic mandibular ridge, such as vertical ridge augmentation and dental implant surgery. The potential intraoperative complications are presented, as well as clinical implications of which the clinician must be aware to prevent adverse surgical events during regenerative surgery and implant placement in this anatomical region.
10.11607/prd.3199
Principles for Vertical Ridge Augmentation in the Atrophic Posterior Mandible: A Technical Review.
Urban Istvan A,Monje Alberto,Lozada Jaime,Wang Hom-Lay
The International journal of periodontics & restorative dentistry
Guided bone regeneration has become more predictable due to advances in material sciences. Nevertheless, vertical ridge augmentation (VRA) remains a potential challenge due to the complexity of soft tissue management. This becomes more complicated in the posterior atrophic mandible due to limited access and poorer blood supply. As such, a number of critical elements must be taken into consideration in treatment planning. Anatomical structures potentially jeopardize intraoperative adverse events such as bleeding or neurosensory disturbances. The attachment of the mylohyoid often compromises lingual flap advancement. This technical review summarizes the critical factors to be assessed prior to VRA for the posterior mandible and provides a sequenced approach to bone grafting and to attaining a tension-free flap for successful bone regeneration and long-term peri-implant tissue stability.
10.11607/prd.3200
Effectiveness of Two Different Lingual Flap Advancing Techniques for Vertical Bone Augmentation in the Posterior Mandible: A Comparative, Split-Mouth Cadaver Study.
Urban Istvan,Traxler Hannes,Romero-Bustillos Miguel,Farkasdi Sandor,Bartee Barry,Baksa Gabor,Avila-Ortiz Gustavo
The International journal of periodontics & restorative dentistry
Vertical ridge augmentation in the posterior mandible is a technique-sensitive procedure that requires adequate anatomical knowledge and precise surgical skills to minimize the risk of complications. One of the most important but also challenging aspects of the surgical technique is proper flap management to allow for passive flap closure and reduce the chances of postoperative complications affecting deep anatomical spaces. This article presents a detailed description of a novel lingual flap advancement technique and its validation via a split-mouth, comparative study using a cadaver model. A total of 12 fresh cadaver heads presenting bilateral posterior mandibular edentulism were selected. Sides were randomized to receive a classic lingual flap release technique (control) or the modified technique presented here, which involves the intentional preservation of the mylohyoid muscle attachment to the mandible. Vertical flap release was measured at three different zones using standard forces. The mean difference between the test and control group in zones I (retromolar pad area), II (middle area), and III (premolar area) was 8.273 ± 1.794 mm (standard error of the mean [SEM] = 0.5409 mm), 10.09 ± 2.948 mm (SEM = 0.8889 mm), and 10.273 ± 2.936 mm (SEM = 0.8851 mm), respectively, reaching very strong statistical significance (P < .0001) in all three zones.
10.11607/prd.3227
Decision Tree for Vertical Ridge Augmentation.
Plonka Alexandra B,Urban Istvan A,Wang Hom-Lay
The International journal of periodontics & restorative dentistry
Vertical ridge augmentation (VRA) procedures before or during dental implant placement are technically challenging and often encounter procedure-related complications. To minimize complications and promote success, a literature search was conducted to validate procedures used for VRA. A decision tree based on the amount of additional ridge height needed (< 4, 4 to 6, or > 6 mm) was then developed to improve the procedure-selection process. At each junction, the clinician is urged to consider anatomical, clinical, and patient-related factors influencing treatment outcomes. This decision tree guides selection of the most appropriate treatment modality and sequence for safe, predictable management of the vertically deficient ridge in implant therapy.
10.11607/prd.3280
Effectiveness of vertical ridge augmentation interventions: A systematic review and meta-analysis.
Journal of clinical periodontology
AIM:The primary aim of this systematic review was to evaluate the effect of various techniques used for vertical ridge augmentation on clinical vertical bone gain. MATERIAL AND METHODS:A protocol was developed to answer the following focused question: "In patients with vertical alveolar ridge deficiencies, how effective are different augmentation procedures for clinical alveolar ridge gain?" Randomized and controlled clinical trials and prospective and retrospective case series were included, and meta-analyses were performed to evaluate vertical bone gain based on the type of procedure and to compare bone gains in controlled studies. RESULTS:Thirty-six publications were included. Results demonstrated a significant vertical bone gain for all treatment approaches (n = 33; weighted mean effect = 4.16 mm; 95% CI 3.72-4.61; p < 0.001). Clinical vertical bone gain and complications rate varied among the different procedures, with a weighted mean gain of 8.04 mm and complications rate of 47.3% for distraction osteogenesis, 4.18 mm and 12.1% for guided bone regeneration (GBR), and 3.46 mm and 23.9% for bone blocks. In comparative studies, GBR achieved a significant greater bone gain when compared to bone blocks (n = 3; weighted mean difference = 1.34 mm; 95% CI 0.76-1.91; p < 0.001). CONCLUSIONS:Vertical ridge augmentation is a feasible and effective therapy for the reconstruction of deficient alveolar ridges, although complications are common.
10.1111/jcpe.13061
Bilateral vertical ridge augmentation with block grafts and guided bone regeneration in the posterior mandible: a case report.
Peñarrocha Maria A,Vina Jose A,Maestre Laura,Peñarrocha-Oltra David
The Journal of oral implantology
The aim is to describe bilateral vertical ridge augmentation with intraoral block grafts and guided bone regeneration in the posterior mandible in preparation for implant placement. A 61-year-old woman, edentulous in the posterior mandible, presented for implant rehabilitation. The radiographic study showed 3 to 6 mm of bone height from the ridge to the mandibular canal. Autogenous bone block grafts from the chin and the mandibular ramus, harvested with ultrasonics, were used to augment the alveolar ridge. To reduce resorption, the grafts were covered with particulate alloplastic material and a collagen membrane. Delayed implants were placed 6 months after vertical augmentation, and 3 months later implants were loaded with a fixed prosthesis. A temporary sensory complication occurred, but 12 months after implant loading, there were no failures. In this case report block bone grafting was a feasible option to vertically augment the alveolar ridge in the posterior mandible.
10.1563/AAID-JOI-D-10-00075
Vertical bone augmentation and regular implants versus short implants in the vertically deficient posterior mandible: a systematic review and meta-analysis of randomized studies.
Terheyden H,Meijer G J,Raghoebar G M
International journal of oral and maxillofacial surgery
The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short dental implants (≤7mm) versus vertical bone augmentation followed by regular dental implants (>7mm) in the deficient posterior mandible. In total, eight RCTs (six using interpositional sandwich grafting and two using a guided bone regeneration technique) were reported in 17 articles at different time points. In the meta-analysis of the sandwich group, the relative risk (RR) for implant loss at 1year was in favour of short implants (RR 0.41, P=0.02), while no significant difference was found at 3 years (RR 0.65, P=0.43), 5 years (RR 1.08, P=0.86), or 8 years (RR 1.53, P=0.52). The risk of complications was in favour of short implants (RR 0.34, P=0.0002), as was the mean difference in marginal bone resorption after 1 year (-0.09mm, P=0.17), 3 years (-0.32mm, P<0.00001), 5 years (-0.65mm, P<0.00001), and 8 years (-0.88, P<0.00001). The mean residual osseointegration length of the implants was between 2.94mm and 4.44mm in the short implants group and between 7.97mm and 8.62mm in the regular implants group after 5 years. In conclusion, in the deficient atrophic posterior mandible, short implants and regular implants demonstrate comparable outcomes within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options.
10.1016/j.ijom.2021.01.005
Supplemental periodontal regeneration by vertical ridge augmentation around dental implants. A preclinical in vivo experimental study.
Lee Changseok,Kim Sungtae,Kim Junhwan,Namgung Dajeong,Kim Kyounghwa,Ku Young
Clinical oral implants research
OBJECTIVES:To evaluate the supplemental periodontal regeneration on adjacent teeth by vertical ridge augmentation around dental implants. MATERIAL AND METHODS:The second premolar and the fourth premolar were extracted from both sides of the mandible in four beagle dogs. After 2 months, defects of 3 mm and 5 mm deep were formed. In the test group, vertical ridge augmentation was performed around a dental implant, and in the control group, vertical ridge augmentation was performed without implant placement. The animals were euthanized 3 months after the procedure, and radiographic and histomorphometric analyses were performed. RESULTS:Overall, the test group showed better results than the control group. The presence of new cementum in the histological examination of the test group confirmed that vertical ridge augmentation with proper space maintaining could contribute to periodontal regeneration of adjacent teeth. Statistically significant difference in new bone height (%) was found in group I (5-mm defect depth and implant placement, GBR) when compared with group III (5-mm defect depth, GBR) and IV (3-mm defect depth, GBR). New bone area (%) was statistically different between groups I and IV. CONCLUSIONS:In conclusion, within the limitation of this study using mandibular residual ridges after extraction of a single tooth in dogs, grafted space was maintained by dental implants better in the deep defect (5-mm depth) than the shallow defect (3-mm depth). Vertical ridge augmentation around dental implants also promoted neighboring periodontal regeneration.
10.1111/clr.13525
Vertical and Horizontal Augmentation of Deficient Maxilla and Mandible for Implant Placement.
Andre Amanda,Ogle Orrett E
Dental clinics of North America
Ridge augmentation for implant procedures has been shown to be highly successful. There are several techniques available to the dentist, but they require some degree of surgical expertise and experience. No particular technique has been shown to be superior. This article presents the indications, techniques, and complications of the various procedures for alveolar ridge augmentation. This information will educate the general dental practitioner of the techniques available and provide information on the surgical procedures that could be used to discuss with patients when they are being referred to a specialist.
10.1016/j.cden.2020.09.009
Evaluation of Alveolar Ridge Height Gained by Vertical Ridge Augmentation Using Titanium Mesh and Novabone Putty in Posterior Mandible.
Journal of maxillofacial and oral surgery
AIM:The purpose of this case series was to report the clinical and radiographical outcomes of vertical ridge augmentation in edentulous posterior mandible using a combination of titanium mesh with novabone putty. MATERIAL AND METHOD:Twenty patients were included, and grafting was done using alloplastic novabone putty supported by titanium mesh as the barrier for guided bone regeneration. RESULTS:Sixteen patients exhibited good soft tissue healing. Postoperative flap dehiscence occurred relatively early in the healing period in one patient followed by graft extrusion and delayed healing in other three patients. The mean vertical height of augmented bone was 4.825 ± 1.1387 mm. CONCLUSION:This report demonstrates the remarkable efficacy of guided bone regeneration using a combination of titanium mesh and novabone putty for vertical ridge augmentation, thus expanding the indications for implant therapy and allowing recovery of the three-dimensional esthetic architecture in a severely resorbed alveolar ridge.
10.1007/s12663-019-01250-9
3D vertical alveolar crest augmentation in the posterior mandible using the tunnel technique: A 10-year clinical study.
International journal of oral implantology (Berlin, Germany)
PURPOSE:To evaluate the short- and long-term outcomes of vertical 3D bone augmentation in the posterior mandible, performed using the split bone block technique with a tunnel technique. MATERIALS AND METHODS:Patients were treated for vertical and horizontal alveolar bone defects without simultaneous implant placement and followed up for at least 10 years postoperatively. Autogenous bone blocks were harvested from the mandibular retromolar area following the MicroSaw protocol (Dentsply Sirona, Charlotte, NC, USA). The harvested bone blocks were split longitudinally according to the split bone block technique and grafted in 3D form using a tunnel technique. Implants were inserted and exposed after 3 months and prosthetic restoration was performed. RESULTS:A total of 117 consecutively treated patients with 128 grafted sites in 3D form were enrolled in the present study and followed up over a period of up to 17 years. The 10-year results were collected with a total patient dropout rate of 24.13%. Minimal late graft exposure was documented postoperatively for 4 to 8 weeks on the lingual site in two cases but did not influence the outcome. Infection of the grafted area occurred in one other case, leading to loss of the grafted bone. The postoperative mean vertical bone gain was 7.6 ± 3.1 mm and the mean bone width achieved after surgery was 8.1 ± 1.6 mm. A total of 287 implants were inserted 3 months after the augmentation procedure. The maximum vertical bone resorption, which was calculated around implants, was 0.66 ± 0.38 mm after 1 year, 0.72 ± 0.31 mm after 5 years and 0.75 ± 0.43 mm after 10 years. Furthermore, five implants were lost during this time, due to peri-implantitis and chronic pain. After 10 years, the mean vertical bone gain was stable at 6.72 ± 2.26 mm and the resorption rate was 11.4%. CONCLUSIONS:The short- and long-term results of the present study confirm the predictability of using mandibular bone blocks according to the split bone block technique for 3D bone reconstruction in the posterior mandible.
An Updated Decision Tree for Vertical Bone Augmentation.
Misch Craig M,Basma Hussein,Misch-Haring Maggie A,Wang Hom-Lay
The International journal of periodontics & restorative dentistry
Vertical bone augmentation (VBA) procedures for dental implant placement are biologically and technically challenging. Systematic reviews and meta-analyses of studies on VBA have failed to identify clinical procedures that provide superior results for treatment of the vertical ridge deficiencies. A decision tree was developed to guide clinicians on selecting treatment options based on reported vertical bone gains (< 5 mm, 5 to 8 mm, > 8 mm). The choice of a particular augmentation technique will also depend on other factors, including the size and morphology of the defect, location, and clinician or patient preferences. Surgeons should consider the advantages and disadvantages of each option for the clinical situation and select an approach with low complications, low cost, and the highest likelihood of success.
10.11607/prd.4996
Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study.
Maiorana Carlo,Fontana Filippo,Dal Polo Marco Rasia,Pieroni Stefano,Ferrantino Luca,Poli Pier Paolo,Simion Massimo
The journal of contemporary dental practice
AIM AND OBJECTIVE:The aim of the present split-mouth prospective study was to evaluate clinically and histologically the bone regeneration obtained following preprosthetic vertical bone augmentation performed with titanium-reinforced dense polytetrafluoroethylene membrane (d-PM) compared to titanium mesh (TM). MATERIALS AND METHODS:Healthy adult patients presenting with bilateral partial edentulism in the posterior mandible requiring vertical ridge augmentation for implant placement purposes were consecutively included. One side of the mandible was randomly assigned to the use of d-PM, the other to TM. The graft consisted in a mixture of autogenous bone harvested nearby the surgical site and deproteinized bovine bone mineral particles in a 1:1 ratio. On each side during bone augmentation surgery, a 2-mm diameter mini-implant was inserted for clinical and histological analyses. After a healing period of 8 months, the second surgical phase was carried out to remove the nonresorbable barriers, to evaluate clinically the vertical bone gain, and to collect a bone biopsy that included the mini-implant. During the same surgical session, dental implants were inserted in a prosthetically guided position. RESULTS:A total of five patients were enrolled. Eight out of 10 sites healed uneventfully. In the remaining two sites, premature exposure of the TM was observed. Mean vertical bone gain of 4.2 and 1.5 mm was achieved in d-PM and TM groups, respectively ( = 0.06). A mean mineralized tissue of 48.28 and 35.54% was observed in d-PM and TM groups, respectively ( = 0.51). CONCLUSION:The vertical bone gain, although not significantly, was higher in the d-PM group. Similar histological outcomes were noticed if exposure did not occur. In case of wound dehiscence, major resorption was observed. CLINICAL SIGNIFICANCE:Both d-PM and TM can be used to augment atrophic localized ridges vertically. The outcome of bone regeneration seems to be impaired by exposure of the device. How to cite this article: Maiorana C, Fontana F, Rasia dal Polo M, . Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study. J Contemp Dent Pract 2021;22(5):465-472.
Comparative analysis of two biomaterials mixed with autogenous bone graft for vertical ridge augmentation: A histomorphometric study in humans.
Clinical implant dentistry and related research
BACKGROUND:The vertical increase of the alveolar ridge dimension using allograft or xenograft mixed with autogenous bone graft and covered by a nonabsorbable high-density polytetrafluoroethylene (d-PTFE) membrane is well documented in the literature. PURPOSE:The aim of this study was to assess vital mineralized tissue formation in vertical ridge augmentation (VRA) procedures using autogenous bone chips mixed either with an allograft or a xenograft. METHODS:This prospective clinical trial recruited 16 partially edentulous patients to undergo vertical ridge augmentation in one or more sites, making up a total of 24 samples for histological evaluation. Patients were sequentially stratified into Group A (treated with a freeze-dried bone allograft [FDBA] mixed with autogenous bone) or to Group B (treated with a bovine xenograft mixed with autogenous bone). Histological samples were analyzed according to the biomaterial used for VRA. Histological samples were obtained on the same day of membrane removal and implant placement. RESULTS:Thirty-three implants were placed in 16 sites of regenerated bone via VRA, 13 patients with ridge augmentation in the posterior mandible, and 3 patients with VRA in the anterior maxilla. Group A (FDBA + autogenous) and Group B (xenograft + autogenous) showed a percent vital mineralized tissue (VMT) area of 67.64 ± 16.84 and 60.93 ± 18.25, respectively. A significant difference between the two biomaterials was not observed. CONCLUSION:When mixed with autogenous bone, either allografts or xenografts may provide a successful augmentation. Either mixture could serve as reliable alternative in VRA for obtaining a high percentage of VMT.
10.1111/cid.13124
Healing complications and their detrimental effects on bone gain in vertical-guided bone regeneration: A systematic review and meta-analysis.
Tay John Rong Hao,Ng Ethan,Lu Xiaotong Jacinta,Lai Wei Ming Clement
Clinical implant dentistry and related research
PURPOSE:Guided bone regeneration (GBR) utilizes a barrier membrane to allow osteogenic cells to populate a space by excluding epithelial and connective tissue cells. The purpose of this systematic review was to investigate the ratio of means (RoM) of vertical bone gained (Outcome) in vertical GBR procedures with healing complications (Intervention) and in vertical GBR procedures without healing complications (Comparison) in patients with vertically resorbed edentulous ridges that require dental implant placement (Population). A further aim was to investigate the incidence of complications after vertical GBR, and the influence of the timing of implant placement and regenerative devices on complications. MATERIALS AND METHODS:MEDLINE (through PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched in duplicate up to, and including, November 2020 for randomized and controlled clinical trials and prospective and retrospective case series. Outcomes included patient-level and site-level RoM of vertical bone gain between healing complications and uneventful healing, and incidences of complications that occurred after vertical GBR. Random-effects and fixed-effects meta-analyses were performed where appropriate. This study was registered on PROSPERO (CRD42021226432). RESULTS:A total of 31 publications were selected for the qualitative and quantitative analyses. The RoM of vertical bone gained was 0.65 [95% CI = 0.47, 0.91] and 0.62 [95% CI = 0.45, 0.85] when membrane exposure without suppuration and abscess formation without membrane exposure occurred respectively, in comparison to uneventful healing. The overall incidence proportion of healing complications occurring at the augmented site at a site- and patient-level was 11.0% [95% CI = 7.0, 15.6] and 10.8% [95% CI = 6.6, 15.7]. At a patient-level, there were no significant differences between a simultaneous or staged approach, or with the regenerative device used. The site-level incidence proportion of membrane exposure without suppuration, membrane exposure with suppuration, and with abscess formation without membrane exposure was 8.7% [95% CI = 4.2, 14.2], 0.7% [95% CI = 0.0, 2.9], and 0.5% [95% CI = 0.0, 1.7], respectively. The site-level weighted mean incidence proportion of neurologic complications occurring at the donor site was 0.8% [95% CI = 0.0, 5.3]. CONCLUSIONS:There is a significant reduction in bone gain when healing complications occur. However, healing complications are relatively uncommon surgical complications after vertical GBR.
10.1111/cid.13057
Bone Regeneration in Vertical Osseous Defect in Periodontitis Patients using Bovine Colostrum.
Case reports in dentistry
Background:The treatment plan for periodontitis may include both nonsurgical and surgical phases. During surgical procedures, bone grafts and barrier membranes were used after degranulation in order to achieve healing. Colostrum is one of the materials that is composed of bioactive components which has either osteoinductive or regenerative potential. Aim:The aim of the present study is to evaluate the effectiveness of bovine colostrum as bone regeneration material in periodontitis. . Clinical periodontal parameters, including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI), were evaluated. Patients who were diagnosed with localised periodontitis were selected. Three patients presenting vertical defect at buccal sites were treated with bovine colostrum. Following nonsurgical treatment, flap surgery was performed using bovine colostrum. After 6 months, favourable clinical and radiographical improvements were obtained. Conclusion:All cases showed reduction in PD; these findings suggest that the bovine colostrum could favour periodontal regeneration. The clinical significance is that bovine colostrum is cost effective and easily available and enhances bone regeneration. It can therefore be used as an alternative to bone grafts during periodontal surgery.
10.1155/2022/4183552
Feasibility of using allograft bone with resorbable collagen membrane for alveolar ridge vertical defect augmentation for dental implant placement in Patient with Aggressive Periodontitis: A case report.
Al-Askar Mansour,Alsaffar Duaa
The Saudi dental journal
PURPOSE:This case report demonstrates the feasibility of using allograft bone with a resorbable collagen membrane to correct an alveolar ridge defect and achieve a highly esthetic restoration. CASE PRESENTATION:A 30-year-old woman with generalized aggressive periodontitis and advanced periodontal vertical bone loss in periodontally hopeless upper left right premolar which required a fixed restoration. A staged surgical strategy was devised. First, a resorbable collagen membrane and allograft bone grafts were used to guide bone regeneration in the vertical alveolar defect. After 6 months, complete bone regeneration was achieved and the dental implants were submerged in the bone. Three months later, the implants were exposed and subsequently restored with a crown. CONCLUSION:The vertical guided bone regeneration strategy of using allograft bone and a resorbable collagen membrane has the potential to eliminate the need for additional procedures, which are required with non-resorbable membranes, sinus lift procedures, and extensive block graft procedures.
10.1016/j.sdentj.2018.05.004
EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Kc Kumar,Bhattarai Bishwa Prakash,Shrestha Shilu,Shrestha Bijaya,Shrestha Manash
The journal of evidence-based dental practice
OBJECTIVE:To assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants. MATERIALS AND METHODS:Three electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required. RESULTS:Among the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I² = 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I² = 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I² = 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I² = 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I² = 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I² = 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59-0.07; P = 0.01; I² = 0%) periods was observed when bisphosphonate coated dental implants were used. CONCLUSION:Locally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.
10.1016/j.jebdp.2021.101580