RESUMEN
BACKGROUND: This article intends to showcase a case of guided bone regeneration (GBR) utilizing a partially demineralized dentin plate processed from an extracted second molar for horizontal augmentation of the posterior ridge for implant placement. METHODS AND RESULTS: A 60-year-old patient presented with horizontal ridge deficiency at site #30 and an endodontically treated tooth #31 with recurrent decay. A treatment plan was proposed to extract tooth #31 and utilize a dentin graft from the tooth for ridge augmentation at site #30. Following the atraumatic extraction of tooth #31, it was sectioned into a 1 mm thick dentin plate, sterilized, and processed to obtain a demineralized dentin graft. Following a mid-crestal incision and full-thickness flap elevation, the dentin plate was adapted on the buccal defect of site #30 with 10 mm fixation screws, and the gap between the plate and the buccal bone was filled with 0.5 cc of 50/50 cortico-cancellous bone allograft hydrated with saline, covered with collagen membrane followed by primary closure. At 6 months, a postoperative cone-beam computed tomography (CBCT) was obtained to evaluate the ridge width revealing sufficient ridge width for optimal implant placement. The radio-opaque dentin plate was visible on the CBCT depicting integration with the alveolar ridge. Following surgical implant preparation protocol, a 4 mm diameter and 8.5 mm length implant was placed in a restoratively driven position. CONCLUSION: This case reports favorable outcomes for GBR using a partially demineralized dentin plate as an alternative to an autogenous bone block graft for horizontal ridge augmentation for future implant placement. KEY POINTS: This case introduces a novel method utilizing partially demineralized dentin plates derived from extracted teeth for guided bone regeneration, showcasing its potential efficacy in addressing ridge deficiencies. Success, in this case, relies on meticulous sectioning of the tooth and processing of the dentin graft, precise adaptation and fixation of the graft to the residual ridge, and achieving primary closure for undisturbed healing. Limitations to success include the availability of teeth for extraction coinciding with the need for ridge augmentation and unstable graft fixation.
RESUMEN
BACKGROUND: Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm. However, managing cases becomes more challenging when a maxillary sinus pseudocyst is present or when there is insufficient bone width. In this case, we utilized the bone window prepared during the lateral window sinus lift as a shell for horizontal bone augmentation. This allowed for simultaneous horizontal and vertical bone augmentation immediately after the removal of the maxillary sinus pseudocyst. CASE SUMMARY: A 28-year-old female presented to our clinic with the chief complaint of missing upper left posterior teeth. Intraoral examination showed a horizontal deficiency of the alveolar ridge contour. The height of the alveolar bone was approximately 3.6 mm on cone beam computed tomography (CBCT). And a typical well-defined 'dome-shaped' lesion in maxillary sinus was observed on CBCT imaging. The lateral bony window was prepared using a piezo-ultrasonic device, then the bony window was fixed to the buccal side of the 26 alveolar ridge using a titanium screw with a length of 10 mm and a diameter of 1.5 mm. The space between the bony window and the alveolar ridge was filled with Bio-Oss, covered with a Bio-Gide collagen membrane, and subsequently sutured. Nine months later, the patient's bone width increased from 4.8 to 10.5 mm, and the bone height increased from 3.6 to 15.6 mm. Subsequently, a Straumann® 4.1 mm × 10 mm implant was placed. The final all-ceramic crown restoration was completed four months later, and both clinical and radiographic examinations showed that the implant was successful, and the patient was satisfied with the results. CONCLUSION: The bone block harvested from the lateral window sinus lift can be used for simultaneous horizontal bone augmentation acting as a shell for good two-dimensional bone augmentation.
RESUMEN
Tooth loss often leads to significant alveolar bone resorption, presenting a challenge for dental implant placement. This case report presents the effectiveness of concentrated platelet-rich fibrin (C-PRF) in combination with bone allograft for horizontal bone augmentation in a severely atrophic maxilla. A 33-year-old female patient with extensive bone loss in the upper anterior maxilla was treated in two stages. The initial stage involved horizontal bone augmentation using a mixture of C-PRF and bone allograft. This was followed, 5 months later, by dental implant placement. The preparation of C-PRF, surgical procedure, and postoperative care are thoroughly described. Post-treatment Cone Beam Computed Tomography showed an increase in alveolar bone thickness from 2.4-3.4 mm pre-operatively to 6.3-7.3 mm, demonstrating the procedure's effectiveness in achieving adequate bone volume for implant placement. The use of C-PRF with allograft in horizontal bone augmentation shows promise in enhancing bone regeneration, especially in a severely atrophic maxilla.
RESUMEN
The aim of this study was to compare the clinical, tomographic, and histological performance of collagenated xenogeneic bone blocks (CXBB) in horizontal bone augmentations for implant placement. Five patients with an absence of the 4 upper incisors and an HAC 3 horizontal bone defect, with a remaining of 3 to 5 mm, underwent a bone-grafting procedure with CXBB (test group [TG], n = 5) and autogenous graft (control group [CG], n = 5), with one type of graft used on the right side and other type on the left side. Changes in bone thickness and density (tomographic evaluation), levels of complications (clinically), and distribution pattern between mineralized and nonmineralized tissue (histomorphometrically) were analyzed. Tomographic analysis showed a horizontal bone increase of 4.25 ± 0.78 mm in the TG and 3.08 ± 0.8 mm in the CG between baseline and 8 months postoperatively (P < .05). The horizontal loss between the day of installation of the blocks and 8 months postoperatively was 1.02 ± 0.39 mm for the TG and 1.10 ± 0.71 mm for the CG (P > .05). With regard to bone density, the TG blocks right after installation had 440.2 ± 89.15 HU, and after 8 months, the region reached 730.7 ± 130.98 HU, representing an increase of 29.05%. For the CG blocks, bone density increased from 1052.2 ± 398.35 HU to 1222.5 ± 453.28 HU, representing an increase of 17.03%. The increase in bone density was significantly higher in the TG (P < .05). Clinically, no cases of exposure of the bone blocks and no failure of incorporation were observed. Histomorphometrically, the percentage of mineralized tissue was lower in the TG than in the CG (48.10% ± 2.88% and 53.53% ± 1.05%, respectively), and the opposite was verified for the levels of nonmineralized tissue (52.79% ± 2.88% and 46.47% ± 1.05%, respectively; P < .05). The use of CXBB achieved higher levels of horizontal gain, with lower bone density and lower levels of mineralized tissue when compared with the use of autogenous blocks.
Asunto(s)
Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Humanos , Implantación Dental Endoósea/métodos , Proyectos Piloto , Estudios Prospectivos , Aumento de la Cresta Alveolar/métodos , Boca , Trasplante Óseo/métodosRESUMEN
The objectives of this study were to observe hard tissue changes in guided bone regeneration (GBR) with intact periosteum and soft block deproteinised bovine bone mineral (DBBM), and evaluate whether the result of horizontal bone augmentation varied by initial peri-implant defect depth. Forty patients with a single missing tooth and contained peri-implant defect were categorised into three groups according to their presurgical defect depth (≤ 2, 2-4, and 4-6 mm). Cone-beam computed tomography (CBCT) images were collected and reconstructed preoperatively, postoperatively, and at six months' follow up. The buccal bone width (BBW -0, -3, -5), alveolar bone width (ABW -0, -3, -5) and volume of augmented area were measured. At the six-month follow up the increase in BBW, ABW at all levels, and in bone volume, was statistically significant (all p < 0.001). No statistical significance in bone dimensions or bone resorption was found among groups (all p > 0.05). Histological analysis detected new bone formation in intimate contact with bone grafts underlying the periosteum. Within the limitations of this study, the insights gained may be of assistance to suggest that comparable and acceptable results of horizontal bone augmentation can be achieved in cases of peri-implant defect depth of ≤6 mm by means of GBR with intact periosteum.
Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Humanos , Animales , Bovinos , Implantación Dental Endoósea/métodos , Periostio/cirugía , Estudios Retrospectivos , Regeneración Tisular Guiada Periodontal/métodos , Regeneración Ósea , Aumento de la Cresta Alveolar/métodosRESUMEN
Background: Placement of dental implant in narrow alveolar ridge is challenging to be treated. GBR procedure is currently most widely used to augment the deficient alveolar ridges and to treat the fenestration and dehiscence around dental implant. Thus, the objectives of the present study were to evaluate as well as compare the clinical performance of collagen membrane and titanium mesh for horizontal bone augmentation at dehisced implant sites. Methods and material: Total 12 single edentulous implant sites with buccal bone deficiency in 8 subjects were equally divided and treated simultaneously with either of the two membranes and DBBM(Bio-Oss) bone graft. Primary outcome measurements in terms of defect height and defect width were made using calibrated plastic periodontal probe. Re-entry surgery was performed to remeasure augmented site and to remove Ti-mesh at 6th months. Independent paired t-test for the inter-group comparison and student paired t-test for intra-group comparison were performed. The differences were considered to be significant at p ≤ 0.05. Results: Mean defect fill with respect to height and width was 3.50 ± 0.54 mm (87%) and 2.33 ± 0.51 mm (82%) for collagen membrane and 3.83 ± 0.75 mm (92%) and 2.50 ± 0.54 mm (88%) for Ti-mesh group respectively. Conclusions: Within the limitation of the study, it was concluded that mean defect height and width after 6 months were statistically significant within the group without significant difference between them, Although defect resolution was better in Ti-mesh.
RESUMEN
PURPOSE: The present systematic review and meta-analysis aimed to investigate the available evidence in the literature to answer the following focused question: In partially edentulous arches with reduced bone width, do implants placed after horizontal bone augmentation exhibit differences in survival and success rate compared to narrow-diameter implants placed in native bone? MATERIALS AND METHODS: A population, intervention, comparison and outcome question was defined and an electronic search was conducted using the MEDLINE (via PubMed) and Cochrane Oral Health Group databases to identify all studies analysing the use of standard-diameter implants inserted in regenerated bone or narrow-diameter implants for the rehabilitation of partially or completely edentulous atrophic maxillae and mandibles. Inclusion criteria and quality assessments were established, and studies were selected on this basis. RESULTS: Twenty-four studies met the inclusion criteria and were analysed cumulatively. A comparative meta-analysis was not possible due to the lack of studies directly comparing the two rehabilitation methods in question. A cumulative implant survival rate of 97.80% (1246/1274; pooled proportion 0.984, 95% confidence interval 0.977-0.991) was reported for the narrow implants placed in atrophic ridges, while similar results were obtained for the standard-diameter implants placed in regenerated bone, with a cumulative implant survival rate of 97.94% (1332/1360; pooled proportion 0.983, 95% confidence interval 0.976-0.990). CONCLUSIONS: The present systematic review found high and comparable survival rates between narrow- and standard-diameter implants placed in regenerated bone; however, well-designed randomised controlled trials are required to support the hypothesis that both treatment strategies are successful in comparable circumstances.
Asunto(s)
Implantes Dentales , Boca Edéntula , Humanos , Mandíbula/cirugía , Boca Edéntula/cirugíaRESUMEN
AIM: This prospective randomized clinical trial was designed to compare the apical U-shape splitting technique (AUST) combined with guided bone regeneration (GBR) vs GBR alone for horizontal bone augmentation in maxillary labial undercut areas. MATERIALS AND METHODS: The study included twelve patients with labial undercuts that made their alveolar ridges not able to compass dental implants. They received a total of 14 dental implants in the anterior maxilla where 7 (group I) were placed after AUST with GBR and the other 7 (group II) after the conventional GBR. The clinical and radiographic evaluations were done preoperatively, after surgery, and 6 months later. Facial flap fracture, peri-implant health, ridge width (RW) gain and loss, marginal bone loss (MBL), and implant esthetics were measured. Data were analyzed and compared and for any of the used tests, results were considered statistically significant if p-value ≤ 0.05. RESULTS: For group I, no fracture of the bone flap happened and the gain in RW was significantly higher at 6 months postoperatively. Marginal bone loss was similar for both groups. The total pink esthetic score was significantly higher in group I vs group II (p = 0.024). CONCLUSION: Within the limitations of this study, it was concluded that AUST combined with GBR was more effective in RW gain than GBR alone and it provided a merit approach for restoring function and esthetics if labial fenestration was unavoidable during implant placement. CLINICAL SIGNIFICANCE: Apical U-shape splitting technique for horizontal ridge augmentation is a valuable option for the benefit of patients in clinics who need dental implants and have anterior undercut areas that may lead to fenestration and usually requires onlay bone grafting which is less successful in maintaining the RW.
Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Humanos , Implantación Dental Endoósea/métodos , Estudios Prospectivos , Trasplante Óseo , Maxilar/cirugía , Aumento de la Cresta Alveolar/métodos , Estética Dental , Regeneración Ósea , Resultado del TratamientoRESUMEN
@#Tooth loss is accompanied by alveolar bone absorption or defect, resulting in insufficient bone and soft tissue. In addition to restoring the masticatory function of missing teeth, implant treatment should also needs to restore the contour and shape of the dental arch. Guided bone regeneration is a common means of bone increase. Xenogeneic granular bone substitute materials are widely used in the field of clinical bone augmentation due to their advantages of long degradation time and low immunogenicity, but other problems, such as inconvenient operation and low osteogenic activity, remain. Plasmatrix can effectively improve the effect of oral tissue regeneration and reduce the occurrence of postoperative complications, and its application in oral tissue regeneration is gradually increasing. This article first introduces the main application forms of plasmatrix in horizontal bone augmentation (mainly solid plasmatrix membrane and plasmatrix bone block), and reclassifies horizontal bone defects according to commonly used decision-making schemes in clinical bone augmentation, in other words, whether the implant can be placed in the ideal position and whether there is bone dehiscence after implantation. Type Ⅰ defects refers to the situation where the bone at the implant site can allow the insertion of an implant with ideal size, and there is no bone dehiscence around the implant, but the alveolar bone contour is not ideal; type Ⅱ defects refers to the situation that when an ideal size implant is placed at the implant site determined by the future prosthesis position, there will be bones on three sides of the implant, but there is bone dehiscence in the buccal bone wall (the length of bone dehiscence is less than 50% of the implant length); type Ⅲ defects refers to the situation where the bone volume at the implant site is not enough to for the placement of the ideal size implant at the ideal position, and bone grafting is required to restore the bone volume before the implant placement. The application of plasmatrix in different types of bone defects is then described. In type Ⅰ bone defects, the solid plasmatrix membrane is used instead of the collagen membrane; in type Ⅱ bone defects, the bone defect around the implant is filled by plasmatrix bone block and then covered with collagen membrane and solid plasmatrix membrane; and in type Ⅲ bone defects, plasmatrix bone block is used to replace autogenous bone block to fill the defect area, and titanium screws are used for fixation. The defect is then covered with a collagen membrane and a solid plasmatrix membrane. This article aims to provide oral clinicians with a comprehensive understanding of plasmatrix and simplify the guidelines for bone regeneration operations.
RESUMEN
PURPOSE: To introduce a novel and efficient procedure to solve a multidisciplinary issue connected to implant-related surgery in areas near periapical lesions of adjacent teeth using single-stage combined surgery while exploring a new way to prevent retrograde peri-implantitis. MATERIALS AND METHODS: A 31-year-old woman diagnosed with a Kennedy III dentition defect in the maxillary right central incisor and posttreatment apical periodontitis in the maxillary right lateral incisor was treated using a multidisciplinary procedure. First, the preoperative data were collected from intraoral, extraoral facial and CBCT scans. Then, the aesthetic appearance of the anterior teeth was planned digitally and implant insertion was simulated. Next, virtual bone augmentation was carried out with reference to the simulated implant position, and according to the virtual augmentation, the templates for bone shell harvesting (also used for apical osteotomy and root tip resection during endodontic microsurgery) and bone shell grafting of the edentulous area were designed and fabricated. The templates for combined surgery (endodontic microsurgery and horizontal bone augmentation) consisted of one basal template and multiple interchangeable attachments via a plugin design to make guided endodontic microsurgery and digitally guided bone augmentation more efficient. Combined surgery was then carried out using the templates for guidance. During surgery, the apical inflammation affecting the maxillary right lateral incisor was first removed and its preserved apical bony window was prepared as an autogenous bone shell for bone augmentation of the maxillary right central incisor site. Guided bone regeneration of the edentulous area and guided tissue regeneration were then performed for the adjacent tooth. Six months after the combined surgery, digital guided implant surgery was carried out for the edentulous area. The final prosthesis was delivered in accordance with the preoperative aesthetic design and achieved using an implant-supported restoration for the maxillary right central incisor, full crown restoration for the maxillary right lateral incisor, and ceramic veneers for the maxillary left central and lateral incisors for space closure. RESULTS: The horizontal bone augmentation in the edentulous area and endodontic microsurgery on the neighbouring tooth were performed successfully in a single-stage surgical procedure; thus, augmentation of the resorbed alveolar bone and removal of infection in the adjacent site were achieved simultaneously. At the 1-year follow-up after combined surgery, the healing of the natural maxillary right lateral incisor and the area having undergone bone augmentation showed promising results with no postoperative complications. CONCLUSIONS: This novel digital workflow appears effective in addressing the problem of periapical lesions in retained teeth adjacent to the edentulous area that requires horizontal bone augmentation in one surgical procedure, providing an efficient way of resolving the problem using endodontics and implantology, and preventing retrograde peri-implantitis.
Asunto(s)
Microcirugia , Boca Edéntula , Adulto , Femenino , Estudios de Seguimiento , Humanos , Incisivo/diagnóstico por imagen , Maxilar/diagnóstico por imagenRESUMEN
PURPOSE: The objective of this systematic review was to evaluate and compare the clinical efficacy of horizontal alveolar ridge augmentation techniques described by Khoury and Urban. METHODS: A systematic electronic search in the MEDLINE databases, SCOPUS, WOS, and the Cochrane Central Register of Controlled Trials (CENTRAL) as well as a manual search, were conducted independently by two reviewers up to July 2021. RESULTS: Six studies met the pre-established inclusion criteria and were included in the descriptive analysis. Due to the heterogeneity found across the included studies, meta-analysis could not be performed. Horizontal bone gain was between 3.93 ± 0.9 mm and 5.02 ± 0.8 mm with the Khoury technique and between 3.9 ± 0.9 mm and 5.68 ± 1.42 mm with the Urban technique. Similar complication rates were reported in both groups: infection (7%), in the Khoury technique, and membrane exposure (3.2-13.6%), in the Urban technique, being the most frequent events. CONCLUSIONS: Both techniques were found to be effective, in terms of clinical bone gain, for horizontal alveolar ridge gain. Nevertheless, available literature is limited, and there is a lack of comparative studies to better evaluate the results.
RESUMEN
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.
Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Trasplante Óseo , Implantación Dental Endoósea , Odontólogos , Humanos , Mandíbula/cirugía , Maxilar/cirugía , Rol ProfesionalRESUMEN
BACKGROUND: To our acknowledgment, there were limited clinical studies about the guided bone regeneration (GBR) for both vertical and horizontal augmentation at the same time using titanium mesh (Ti-mesh) with simultaneous implant placement in the esthetic zone. Meanwhile, studies that specially evaluate resorption and long-term stability of the augmented labial bone after loading were also rare. Therefore, this study introduced a newly designed L-shaped Ti-mesh used for GBR with simultaneous implant placement and evaluated the bone augmentation effectiveness, resorption, and long-term stability of peri-implant bone with this newly designed L-shaped Ti-mesh. MATERIALS AND METHODS: Twelve patients (16 implants) who had underwent a GBR procedure using L-shaped Ti-mesh with simultaneous implants placement were reviewed in this study. Complications, implant success, and survival rate were recorded and calculated. Furthermore, the bone gain values, labial bone resorption, and remaining labial bone volume were measured by cone beam CT (CBCT) during 13-41 months follow-up. RESULTS: After GBR using L-shaped Ti-mesh, the average bone gain values were 3.61 ± 1.50 mm vertically and 3.10 ± 2.06 mm horizontally. The implant success and surviving rate were 93.75% and 100%, respectively during the longest 41 months follow-up. The vertical labial bone resorption was -0.81 ± 1.00 mm, horizontal labial bone resorption was -0.13 ± 1.19 mm at the top of the implants. The remaining labial bone thickness was 2.24 ± 1.29 mm at the top of the implants and 2.86 ± 1.08 mm at the 2 mm apically from the implant tops after loading. There was still 1.13 ± 1.18 mm vertical labial bone remaining above the top of implants for approximately 87.5% sites. CONCLUSIONS: GBR using L-shaped Ti-mesh with simultaneous implant placement (one-step surgery) in the esthetic zone could achieve predictable results for vertical and horizontal bone augmentation at the same time. Meanwhile, L-shaped Ti-mesh could preferably reconstruct and reduce the labial bone resorption to achieve long-term esthetics. This newly designed L-shaped Ti-mesh may offer predictable and excellent outcomes for the implant restoration in the esthetic zone.
Asunto(s)
Aumento de la Cresta Alveolar , Regeneración Ósea , Trasplante Óseo , Implantación Dental Endoósea , Estética Dental , Humanos , Estudios Retrospectivos , Mallas Quirúrgicas , Titanio , Resultado del TratamientoRESUMEN
Three cases with severe horizontal bone deficiency on mandibular posterior region were committed by modified alveolar ridge augmentation. The therapeutic outcomes show that it is an effective methodology in cases with compromised horizontal bone.
RESUMEN
The aim of this study was to investigate a novel apical U-shape splitting technique for horizontal bone augmentation in undercut areas and to compare its efficacy with that of guided bone regeneration (GBR). This was a prospective non-randomized controlled clinical trial. A total of 36 patients, who presented with a labial undercut that was not able to house a normally inclined implant, underwent the new technique or GBR. Radiographic and clinical data were obtained preoperatively, immediately after surgery, and 12 months after surgery. Pairwise comparisons of changes in ridge width gain, marginal bone loss, and pink aesthetic score were performed; correlations with pristine ridge morphology were investigated. The results showed similar marginal bone loss in the two groups. The overall ridge width gains in the new technique group (2.56±1.92mm) and GBR group (0.73±1.21mm) differed significantly (P<0.05). The pink aesthetic score was higher for the new technique group (11.75±1.22) than for the GBR group (9.25±1.86) (P<0.01). The morphology of the concavity had different impacts on regeneration in the two groups. The apical U-shape splitting technique, as a safe and effective alternative to GBR, provided a significant increase in bone volume gain where labial fenestration was inevitable during implant placement.
Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Implantación Dental Endoósea/métodos , Regeneración Tisular Guiada Periodontal/métodos , Adulto , Sustitutos de Huesos/uso terapéutico , Tomografía Computarizada de Haz Cónico , Implantes Dentales , Estética Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
PURPOSE: The objective of this 3-year post-loading parallel randomised controlled trial is to compare two bone substitutes and resorbable membranes in a one-stage procedure for horizontal bone augmentation: anorganic bovine bone and porcine collagen membranes (BB group) versus synthetic resorbable bone graft substitute made of pure ß-tricalcium phosphate and porcine pericardium collagen membranes (CJ group). MATERIALS AND METHODS: Patients in need of implant treatment having at least one site with horizontal osseous defect at a private clinic in Rimini, Italy, were included in this study. Patients were randomised to receive either BB or CJ in a one-stage procedure for horizontal bone augmentation in a submerged approach. Randomisation was computer-generated with allocation concealment by opaque sequentially numbered sealed envelopes. Patients and the outcome assessor were blinded to group assignment. The abutment connection was made after 6 months of healing. The application of the provisional prosthesis was performed after abutment connection and a definitive metal-ceramic prosthesis was placed 6 months post-loading. The patients were followed-up to 3 years post-loading. Primary outcome measures were: implant failure, complications and peri-implant margin bone level changes. Secondary outcome measures were: visual analogue scale (VAS) for functional and aesthetic satisfaction and pink aesthetic score (PES). RESULTS: Twenty-five patients with 32 implants were randomly allocated to the BB group and 25 patients with 29 implants to the CJ group. All 50 randomised patients received the treatment as allocated and there were 7 drop-outs in the BB group and 11 drop-outs in the CJ group up to 3 years' post-loading. There were no implant failures. There were six complications in five patients of the BB group and three complications in three patients of the CJ group (relative risk: 1.32, 95% CI from 0.37 to 4.64, P = 1.0000). Radiographic bone loss was 1.61 mm for the BB group and 1.02 mm for the CJ group (difference 0.54 mm, 95% CI from -0.53 to 1.60, P = 0.3100). The functional VAS was 9.0 for the BB group and 9.6 for the CJ group (difference 0.6, 95% CI from -0.4 to 1.5, P = 0.2393). The aesthetic VAS was 9.4 for the BB group and 9.6 for the CJ group (difference 0.2, 95% CI from -0.5 to 0.8, P = 0.6141). PES was 8.7 for the BB group and 8.5 for the CJ group (difference -0.1, 95% CI from -2.9 to 2.7, P = 0.9360). CONCLUSIONS: No significant differences were observed in this randomised controlled trial comparing anorganic bovine bone with porcine collagen membranes versus synthetic resorbable bone made of pure ß-tricalcium phosphate with pericardium collagen membranes for horizontal augmentation.
Asunto(s)
Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental , Aumento de la Cresta Alveolar , Animales , Productos Biológicos , Sustitutos de Huesos , Fosfatos de Calcio , Bovinos , Prótesis Dental de Soporte Implantado , Método Doble Ciego , Humanos , Membranas , MineralesRESUMEN
Objective To evaluate the therapeutic outcome of horizontal bone augmentation by using the modified split crest technique of piezosurgery in mandible molar area. Methods The present study reviewed the record of 15 patients from 2016 January to 2017 March in the department of oral implantology center of Stomato-logical Hospital of Southern Medical University,who underwent the modified split crest technique of piezosurgery in mandible molar area. Preoperative CBCT was performed to determine the bone thickness of the toothless alveo-lar crest of the mandibular posterior region,and the bone thickness was less than 3 mm. The modified split crest technique of piezosurgery was performed for the horizontal bone augmentation at mandibular posterior region. Meanwhile,GBR and the postoperative CBCT were performed to determine the bone width increments,followed with 1-week anti-inflammatory therapy postoperation. Three months after the operations,the bone width incre-ment was examined by CBCT. SPSS13.0 software was used to analyze the collected data. Results The modified split crest technique of piezosurgery in mandible molar area was successfully established,resulting in the mini-mal operative wounds and the slight postoperative reaction,without obvious infection. The postoperative crest width increase achieved 6.05 ± 0.65 mm. At 3 months after operation,the crest width increase reduced to(5.81 ± 0.61)mm. There were significant differences of the alveolar ridge thickness between the preoperative and post-operative patients(P<0.05). There were significant differences between the preoperative crest width and the 3 months after treatment(P<0.05). Conclusion Horizontal bone augmentation of the modified split crest tech-nique of piezosurgery was efficient,which could be performed in very narrow alveolar ridge,and which was rela-tively safe and accurate,with less trauma. No damage was observed to the soft tissue,and the cutting direction can be well controlled.
RESUMEN
PURPOSE: The aim of this systematic review was to evaluate clinical, radiological and histological outcomes of the alveolar ridge splitting/expansion technique (ARST) with or without GBR. MATERIALS AND METHODS: A screening of two databases MEDLINE (PubMed) and EMBASE (OVID) and hand search of articles were performed. Human and animal studies reporting on dental implants placed with simultaneous ARST up to May 31st 2014 were considered. Quality assessment of selected full-text articles was performed according to the ARRIVE guidelines and the Cochrane collaboration's tool to assess risk of bias. RESULTS: Overall, 18 human and six animal studies (risk of bias: high/unclear) were included in this review. No randomized controlled trials were found. Due to the heterogeneity of study designs, definitions of success criteria, outcome variables, observation times and surgical procedures, no meta-analysis was performed. Reported survival (18 studies) and success (nine studies) rates ranged from 91.7 to 100% and 88.2 to 100%, respectively, with a mean follow-up of 1-10 years. Crestal bone level changes (∆CBL) in some studies indicate slightly higher bone loss before and after loading. Histologic and histomorphometric data from six animal studies confirm the crestal bone loss, particularly at buccal sites. CONCLUSIONS: Within the limitations of this review, ARST seems to be a well-functioning one-stage alternative to extended two-stage horizontal grafting procedures. Data indicate that during healing and first year of loading, increased ∆CBL particularly at buccal sites must be anticipated. Additional horizontal GBR can help to preserve buccal bone height and width.
Asunto(s)
Pérdida de Hueso Alveolar/patología , Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Implantación Dental Endoósea/métodos , Implantes Dentales , Animales , Trasplante Óseo/métodos , Regeneración Tisular Guiada Periodontal/métodos , HumanosRESUMEN
AIM: The present work describes a horizontal ridge augmentation in which a titanium mesh was preshaped by adapting it to a stereolithographic model of the patient's jaw that was fabricated from CT scans. BACKGROUND: Guided bone regeneration (GBR) involves covering the augmentation site with a long-lasting barrier to protect it from the invasion of surrounding soft tissues. Among barriers, titanium meshes may provide a successful outcome, but the intraoperatory time needed to shape them is a disadvantage. CASE DESCRIPTION: The 54-year-old patient, missing the right mandibular second bicuspid, first molar, and second molar, had her atrophic ridge augmented with a 30:70 mixture of autogenous bone and equine, enzyme-deantigenic collagen-preserved bone substitute. Two conical implants were inserted concomitantly in the second bicuspid and first molar positions, and the site was protected with the preshaped mesh. Four months later, the titanium mesh was retrieved, a bone sample was collected, and histological and histomorphometric analyses were performed. Provisional and definitive prostheses were then delivered, and follow-up controls were performed for up to 24 months. CONCLUSION: Preshaping the mesh on a model of the patient's mandible shortened the surgical time and enabled faster mesh placement. Two years after surgery, the implants were perfectly functional, and the bone width was stable over time as shown by radiographic controls. Histological analysis of the bone sample showed the heterologous biomaterial to be biocompatible and undergoing advanced remodeling and replacement with newly formed bone. CLINICAL SIGNIFICANCE: Preshaping a titanium mesh over a stereolithographic model of the patient's jaw allowed for a significant reduction of the intraoperative time and may be therefore, advisable in routine practice.
Asunto(s)
Aumento de la Cresta Alveolar/instrumentación , Materiales Biocompatibles/química , Regeneración Ósea/fisiología , Trasplante Óseo/métodos , Regeneración Tisular Guiada Periodontal/instrumentación , Xenoinjertos/trasplante , Enfermedades Mandibulares/cirugía , Mallas Quirúrgicas , Titanio/química , Animales , Autoinjertos/patología , Autoinjertos/trasplante , Sustitutos de Huesos/uso terapéutico , Colágeno/uso terapéutico , Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico/métodos , Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado , Femenino , Estudios de Seguimiento , Xenoinjertos/patología , Caballos , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Arcada Parcialmente Edéntula/cirugía , Persona de Mediana Edad , Modelos AnatómicosRESUMEN
The aim of the present study was to use cone-beam computerized tomography (CBCT) to assess horizontal bone augmentation using block grafts, harvested from either the iliac crest (IC) or mandibular ramus (MR) combined with particulate xenograft and a collagen membrane for in the severe maxillary anterior ridge defects (cases Class III-IV according to Cadwood and Howell's classification). Fourteen healthy partially edentulous patients requiring extensive horizontal bone reconstruction in the anterior maxilla were selected for the study. Nineteen onlay block grafts (from IC or MR) were placed. The amount of horizontal bone gain was recorded by CBCT at 3 levels (5, 7, and 11 mm from the residual ridge) and at the time of bone grafting as well as the time of implant placement (≈5 months). Both block donor sites provided enough ridge width for proper implant placement. Nonetheless, IC had significantly greater ridge width gain than MR (Student t test) (4.93 mm vs 3.23 mm). This was further confirmed by nonparametric Mann-Whitney test (P = .007). Moreover, mean pristine ridge and grafted ridge values showed a direct association (Spearman coefficient of correlation = .336). A combination of block graft, obtained from the IC or MR, combined with particulate xenograft then covered with an absorbable collagen membrane is a predictable technique for augmenting anterior maxillary horizontal ridge deficiency.