Histomorphometric analysis of bone interphase

Abstract

Background: Different surgical techniques have been advocated for esthetic rehabilitation of deficient alveolar ridges with implant placement: Guided bone regeneration (GBR), Alveolar distraction osteogenesis, Onlay block graft (autogenous and allograft); However, autogenous block graft still provides with predictable outcome since being the gold standard for regeneration and augmentation. Objective: The aim of the present study was to compare histomorphometrically the bone interphase of augmented site with and without GTR (guided bone regeneration) membrane before implant placement. Material and Methods: In this study, a total of 16 patients with missing incisor with Siberts Class 1 alveolar defects were selected, parasymphysial block graft were harvested and stabilized with miniscrews, DFDBA graft material around the block graft were placed, and 8 were covered with GTR resorbable membrane. Miniscrews were removed after 6 months. Bone core biopsy of interphase were retrieved by 2.9 mm diameter trephine bur and sent for histologic and histomorphometric analysis using histometry software. Results: Data were evaluated using paired sample t-test and Shapiro-Wilk test. Histological evidence of fibrous tissue interphase was observes in specimen without GTR group. Though there were no statistically significant difference between the two groups in terms of amount of new bone 31.47 versus 30.6% (P = 0.5362), while there was a statistically significant difference in percentage of residual grafted material higher in non GTR augmented site (t value= 4.501 P = 0.0003) and marrow space in GTR group with statistical significance (t = 2.887 P = 0.0098). Conclusion: Only few studies have tested histomorphometrically to see the exact uptake of the augmented site, comparing interpositioning of fibrous tissue, newly formed bone at site, residual graft material and marrow space. It is most appropriate to use an evidenced-based approach when a treatment plan is being developed for bone augmentation cases. This study will add to the evidence of use of autogenous block graft with GTR membrane thus providing a connective tissue interphase free augmentation.