Ibandronate Reduces the Surface Bone Resorption of Mandibular Bone Grafts: A Randomized Trial With Internal Controls.

Jahan Abtahi,Benjamin Klintström,Eva Klintström

doi:10.1002/jbm4.10468

Jahan Abtahi, Benjamin Klintström + Show 1 more

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https://doi.org/10.1002/jbm4.10468

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Abstract

ABSTRACTAutologous bone grafts are considered the gold standard for reconstruction of the edentulous alveolar ridges. However, this procedure is associated with unpredictable bone loss caused by physiological bone resorption. Bisphosphonates are antiresorptive drugs that act specifically on osteoclasts, thereby maintaining bone density, volume, and strength. It was hypothesized that the resorption of bone grafts treated with an ibandronate solution would be less advanced than bone grafts treated with saline. Ten patients who underwent bilateral sagittal split osteotomy were included in a randomized double‐blind trial with internal controls. Each patient received a bone graft treated with a solution of ibandronate on one side and a graft treated with saline (controls) contralaterally. Radiographs for the measurement of bone volume were obtained at 2 weeks and at 6 months after surgery. The primary endpoint was the difference in the change of bone volume between the control and the ibandronate bone grafts 6 months after surgery. All of the bone grafts healed without complications. One patient was excluded because of reoperation. In eight of the nine patients, the ibandronate bone grafts showed an increase in bone volume compared with baseline, with an average gain of 126 mm3 (40% more than baseline) with a range of +27 to +218 mm3. Only one ibandronate‐treated graft had a decrease in bone volume (8%). In the controls, an average bone volume loss of −146 mm3 (58% of baseline) with a range of −29 to −301 mm3 was seen. In the maxillofacial field, the reconstructions of atrophic alveolar ridges, especially in the esthetical zones, are challenging. These results show that bone grafts locally treated with ibandronate solution increases the remaining bone volume. This might lead to new possibilities for the maxillofacial surgeons in the preservation of bone graft volumes and for dental implant installations. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Highlights

The irreversible physiological resorption of alveolar bone occurs as early as 3–6 months following tooth extraction, tooth loss, or dental aplasia.[1]
Various surgical techniques have been described for the reconstruction of bone defects, including onlay block grafting, particulate bone grafting, and guided bone regeneration.[2,3] Autogenous bone graft is considered the gold standard in treating an atrophic alveolar ridge caused by its osteogenesis, osteoconduction, and osteoinduction abilities compared with other bone substitutes.[4] an increase in intervention morbidity, unpredictable bone resorption at the recipient site, and limited intraoral bone volume are limitations of this bonegrafting procedure.[5]
A variety of regional or distant donor sites are being used, including iliac crest bone, intraoral bone, proximal tibial bone, costal bone, and calvarium.[6,7,8,9,10,11] Mandibular bone harvesting is associated with less resorption compared with a bone graft of the iliac crest, which has been attributed to the iliac graft’s relatively higher trabecular structure.[6,12] The reported resorption rates for cortical onlay grafts of the iliac crest and particulate inlay grafts of trabecular bone for the reconstruction of maxillary bone defects were approximately 50%.(6) The resorption rates of a symphyseal mandibular graft augmenting in the anterior maxilla are estimated to be 25% after 4 months and 60% after

Summary

Introduction

The irreversible physiological resorption of alveolar bone occurs as early as 3–6 months following tooth extraction, tooth loss, or dental aplasia.[1]. Various surgical techniques have been described for the reconstruction of bone defects, including onlay block grafting, particulate bone grafting, and guided bone regeneration.[2,3] Autogenous bone graft is considered the gold standard in treating an atrophic alveolar ridge caused by its osteogenesis, osteoconduction, and osteoinduction abilities compared with other bone substitutes.[4] an increase in intervention morbidity, unpredictable bone resorption at the recipient site, and limited intraoral bone volume are limitations of this bonegrafting procedure.[5]. Reconstruction of atrophic alveolar ridges is challenging for implant practitioners because of a high resorption rate, especially in the esthetical zones. This might be reduced by the use of locally administered bisphosphonates. We hypothesized that mandibular bone grafts treated with an ibandronate solution would show less resorption than the controls.

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