Lateral alveolar ridge augmentation procedure using subperiosteal tunneling technique: a pilot study

Ashish Kakar,Aditya Patney,Gaurav Jain,Annette Lindner,Heiner Nagursky,Kanupriya Kakar,Bappanadu H Sripathi Rao

doi:10.1186/s40902-018-0142-8

Abstract

BackgroundIn this research article, we evaluate the use of sub-periosteal tunneling (tunnel technique) combined with alloplastic in situ hardening biphasic calcium phosphate (BCP, a compound of β-tricalcium phosphate and hydroxyapatite) bone graft for lateral augmentation of a deficient alveolar ridge.MethodsA total of 9 patients with deficient mandibular alveolar ridges were included in the present pilot study. Ten lateral ridge augmentation were carried out using the sub-periosteal tunneling technique, including a bilateral procedure in one patient. The increase in ridge width was assessed using CBCT evaluation of the ridge preoperatively and at 4 months postoperatively. Histological assessment of the quality of bone formation was also carried out with bone cores obtained at the implant placement re-entry in one patient.ResultsThe mean bucco-lingual ridge width increased in average from 4.17 ± 0.99 mm to 8.56 ± 1.93 mm after lateral bone augmentation with easy-graft CRYSTAL using the tunneling technique. The gain in ridge width was statistically highly significant (p = 0.0019). Histomorphometric assessment of two bone cores obtained at the time of implant placement from one patient revealed 27.6% new bone and an overall mineralized fraction of 72.3% in the grafted area 4 months after the bone grafting was carried out.ConclusionsWithin the limits of this pilot study, it can be concluded that sub-periosteal tunneling technique using in situ hardening biphasic calcium phosphate is a valuable option for lateral ridge augmentation to allow implant placement in deficient alveolar ridges. Further prospective randomized clinical trials will be necessary to assess its performance in comparison to conventional ridge augmentation procedures.

Highlights

In this research article, we evaluate the use of sub-periosteal tunneling combined with alloplastic in situ hardening biphasic calcium phosphate (BCP, a compound of β-tricalcium phosphate and hydroxyapatite) bone graft for lateral augmentation of a deficient alveolar ridge
We present a series of 9 patients with a total of 10 lateral augmentation of deficient alveolar ridges using graft material applied through the subperiosteal tunneling approach
A total of 9 patients who fulfilled the inclusion criteria were enrolled in the study, and a total 10 ridge augmentations were performed using the subperiosteal tunneling technique with an alloplastic in situ hardening bone graft substitute

Summary

Introduction

We evaluate the use of sub-periosteal tunneling (tunnel technique) combined with alloplastic in situ hardening biphasic calcium phosphate (BCP, a compound of β-tricalcium phosphate and hydroxyapatite) bone graft for lateral augmentation of a deficient alveolar ridge. The use of autogenous bone for the reconstruction and augmentation of such ridges to facilitate implant rehabilitation has traditionally been the gold standard in this area [3]. Use of autogenous bone carries the obvious drawbacks of Calcium phosphates have been amongst the earliest of the potential bone graft substitute materials to be identified, based upon their similarity to the chemical structure of the inorganic components of native bone [5] which is largely composed of crystalline hydroxyapatite form of calcium phosphate. While the β-tricalcium phosphate resorbs completely and is replaced with new bone, hydroxyapatite remains unresorbed but integrates into newly forming host bone [4, 6,7,8]

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