Reconstruction of alveolar jaw bone. An experimental and clinical study of immediate and preformed autologous bone grafts in combination with osseointegrated implants.

Abstract

In edentulousness, which cannot be adequately compensated for by a denture but causes considerable oral dysfunction, the treatment of choice is a bridge construction on osseointegrated titanium fixtures. In those cases, where the quantity or quality of the alveolar ridge--as a consequence of progressing resorption--does not provide enough bone tissue for lasting implant anchorage, restoration of jaw bone anatomy is required. In attempts to evaluate the best material and method for bone reconstruction in these cases, experimental and clinical studies on various grafting procedures were performed. The immediate, autologous cancellous bone and marrow graft was not found to provide volume restitution to the required extent because of rapid graft resorption. The biomechanical capacities of the jaw bone were, however, restored to such a degree that fixtures could be integrated and permanent bridge stability achieved in 13 out of 18 cases. In order to avoid resorptive derangement of the anatomy of the reconstructed alveolar region a modified transplantation technique was developed. In an experimental study in dogs a procedure of preformation of autologous composite bone grafts containing integrated titanium implants was designed. The results indicated that this procedure could provide graft persistance together with implant stability. Clinical applications of this reconstructive procedure showed that preformed grafts containing incorporated implants from the proximal tibial metaphysis could be used to restore jaw bone anatomy and that the implants remained integrated within the transplanted, remodelled bone, providing permanent support for bridge constructions.