Abstract
Objective: The aim of this study was to compare the horizontal dimensional changes of split-bone block and cortico-cancellous block graft in horizontal ridge augmentation using Cone Beam Computed Tomography (CBCT). The quality of the regenerated bone in both groups was compared histologically and histomorphometrically. Material and methods: Twenty patients were randomly divided in two equal groups (n= 10): Split-bone block group which was harvested from the external oblique ridge or cortico-cancellous block graft group which was harvested from the mandibular symphysis. Pre-augmentation crestal ridge width was measured using bone caliper. CBCT scans were taken on the 2nd week and 4th month post-operatively to measure crestal and total horizontal ridge dimensions. A biopsy was collected from the regenerated ridge immediately before implant insertion on the 4th month post-operatively. Results: Pre-augmentation crestal bone widths of both groups were comparable (P= 0.870). On the 2nd week and 4th month post-operatively, split-bone block showed a significantly wider crestal (P= 0.028 and P= 0.001 respectively) and total horizontal ridge dimension (P= 0.025 and P= 0.002 respectively), and on the 4th month post-operatively, it showed significantly lesser resorption at crest (P= 0.040) and in total horizontal ridge dimension (P= 0.017) than cortico-cancellous block. Histologically, the regenerated bone quality was similar in both groups. Histomorphometric analysis showed a non-significant difference in percentage of mature (P= 0.365) and immature collagen (P= 0.531) between both groups. Conclusion: Split-bone block maintained a significantly wider ridge and experienced less resorption after 4 months than the cortico-cancellous block graft, with no difference in regenerated bone quality between both groups. Keywords Dental implants; CBCT; Cortico-cancellous block graft; Histomorphometric analysis; Split-bone block technique.
Highlights
After tooth loss, the alveolar ridge experiences an irreversible and progressive diminution in both width and height [1]
Intramembranous autogenous osseous grafts have been considered as a reliable grafting material for the reconstruction of atrophied ridges as they combine all properties required in a bone graft material: osteoinduction, osteoconduction and osteogenesis [4]
The cortico-cancellous block grafts harvested from the mandibular symphysis provide mechanical support and rigidity of the cortical portion, and enhanced revascularization of the cancellous portion, ensuring adequate ridge augmentation [5]
Summary
The alveolar ridge experiences an irreversible and progressive diminution in both width and height [1]. This may render implant placement impossible, or in an incorrect position both functionally and esthetically [2,3]. The cortico-cancellous block grafts harvested from the mandibular symphysis provide mechanical support and rigidity of the cortical portion, and enhanced revascularization of the cancellous portion, ensuring adequate ridge augmentation [5]. Block grafts harvested from the external oblique ridge are composed only of cortical bone, which take longer period for re-vascularization and remodeling, and may suffer sequestration years after augmentation [6]
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