Alveolar Ridge Reconstruction Research Articles

Long-Term Outcomes of Dental Rehabilitation and Quality of Life after Microvascular Alveolar Ridge Reconstruction in Patients with Head and Neck Cancer

Long-Term Outcomes of Dental Rehabilitation and Quality of Life after Microvascular Alveolar Ridge Reconstruction in Patients with Head and Neck Cancer

Efficacy of bone ring grafts for the reconstruction of alveolar ridge deficiencies: a systematic review. Part II: animal trials.

Bone ring (BR) grafts have been introduced to reconstruct alveolar ridge defects with simultaneous implant placement, but their clinical effectiveness remains undetermined. The aim of the current systematic review was to critically appraise evidence from animal studies regarding the effectiveness of BR grafts in alveolar ridge reconstruction and their variations under different surgical protocols. Electronic retrieval of six databases (MEDLINE, Embase, Cochrane Library, ScienceDirect, Web of Science, and Scopus) and citation search until 11 October 2023, for animal studies on bone augmentation employing BR grafts. The outcome variables were total bone area (BA), bone volume (BV), bone-implant contact (BIC), and histology. The protocol was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered with PROSPERO (CRD42023453949). Ten studies were included in the qualitative analysis according to the screening criteria. Two studies demonstrated favorable bone remodeling and osseointegration of the BR with both the implant and pristine bone. A comparative study between autogenous BRs and allogenic BRs reported a higher percentage of BA and BIC at 4 months of healing, but conflicting data were observed at 8 months. Another study indicated a significant advantage of autogenous BRs over bovine and biphasic ceramic BRs in terms of BA and BIC after 5 weeks. Three studies found that using collagen membranes did not significantly affect BA, BV, or BIC when used simultaneously with autogenous BRs during implant placement. Two studies evaluated one-stage and two-stage implant placement in conjunction with BR grafts, revealing similar levels of BA, BV, and BIC except for differences in total treatment time. Furthermore, one study found that the use of mucogingival junction incision and split-thickness flap significantly reduced the incidence of wound dehiscence compared with conventional incision and flap. Vertical bone augmentation surgery utilizing BR grafts with one-stage implant placement yielded histological and histomorphometric outcomes comparable to those achieved with two-stage implant placement or the additional application of collagen membrane.

Mechanical Characteristics of Individualized Biodegradable Augmentation Scaffold-In Vitro Pilot Study.

The alveolar ridge reconstruction of vertical and combined bone defects is a non-predictable procedure with varying percentages of success. The greatest challenge for vertical and combined bone augmentation is to maintain mechanical stability of the bone graft; therefore, it is mandatory to provide and preserve space for bone regeneration. The development of biomaterials and 3D printing has enabled the use of polymer scaffolds in the reconstruction of alveolar ridge defects. The aim of this pilot study was to evaluate the mechanical characteristics of an innovative individualized biodegradable polylactic acid (PLA) scaffold, under dynamic conditions, simulating biodegradation and the influence of masticatory forces. After the design and 3D printing of PLA scaffolds, two groups of 27 scaffolds were formed according to the compression testing procedure. The compression tests were performed in occlusal and lateral directions. In each of the two groups, nine subgroups of three scaffolds were formed for different testing periods during in vitro degradation with a total period of 16 weeks. Results showed that biodegradation and load application had no significant influence on mechanical characteristics of tested scaffolds. It can be concluded that simulated masticatory forces and biodegradation do not significantly influence the mechanical characteristics of an individualized biodegradable augmentation scaffold.

Clinical and Biological Validation of an Allogeneous Cancellous Bone Block for Alveolar Maxillary Ridge Reconstruction: A Case Series.

This exploratory case series clinically and histologically investigated the performance of allogeneic cancellous freeze-dried bone allograft (FDBA) bone blocks (Maxgraft®) for the lateral augmentation of local alveolar defects in the posterior maxilla as part of two-staged implant therapy. Five patients receiving eight implants 5 months after block augmentation with a follow-up period of up to 3 years were documented and analyzed. Horizontal alveolar dimensions before and 5 months after block augmentation were quantified using CBCT. Radiographic marginal bone level changes were quantified at implant placement, loading, and 1 year post-placement. Graft integration and resorption were histologically qualitatively evaluated from core biopsies retrieved at implant placement. Block augmentations resulted in a pronounced horizontal median bone gain of 7.0 (5.5 to 7.8) mm. Marginal implant bone levels in block-augmented bone remained constant over the 1 year follow-up period. Block grafts appeared histologically well integrated. Histologic analysis also revealed signs of progressive resorption and new bone formation at the lateral aspects of the grafts. The results of this case series support using Maxgraft® cancellous FDBA blocks as suitable materials for the lateral augmentation of local alveolar defects.

The Assessment of Volumetric Changes for Alveolar Ridge Preservation or Reconstruction by Three-dimensional Analysis at Posterior Extraction Sites with Severe Bone Defects Using DBBM-C Collagen Membrane and PRF: A Prospective and Randomized Clinical Trial.

Volumetric resorption of the alveolar ridge often occurs following tooth extraction in both horizontal and vertical directions. There is a specific lack of evidence for alveolar ridge reconstruction at molar and premolar sites with severe bone resorption. This randomized and controlled trial aimed to use three dimensional and linear analyses to evaluate volumetric changes of the alveolar bone following alveolar ridge reconstruction (ARR) at molar and premolar sites with severe bone resorption as compared with non-assisted socket healing be implant placement. A total of 31 patients (15 males and 16 females) with more than 50% of hard tissue loss in one or more socket walls were recruited and randomized into either a test group (ARR after extraction using deproteinized bovine bone mineral with 10% collagen (DBBM-C) and platelet-rich fibrin (PRF) with a resorbable collagen membrane) or a control group (natural healing after extraction). Then, the clinical, linear, volumetric implant-related and patient-reported outcomes were analyzed after a 4-month healing process. Linear bone assessments revealed significantly greater gains of ridge width in the test group (25% in the mesial, mid-facial and distal aspects) and less reduction of vertical bone ridge than in the control group (P＜0.05). Furthermore, volumetric bone remodeling was significantly higher in the test group (ARR=35.1±34.9%, control=14.2±12.8%, P＜0.05). Patient-reported discomfort and keratinized mucosal changes were comparable between groups. Alveolar ridge reconstruction with a combination of DBBM-C, PRF, and a resorbable membrane at posterior sites with severe socket wall deficiency (＞ 50% bone loss) is a safe and more capable therapeutic method when compared with natural healing and non-assisted sockets. Collectively, our analyses demonstrated that alveolar ridge reconstruction represents an efficient method to maintain and augment crestal bone at posterior extraction sites with severe bone defects when assessed after four months of healing.

Featured Cover

AbstractThe cover image is based on the Original Article Full block or split block?—Comparison of two different autogenous block grafting techniques for alveolar ridge reconstruction by Christian Mertens DDS et al., https://doi.org/10.1111/cid.13263. image

Clinical outcomes following atrophic alveolar ridge reconstruction using collagenated xenogeneic bone block or autogenous bone block: One-year follow-up of a randomized controlled clinical.

This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB). Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test. In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups. Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.

Management of postoperative outcomes of polytetrafluoroethylene membranes in alveolar ridge reconstruction: a systematic review

Guided bone regeneration (GBR) is a validated technique with satisfactory outcomes during 30 years of follow-up.The use of polytetrafluoroethylene (PTFE) membrane for vertical augmentation has been studied extensively.However, studies have reported exposure rates of up to 31%, there is no consensus on the management of postoperative exposure.The objective of this study was to propose a management approach for postoperative exposure of polytetrafluoroethylene (PTFE) membranes in alveolar ridge reconstruction.Material and method: An electronic search in PubMed Central's and additional electronic databases was performed. The search strategy was limited to human studies, full-text English or French articles published from 1990 until april 2023.The extracted data included defect location, membrane type, biomaterials, time to postoperative exposure, and Fontana classification stage.Protocol bias assessment was performed using an adaptation of the QUADAS-2 tool.This review has been registered on PROSPERO (ID: CRD42023445497).Results: A total of 43 articles were found to be eligible, and 11 of these met the predefined inclusion and exclusion criteria.Based on the results of this systematic review, an algorithm for the management of PTFE membrane exposure is proposed.Conclusion: Postoperative membrane exposure is not a determining factor for the success of bone grafting.In cases with postoperative complications, the majority of cases still achieved adequate implant-prosthetic rehabilitation.Lastly, this series of 11 articles was insufficient to draw conclusions regarding good practice recommendations. A larger series is required to validate the specific management approaches.

Full block or split block?-Comparison of two different autogenous block grafting techniques for alveolar ridge reconstruction.

To evaluate radiographic bone gain after alveolar ridge augmentation with two different designs of autogenous block graft harvested from the mandible. Alveolar ridge defects were evaluated by preoperative cone beam computed tomography (CBCT) and grafted in a staged approach using intraoral block grafts. The ridge augmentation was either performed using the full-block technique (group 1) or the split-block technique (cortical plate with autogenous bone chips) (group 2). After 4 months of bone healing, a further CBCT scan was performed before implant placement. Horizontal and vertical bone gain were measured. In this retrospective study, 91 patients were grafted with block grafts (36 patients with full-block grafts; 55 patients with split-block grafts) resulting in 171 block grafts in total. The mean horizontal bone gain was 3.37 ± 0.71 mm in group 1 and 5.79 ± 2.20 mm in group 2. A linear mixed-effect model also showed a statistically significant group difference (p < 0.001, estimate: 3.455, 95% CI: [2.082-4.829]). The mean vertical bone gain was 2.85 ± 0.73 mm in group 1 and 7.60 ± 1.87 mm in group 2. A linear mixed-effect model also showed a statistically significant group difference (p: 0.029, estimate: 3.126, 95% CI: [0.718-5.557]). Mean marginal bone level was 0.33 ± 0.37 mm (group 1) and 0.17 ± 0.29 mm (group 2). The split-block technique resulted in a greater bone gain than the full-block technique. This effect was observed in both the vertical and the horizontal dimensions.

Vertical bone augmentation with customized CAD/CAM titanium mesh for severe alveolar ridge defect in the posterior mandible: A case report.

Case Letter.

The Use of Cancellous Block Allografts for Reconstruction and Following Implant Failure Associated with Severe Bone Loss: A Prospective Survival and Histomorphometric Study.

A failed implant site is prone to reduced alveolar bone volume, both horizontally and vertically. The present study assessed the outcome of using cancellous bone block allografts for ridge reconstruction following the removal of failed implants associated with severe bone loss. Individuals presenting with failed implants and massive bone loss were included. Cancellous bone block allografts were used for reconstruction of the atrophic alveolar ridge. Radiographic evaluation at 6 months postgrafting revealed favorable bone healing, allowing implant placement. Bone biopsy samples were taken during implant placement. Twenty-four blocks and 58 implants were placed in 16 patients. Over a mean follow-up time of 40 ± 15 months, the mean bone gain was 5 ± 0.5 mm horizontally and 7 ± 0.5 mm vertically. Block and implant survival rates were 96% (1 block failed) and 95% (3 implants failed), respectively. Histomorphometrically, the mean percentage of newly formed bone was 40%, with 20% residual cancellous block allograft and 40% marrow and connective tissue. Cancellous bone block allograft is a viable treatment alternative for reconstructing the alveolar ridge to achieve a successful second reimplantation, even in the presence of initial severe bone loss.

Review of the Long-Term Outcomes of Guided Bone Regeneration and Autologous Bone Block Augmentation for Vertical Dental Restoration of Dental Implants.

Vertical bone resorption is a frequent consequence of tooth loss. Hence, implant-supported restorations imply, first of all, bone reconstruction. We aimed to review the current status of guided bone regeneration and autologous bone block augmentation for vertical dental restoration of dental implants. This review identified that between 2009 and 2022 there were few clinical studies that included more than 10 patients and a follow-up period of more than 5 years after bone restoration. The highest vertical bone gain was reported in the autologous bone grafting technique (4-7.6 mm), whereas the minimum augmentation was reported for one of the guided bone regeneration techniques. When comparing intraoral to extraoral bone blocks, the highest values for the mean vertical bone gains were obtained in the cases in which intraoral bone blocks were used as graft material. The highest rate of bone resorption was observed in the extraoral bone block group. Implant survival rate was not significantly influenced by surgical technique. Complications had a higher incidence in autologous bone block augmentation studies. Soft tissue recession showed similar results for guided bone regeneration as for autologous bone block augmentation. Vertical ridge augmentation is a predictable option for the reconstruction of alveolar ridges with severe atrophy, but complications can appear.

Autotransplantation of the Lower Posterior Teeth: A Comprehensive Review

A new era in modern dentistry has emerged where tooth loss is no longer an issue as a result of rapid advancements in implantation and alveolar ridge reconstruction. Despite its wide range of indications, autotransplantation is dependent upon careful patient selection and a suitable technique to ensure successful results both functionally and aesthetically. It is possible to restore physiological occlusion, aesthetics, and masticatory function by varying implant length, diameter, surface, and design, along with autogenous, alogenous, alloplastic, or xenogenous bone substitutes. However, none of the technologies that are used in implant dentistry today can adapt to a child’s growing jaw during adolescence. Thus, the young age of the patient restricts implants and creates a challenge for dentists wishing to replace missing teeth. Therefore, tooth autotransplantation can be a good option for treatment. Our objective in this review is to highlight the biological principles required for the successful autotransplantation of teeth. Limits, indications, and prognoses will be analyzed. Hopefully, with increased awareness and acceptance in the dental profession, autotransplantation will become another viable treatment option for those with compromised teeth who still have significant growth potential.

Autogenous bone block versus collagenated xenogeneic bone block in the reconstruction of the atrophic alveolar ridge: A non-inferiority randomized clinical trial.

To compare the efficacy of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone block (ABB) for lateral alveolar ridge augmentation and two-stage implant placement. Sixty-four patients with tooth gaps up to four teeth and atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. Lateral bone thickness (LBT) was measured 2 mm below the alveolar crest at augmentation surgery and 30 weeks later at implant placement. Implant-related outcomes, adverse events, surgery duration, pain sensation, analgesic consumption, and oral health-related quality of life were also assessed. Data were analysed using Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. At 30 weeks, the median change in LBT amounted to 2.90 (CXBB) and 3.00 (ABB), respectively. Secondary endpoints demonstrated similar results for CXBB and ABB in terms of possibility to place an implant, need to perform a secondary bone augmentation at implant placement and rate of complications. Early implant failure was 20% for CXBB and 10% for ABB, with no difference between the groups. Pain scores and post-operative consumption of analgesics were significantly lower in the CXBB group than in the ABB group, especially during the first days post-surgery. CXBB is non-inferior to ABB for horizontal alveolar ridge augmentation and two-stage implant placement.

Reconstruction of atrophic alveolar edentulous ridge with autologous mandibular symphysis block bone graft for future implant placement

Alveolar ridge resorption after a tooth loss due to disease, atrophy or trauma is a common phenomenon. Often in clinical practice, the loss of a tooth does not coincide with replacement by a dental implant, therefore it is often required that we perform hard tissue ridge augmentation to increase bone volume prior to dental implant placement and restoration so that the implants can be inserted in ideal bucco-lingual and mesio-distal position with good axial inclination and to reshape soft tissue contour. This study demonstrated the amount of resorption of Symphysis Block graft which helps to harvest adequate bone in future to compensate resorption for future implant placement. The accurate graft resorption and required graft harvest was assessed with Cone Beam CT. Five patients underwent harvesting of corticocancellous bone from Mandibular symphysis region for Reconstruction of atrophic alveolar ridge. A tension free closure was obtained. Periosteal scoring was done and flap was closed tension free. We assessed the preoperative available bone and the defect in horizontal and vertical dimensions in the anterior region and evaluated the amount of bone graft necessary to augment the defect.

Alveolar ridge augmentation using autogenous bone graft and platelet-rich fibrin to facilitate implant placement

The maxillary anterior region is considered to be the esthetic zone of human dentition. Missing teeth in this area leads to severely compromised esthetics and function. Endosseous implants are a viable treatment option in this scenario, but the placement of endosteal implants requires adequate bone volume for successful osseointegration. When the morphology of the bone does not allow proper implant placement, there are various bone augmentation procedures which aid in reconstruction of the residual alveolar ridge for ideal implant placement. The mandibular parasymphysis can act as an excellent source of autogenous bone for the augmentation of alveolar ridge deficiencies. This article describes successful augmentation of the maxillary alveolar ridge using block bone autografts harvested from the mandibular symphysis along with platelet-rich fibrin. At 6 months after surgery, implant was inserted, and after a healing period of 5 months, permanent restoration was placed.

Three-Punch Alveolar Ridge Reconstruction Technique: A Novel Flapless Approach in Eight Consecutive Cases.

This clinical and histologic case series aims to evaluate a novel flapless approach to alveolar ridge reconstruction (ARR) of compromised extraction sockets by means of collagenated xenograft sealed with three resorbable layers of hole-punched membrane. Eight postextraction sockets without buccal and/or palatal bone walls and with adjacent natural teeth from eight consecutive patients were included. Pretreatment CBCT scanning was performed. After debridement of the selected sites, a flapless grafting procedure was carried out, and the three-membrane protection was applied. After 6 to 17 months, at implant placement, a posttreatment alveolar ridge CBCT was taken, and a bone core biopsy sample was harvested for histologic and morphometric analyses. Clinical outcomes showed predictable horizontal bone regeneration in all postextraction sockets with good preservation of soft tissue architecture. Pretreatment ridge CBCT measurements showed limited bone width (2.6 ± 1.08 mm). Posttreatment measurements revealed adequate bone width (9.05 ± 1.29 mm) with a mean bone gain of 6.4 ± 1.34 mm. Histologic and morphometric analyses revealed the absence of inflammatory cells and the presence of 25.4% ± 8.7% of new bone and 31.8% ± 8.3% of graft particles inside the biopsy samples. Many graft particles were surrounded and interconnected by new bone, thus demonstrating the formation of a bone-graft network. Rare osteoclasts were found. This novel technique seems to be effective in treating alveolar sockets prior to implant placement, preventing inflammation and bone resorption and promoting bone regeneration.

THE INFLUENCE OF GENERAL DISEASES ON THE RESULTS OF ALVEOLAR CREST RECONSTRUCTION. LITERARY REVIEW

Objectives. In this article we aimed to analyze the general diseases that can influence the results of the reconstruction of the alveolar ridge in preimplantation preparation. Material and methods. The study included 45 articles: 5 of them were of systematic review type, 7 of meta-analysis type, 13 clinical trials, 11 randomized clinical trials and 9 of review type. These articles were selected from the PubMed and IBN platform. Results. According to the selected keywords, the following information was obtained: the impact of the diseases on the results of the growth of the alveolar ridge was found in 93% of the studies, each presenting a rate between 10-15% of the influence. Of these, 16 publications reported about the influence of cardiovascular pathologies, 8 publications – about the impact of diabetes on alveolar ridge reconstruction, 8 articles – about the influence of osteoporosis and bisphosphonate treatment, 5 articles presented data about the influence of long-term administration of corticosteroids on ridge reconstruction and 8 articles – about other pathologies and general conditions. Conclusions. The analysis of studies about the influence of general diseases in alveolar ridge bone reconstructions highlighted the multitude of variables and parameters that can have an impact on healing in alveolar ridge reconstruction operations. The in-depth study of the patient's field, the interdisciplinary communication, the management of the associated pathology, as well as the patient's compliance can lead to the decrease of the risks associated with these types of interventions.

The general condition of patients requiring the alveolar bone crest reconstruction

Objectives: To present the survey questionnaire used for the medical assessment of patients requiring alveolar ridge reconstruction as well as the study of concomitant pathologies and their influence on the healing process. Material and methods: The study involved 173 patients aged between 18 and 69 years. All patients have been assessed according to the survey questionnaire developed to determine the patient’s general condition, life anamnesis, and medical history. Results: Out of the total of 173 patients, 72 (41.6%) had no concomitant pathologies, 8 patients (4.6%) had concomitant pathologies that did not interfere with the operation, 40 (23.1%) had pathologies that might affect the outcome of alveolar ridge reconstruction but still were admitted to surgery, and 53 patients (30.6%) had pathologies that could affect the outcome of the reconstruction procedure and were not admitted to bone grafting. Conclusions: Assessment of patients with alveolar ridge defects during preparation and planning of preimplantation bone reconstruction identified a number of concomitant pathologies, more or less noticed by the patient, which may remain unclear due to superficial study of the patient’s condition that is able to influence the surgical treatment outcome. These issues can be both intraoperative and postoperative and lead to failure of surgical treatment and further reoperation.

Immediate implant placement of BCS implant with and without platelet rich fibrin – An original research

Recently, immediate implant placement has rapidly gained popularity as this procedure definitively shortens the duration of the treatment, reduces the number of surgical sessions, and minimizes the discomfort of patients. However, the clinical effectiveness of immediate implantation in the molar regions has rarely been challenged. It has been reported that immediate implant placement does not seem to counteract alveolar ridge alteration and reconstruction after tooth extraction.