Augmentation Of Deficient Alveolar Ridges Research Articles

Linear bone gain and healing complication rate comparative outcomes following ridge augmentation with custom 3D printed titanium mesh vs Ti-reinforced dPTFE. A randomized clinical trial.

The aim of this randomized clinical trial was to compare the qualitative (linear alveolar ridge changes) and quantitative (healing complications) outcomes after guided bone regeneration (GBR) using a custom-made 3D printed titanium mesh versus titanium reinforced dense PTFE membrane for vertical and horizontal augmentation of deficient alveolar ridges.

Patient-centered outcome measures comparing the autogenous and allogenic bone blocks in the augmentation of deficient alveolar ridges: A pilot study.

The aim of the present study was to evaluate and compare the patient-reported experience and outcome measures (PREMS and PROMS) and three-dimensional augmentation efficacy of the autogenous and allogenic bone block grafts in deficient alveolar ridges through cone beam computed tomography (CBCT). Twenty patients were equally divided into Groups I and II treated with autogenous and allogenic bone block grafts for ridge augmentation, respectively. The radiographic parameters including the apico-coronal defect height (DH) as well as buccolingual defect depth (DD) and mesiodistal defect width (DW) at apical, middle, and cervical zone were measured using CBCT at baseline, 6 months and 1 year. The PREMS and PROMS were evaluated using Visual analogue scale (VAS) scale and questionnaire method. The mean DH, apical DD and DW, middle and cervical zone DW were significantly different between two study groups (P < 0.05). The mean apical 11.6 ± 1.91 and middle zone 9.43 ± 0.89 DD were significantly higher (in Group I as compared to Group II, with P values 0.016 and 0.004, respectively). The mean bone gains in apico-coronal DH and mesio-distal DW dimension in the apical and middle zone was significantly higher in Group I (P < 0.0001). The comparison of PROM revealed better patient satisfaction in Group II as depicted by significantly higher VAS score (P < 0.0001). Superior bone gain and reduced graft resorption was observed in Group I when compared to Group II. On the contrary, better PROMs and PREMs were obtained with the allogenic bone block augmentation.

Applications of maxillary tuberosity block autograft.

Autogenous bone grafts are considered the gold standard due to their compatibility and osteogenic potential to induce new bone formation through osteogenesis, osteoinduction, and osteoconduction. The aim of this paper was to describe clinical applications of the maxillary tuberosity block autograft in small and moderate localized defects of the alveolar process around implants and teeth. Maxillary tuberosity is often used as a particulate graft for augmentation of deficient alveolar ridge or maxillary sinus prior to or simultaneously with implant insertion, but not as a bone block graft. The maxillary tuberosity block autograft may also provide a valuable bone source for challenging situations such as immediate implant placement into types II and III extraction sockets, treatment of horizontal and vertical bone defects with simultaneous implantation, reconstruction of circumferential defects around implants, and preservation of alveolar ridge. The advantages of the maxillary tuberosity include intraoral corticocancellous autogenous graft with fewer intraoperative difficulties, no need for donor site restoration, less morbidity, and an excellent correction of localized alveolar ridge defects. Within the limitations of the presented case reports, the use of maxillary tuberosity block autograft has shown to be successful in alveolar ridges augmentation that lack both width and height.

Soft tissue expansion before vertical ridge augmentation: Inflatable silicone balloons or self-filling osmotic tissue expanders?

Recent advances in periodontal plastic surgical procedures allow the clinician to reconstruct deficient alveolar ridges in more predictable ways than previously possible. Placement of implant/s in resorbed ridges poses numerous challenges to the clinician for successful esthetic and functional rehabilitation. The reconstruction frequently utilizes one or combination of periodontal plastic surgical procedures in conjunction with autogenous bone grafting, allogenic bone block grafting, ridge split techniques, distraction osteogenesis, or guided bone regeneration (GBR) for most predictable outcomes. Current surgical modalities used in reconstruction of alveolar ridge (horizontal and/or vertical component) often involve the need of flap transfer. Moreover, there is compromise in tissue integrity and color match owing to different surgical site and the tissue utilized is insufficient in quantity leading to post surgical graft exposition and/or loss of grafted bone. Soft tissue expansion (STE) by implantation of inflatable silicone balloon or self filling osmotic tissue expanders before reconstructive surgery can overcome these disadvantages and certainly holds a promise for effective method for generation of soft tissue thereby achieving predictable augmentation of deficient alveolar ridges for the implant success. This article focuses and compares these distinct tissue expanders for their clinical efficacy of achieving excess tissue that predominantly seems to be prerequisite for ridge augmentation which can be reasonably followed by successful placement of endosseous fixtures.

Maxillary Tuberosity Block Bone Graft: Innovative Technique and Case Report

Hard tissue defects resulting from trauma, infection, or tooth loss often lead to an unfavorable anatomy of maxillary and mandibular alveolar processes that become not suitable for implant therapy without bone grafting. The goal of pre-implant bone augmentation of the deficient alveolar ridge is reconstruction of the proper alveolar anatomy through the techniques of socket preservation, horizontal and vertical ridge augmentation, sinus bone grafting, and others. A variety of bone grafts and bone grafting materials have been used in the last 30 years for augmentation of deficient alveolar ridge for the purpose of implant treatment of partially and completely edentulous patients. Bone grafting options include autogenous, allogeneic, xenogeneic, synthetic bone, and combination of above. Autogenous bone grafts are considered "the gold standard" due to their compatibility and osteogenic potentials to form the new bone by processes of osteogenesis, osteoinduction, and osteoconduction. A particulate and block autogenous bone has been used for correction of alveolar ridge deficiency. Extraoral sites of autogenous block grafts include: ilium, calvarium, tibia, rib, and others. Intraoral sites of autogenous block grafts include symphysis and retromolar-ramus areas. In the clinical practice, a maxillary tuberosity bone graft has often been used as a particulate graft for augmentation of deficient alveolar ridge or maxillary sinus prior to or simultaneously with implant insertion. This article presents an innovative technique and reports a case of the maxillary tuberosity block bone graft that can be used to correct moderate to severe localized defects of the alveolar process prior to implant placement.

Free gingival graft for the increase of peri-implant attached keratinized mucosa decreased after guided bone regeneration

Purpose: During guided bone regeneration procedures for the augmentation of deficient alveolar ridge, primary closure of flap is necessary. For primary flap closure, flap is repositioned coronally and the zone of attached keratinized mucosa may decreased. The need for attached keratinized mucosa around dental implants is still controversial, but sufficient peri-implant attached keratinized mucosa would be beneficial for functional and esthetic aspects. This case report presents three cases that demonstrated free gingival graft for increasing the zone of peri-implant attached keratinized mucosa which was decreased after guided bone regeneration. Materials and Methods: In first case, maxillary incisors were extracted and guided bone regeneration was performed simultaneously. Because the membrane was exposed at 3 weeks after operation, the membrane was removed and free gingival graft was performed for primary flap closure. Free gingival graft was performed again at implant placement for the increase of attached keratinized mucosa. In second case, guided bone regeneration was performed on lower right first molar area, and implant was placed with free gingival graft. In third case, lower right molar area showed insufficient attached keratinized mucosa after implant placement with guided bone regeneration. When abutments were connected, free gingival graft with apically positioned flap was performed. Result: In these three cases, the zone of attached keratinized mucosa around dental implants was decreased after guided bone regeneration. And the increase of peri-implant attached keratinized mucosa could be obtained effectively by free gingival graft. Conclusion: Free gingival graft could be a effective treatment method increasing the zone of attached keratinized mucosa which was decreased after guided bone regeneration procedures. (J Korean Acad Periodontol 2008;38:723-728)

“PASS” Principles for Predictable Bone Regeneration

Guided bone regeneration is a well-established technique used for augmentation of deficient alveolar ridges. Predictable regeneration requires both a high level of technical skill and a thorough understanding of underlying principles of wound healing. This article describes the 4 major biologic principles (i.e., PASS) necessary for predictable bone regeneration: primary wound closure to ensure undisturbed and uninterrupted wound healing, angiogenesis to provide necessary blood supply and undifferentiated mesenchymal cells, space maintenance/creation to facilitate adequate space for bone ingrowth, and stability of wound and implant to induce blood clot formation and uneventful healing events. In addition, a novel flap design and clinical cases using this principle are presented.

Ｃｅｒａｍｉｃ材料の臨床応用に関する研究 ５ 口くう外科領域でのｈｙｄｒｏｘｙａｐａｔｉｔｅ ｃｅｒａｍｉｃｓの使用経験

It is known that hydroxyapatite ceramics have a good biocompatibility and unite directly to the bone tissue. The authors reported it's promising properties as a bone substitute by animal experiments.In this paper, four cases are reported in which hydroxyapatite ceramics were used as an artificial bone. Three types of hydroxyapatite ceramics-dense, porous and particulate-were used for augmentation of deficient alveolar ridges and for implantation to partial bone defects. There has been no adverse reaction of hard and soft tissues such as surrounding bone resorption or inflammatory changes of soft tissues.However, it is considered necessary that long-term follow-up studies of these cases and further basic studies on degradability of hydroxyapatite ceramics and on cases to which respective shapes of ceramics can be suitably applied will be carried out in the future.

Use of durapatite for the rehabilitation of resorbed alveolar ridges

These investigations were undertaken to evaluate durapatite, a particulate, ceramic, nonresorbable bone-grafting material for augmentation of deficient alveolar ridges. A total of 207 augmentations were reported among 198 patients over 24 months. Subjective and objective data showed that durapatite alone was successful for all classes of ridges augmented; height, bulk, contour, and ridge form generally improved and soft tissue overlying the augmented ridges was firm and immobile. Impressions for dentures usually began 4 to 6 weeks after surgery and these dentures remained stable, retentive, and esthetically pleasing throughout the study. Other than transiently altered sensations resulting from mental nerve manipulation during surgery, no other important procedural complications were noted. No infection or bone resorption beneath the implant was observed throughout these studies. Durapatite used in an outpatient setting provides a less costly and more permanent method for alveolar ridge augmentation than do augmentation procedures using autogenous or banked bone.

Use of hydroxylapatite for the augmentation of deficient alveolar ridges

Investigations were undertaken to evaluate nonresorbable, particulate ceramic hydroxylapatite (durapatite) for augmentation of deficient alveolar ridges. One hundred and fifteen augmentations in both jaws were reported for 110 patients over a 33-month postoperative period. Subjective and objective data show that the implant was successful for all classes of ridges augmented; height, bulk, contour, and ridge form generally improved, and soft tissue overlying the augmented ridges was firm and immobile. Impressions for dentures were usually obtained four to six weeks after surgery, and the dentures were more stable, retentive, and esthetically pleasing than the preoperative prostheses and required fewer relinings. Other than transiently altered sensations resulting from mental nerve manipulation during surgery, patients had few complications. No infection or bone resorption beneath the implant was observed throughout these studies. It was concluded that hydroxylapatite particles placed through a subperiosteal tunnel offer a highly successful method of ridge augmentation and eliminate the most serious problems associated with the use of autogenous or banked bone, namely, morbidity, risk, costliness, and poor results.

Correction of Alveolar Ridge Deficiencies with Nonresorbable Hydroxylapatite

An evaluation is made of a new dense, nonresorbable form of hydroxylapatite for the augmentation of deficient alveolar ridges. Surgical and prosthetic data are discussed. An evaluation is made of a new dense, nonresorbable form of hydroxylapatite for the augmentation of deficient alveolar ridges. Surgical and prosthetic data are discussed.