Bone Augmentation Techniques Research Articles

Long-term effects of vertical bone augmentation: a systematic review.

ABSTRACTExtraction, periodontitis, or trauma can cause a reduction on the alveolar ridge. This could result in an insufficient alveolar bone width and height. Different techniques of vertical bone augmentation are described in literature. However, nowadays there is not enough evidence against lateral augmentation procedures to verify if these techniques are stable over a long period of time. Objective This review analyses the different techniques that are used to vertically augment the bone and evaluate if these techniques are stable over a long period of time.Material and Methods The MEDLINE-PubMed database was searched from its earliest records until December 22, 2014. The following search term was used: Alveolar Ridge augmentation [MESH]. Several journals were hand searched and some authors were contacted for additional information. The primary outcome measure that was analyzed was marginal bone level change around dental implants in the augmented sites, and the secondary outcomes were survival and success rates of dental implants placed in the augmented sites.Results The search yielded 203 abstracts. Ultimately, 90 articles were selected, describing 51 studies meeting the eligibility criteria. The marginal bone level change for the inlay technique and vertical guided bone regeneration are in agreement with the success criteria. Alveolar distraction showed more marginal bone level change after the first year of loading, and for the inlay technique very few studies were available.Conclusions Based on the available data in the current existing studies with a follow-up period of at least 4 to 5 years, one can summarize that there seems to be a trend that the onlay technique, alveolar distraction, and vertical guided bone regeneration are stable for at least 4 to 5 years.

Implantes cigomáticos en pacientes con edentulismo maxilar y reabsorción ósea severa

Treatment with conventional implants can not be part of the implant rehabilitation in edentulous jaws in some patients due to advanced bone resorption or sinus neumatization, which leads to inadequate amounts of bone to anchor the implants. For over three decades, surgical placement of bone prior to or simultaneously with implant placement grafting techniques has become routine in oral rehabilitation. Several bone augmentation techniques such as sinus lift or bone graft, have been reported with the common goal of increasing the volume of load bearing bone. Now with the development of technology in zygomatic implants can prevent these bone graft techniques returning patients better quality of life and appropriate aesthetics. With less trauma and facilitating the treatment and prognosis of it.

Les augmentations osseuses mandibulaires antérieures. Revue de la littérature

Mandibular edentation may lead to major symphyseal resorption making the placement of dental implants impossible. In this situation, bone augmentation techniques are available. The goal of our study was to make a review of the literature of the different techniques in use. A bibliographic research was conducted on the Medline, Ovid and Cochrane Library databases with the following keywords: anterior mandible, bone grafting, mandibular symphysis reconstruction. We selected only articles written in English, published from January 1975 to August 2014 and expressly dealing with anterior mandibular bone augmentation techniques. Sixty-nine articles were analyzed. Eight bone augmentation techniques were reported. Bone grafting using iliac or calvarial bone and immediate or delayed implantation was the most popular technique. The main complications were infection, exposure or resorption of the graft, and chin and lip hypo- or anesthesia. The other reported techniques (osteotomies, distraction osteogenesis, transmandibular implants, mandibular reconstruction plates, fibula free flaps) were more confidential or had specific indications. There was no indication for biomaterials excepted if combined with autologous bone.

Complex bone augmentation in alveolar ridge defects.

The current gold standard for bone grafting is autogenous bone, due to its biocompatibility, lack of antigenicity, osteoconductive, and osteoinducive properties. Radiography using cone-beam computed tomography for complex defects is useful in determining the amount of bone available and what bone augmentation technique will be needed. Many options for treatment of alveolar ridge defects are available, including varying surgical techniques as well as bone graft options.

Use of platelet rich fibrin and Bio-OSS/SINT-Oss for implant-prosthetic rehabilitation in maxillary atrophy with sinus pathology: A 48-month follow-up

The maxillary sinus floor elevation procedure has gained popularity with predictable results, and is a safe, acceptable technique for bone augmentation, providing a base for dental implant treatment. Faint radiopaque lesions at the base of the maxillary sinus are frequent diagnoses on radiographs and must be identified during dental implant planning. The use of autografts, xenografts, allografts, and alloplasts or a combination between them has been demonstrated to be effective for increasing bone height and bone volume in maxillary sinus. The objective of this study was to evaluate the outcome of subjects with considerable sinus membrane pathology (test group) undergoing maxillary sinus floor augmentation using Platelet Rich Fibrin (PRF) as a filling material, in association with the Bio-Oss and Sint-Oss and simultaneous implant placement in a one-stage surgical procedure. All patients reported no pain to percussion, no sign of tissue suffering to the soft peri-implant tissues, the presence of an optimal primary stability of the inserted implants, and the increase in the peri-implant bone density. No complications were encountered during follow-up periods in these patients, including no negative evolution in the sinusitis and all implants are functioning successfully. In conclusion, the use of PRF and Piezosurgery reduced the healing time, favoring optimal bone regeneration and allowing sinus membrane integrity to be maintained during surgical procedures, according to evidence-based dentistry.

Adult stem cells in the use of jaw bone regeneration: current and prospective research.

Concomitant to the increased use of dental implants to replace lost dentition, there is a growing need to regenerate atrophic jaw bone to allow dental implant placement. Current surgical techniques for jaw bone augmentation share several limitations, such as operator sensitivity and relatively low predictability and high morbidity rates. Therefore, alternative treatment approaches have been developed in the field of tissue engineering. Bone tissue engineering integrates the use of different scaffolds, growth factors, and stem cells. This method aims to induce bone augmentation of large bone defects by mimicking biologic processes that occur during embryogenesis. This review will present available sources for adult stem cells, the rationale for using stem cells for bone regeneration, and recent studies that use mesenchymal stem cells (MSC) and endothelial progenitor cells (EPC) to induce bone augmentation.

Minimally invasive piezosurgery for a safe placement of blade dental implants in jaws with severe bone loss

Aim Severe atrophies of edentulous jaws require major reconstructive bone surgery in order to allow the placement of root-form implants with standard diameter. These bone augmentation techniques represent the best option reported in the literature, but they are often rejected by patients because of their high economic and biological costs in addition to the possibility of failure in the short and/or long term. In the maxilla regenerative methods (onlay, inlay, and distraction) have high success rates, whereas in the mandible, especially in the distal atrophic area, they are not so predictable. In such situations an alternative technique for fixed prosthethic rebilitation is the insertion of platform blade implants, which have their elective indication for atrophic bone ridges with reduced width, owing to their reduced thickness. The aim of this study is to assess the effectiveness of the use of piezoelectric ultrasonic handpieces, in order to simplify the placement of blade implants, making it safer and less traumatic than with conventional surgical procedures. Materials and methods Platform blade implants are extension implant functionally and aesthetically reliable, even if they require a more difficult surgical technique compared with the one currently in use for screw implants. A minimally invasive procedure by means of piezosurgery that was performed on 142 subjects is presented and a case is reported which highlights the successful results. Results and conclusion The use of piezoelectric ultrasonic handpieces simplifies the surgical procedure for the placement of blade implant, making it safer and less traumatic.

Comparative study of the osseous healing process following three different techniques of bone augmentation in the mandible: an experimental study

The aim of this study was to evaluate the osseointegration of three different bone grafting techniques. Forty-eight mature New Zealand rabbits were divided randomly into three groups of 16 each. Horizontal augmentation was performed on the corpus of the mandible using three different techniques: free bone graft (FBG), free periosteal bone graft (PBG), pedicled bone flap (BF). The animals were sacrificed at postoperative weeks 1, 3, or 8. Specimens were decalcified for histological examination, and histomorphometric measurements were performed. The histological evaluation demonstrated bony fusion between the grafts and the augmented mandibular bone after 8 weeks in all groups. At week 8, the bone volume was significantly greater in the BF group than in the FBG (P<0.001) and PBG (P=0.001) groups, and also the trabecular thickness was significantly greater than in the FBG (P=0.015) and PBG (P=0.015) groups. Trabecular separation was significantly lower in the BF group than in the FBG group at week 8 (P=0.015). BF demonstrated greater osseous healing capacity compared to FBG and PBG. The preserved vascularization in BF improves the bone quality in mandibular bone augmentations.

The Role of Implant Position on Long‐Term Success

Focused Clinical Question: In the past, implants were placed where the bone was. This mode of treatment often led to implant‐related complications, such as peri‐implant soft‐tissue recession, esthetic challenges, and fractured implants and/or associated suprastructures. Therefore, advances in soft‐tissue and bone augmentation techniques have enabled implants to be placed in an ideal three‐dimensional position, thus ensuring adequate peri‐implant soft tissue and bone thickness for a stable and successful long‐term treatment outcome. The present report aims to answer the question: What are the clinical guidelines for implant placement to achieve long‐term success?Summary: In the maxillary anterior region where esthetics is of paramount importance, 2 mm of buccal bone anterior to the implant is preferred. This ensures stability of the buccal bone plate, minimizing peri‐implant mucosal recession. To achieve an esthetic emergence profile, the implant platform is generally placed 3 to 4 mm apical to the cemento‐enamel junction (CEJ) of the adjacent teeth and 1.5 to 2 mm away from the adjacent roots. In the posterior region, a minimum of 1 mm of buccal bone around the implant ensures stability of the buccal plate. Generally, implants with a polished collar are preferred because the collar can be placed supracrestally to compensate for any vertical ridge deficiency and yet not compromise the esthetics of the restoration. The implant is placed 1.5 to 3 mm apical to the CEJ of the adjacent teeth and 3 to 4 mm away from adjacent roots to create a smooth transition from implant platform to occlusal plane.Conclusion: Ideal three‐dimensional implant positioning ensures a long‐term stable esthetic and functional treatment outcome.

Implant rehabilitation for atrophic maxilla: a review.

A severely atrophied maxilla presents serious limitations for conventional implant placement. This presents challenge to the surgeon for implant placement in harmony with the planned prosthesis. Survey of various literatures using internet sources, manual searches, and common textbooks on dental implants shows, that a thorough knowledge of conventional augmentation procedures such as bone augmentation techniques, guided bone regeneration, alveolar distraction, maxillary sinus elevation techniques with or without grafting and contemporary techniques of implant placement provide effective long-term solutions in the management of the atrophic maxilla.

Regulatory authorities and orthopaedic clinical trials on expanded mesenchymal stem cells.

Skeletal injuries requiring bone augmentation techniques are increasing in the context of avoiding or treating difficult cases with bone defects, bone healing problems, and bone regeneration limitations. Musculoskeletal severe trauma, osteoporosis-related fractures, and conditions where bone defect, bone collapse or insufficient bone regeneration occur are prone to disability and serious complications. Bone cell therapy has emerged as a promising technique to augment and promote bone regeneration. Interest in the orthopaedic community is considerable, although many aspects related to the research of this technique in specific indications may be insufficiently recognised by many orthopaedic surgeons. Clinical trials are the ultimate research in real patients that may confirm or refute the value of this new therapy. However, before launching the required trials in bone cell therapy towards bone regeneration, preclinical data is needed with the cell product to be implanted in patients to ensure safety and efficacy. These preclinical studies support the end-points that need to be evaluated in clinical trials. Orthopaedic surgeons are the ultimate players that, through their research, would confirm in clinical trials the benefit of bone cell therapies. To further foster this research, the pathway to eventually obtain authorisation from the National Competent Authorities and Research Ethics Committees under the European regulation is reviewed, and the experience of the REBORNE European project offers information and important clues about the current Voluntary Harmonization Procedure and other opportunities that need to be considered by surgeons and researchers on the topic.

Classification of the Alveolar Ridge Width: Implant-Driven Treatment Considerations for the Horizontally Deficient Alveolar Ridges

Among many techniques advocated for the horizontally deficient alveolar ridges, ridge-split has many advantages. Here, treatment management strategies of the horizontally collapsed ridges, especially the ridge-split approach, are discussed and a clinically relevant implant-driven classification of the alveolar ridge width is proposed, with the goal to assist an operator in choosing the proper bone augmentation technique. Comparison and advantages of two commonly used techniques, ridge-split and block bone graft, are presented.

Using Cone Beam Computed Tomography Angle for Predicting the Outcome of Horizontal Bone Augmentation

The aim of this study was to assess the influence of ridge morphology on the amount of horizontal bone augmentation achieved with the sandwich bone augmentation (SBA) technique in the reconstruction of buccal dehiscence defects on dental implants. Cone beam computed tomography (CBCT) was used to assess bone width changes in 26 patients who participated in a randomized controlled trial conducted in 2008 to 2011. The amount of horizontal bone gain was evaluated at four different levels (3, 6, 9, and 12 mm apical to the alveolar crest) and three different time points (T1: baseline, T2: at time of graft placement, and T3: 6 months later). Different morphological characteristics of the alveolar ridge were also evaluated to determine their influence on horizontal bone augmentation. A total of 78 CBCT scans were assessed. Comparison of the changes in ridge morphology at all measurement locations showed an overall ridge width gain of 2.30 ± 2.20 mm after 6 months. The use of membranes and the angulation of the concavity played a role in influencing the outcomes of the SBA technique. Critical crest angulation (CA) is 150° for bone gain at 9 mm apical to the crest. When CA is smaller than 150°, the horizontal bone gain was 4.3 ± 2.2 mm; if CA is greater than 150°, the gain was significantly lower at 1.3 ± 1.7 mm (p = .001). SBA is a reliable and predictable technique to gain horizontal ridge width with simultaneous implant placement. Crest ridge angulation can be used as a tool to predict bone gain at 9 mm apical to the bone crest.

Interventions for replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla

Dental implants are used for replacing missing teeth. Placing dental implants is limited by the presence of adequate bone volume permitting their anchorage. Several bone augmentation procedures have been developed to solve this problem. Zygomatic implants are long screw-shaped implants developed as a partial or complete alternative to bone augmentation procedures for the severely atrophic maxilla. One to three zygomatic implants can be inserted through the posterior alveolar crest passing through the maxillary sinus, or externally to it, to engage the body of the zygomatic bone. A couple of conventional dental implants may also be needed in the frontal region of the maxilla to stabilise the prosthesis. The potential main advantages of zygomatic implants could be that bone grafting may not be needed and a fixed prosthesis could be fitted sooner. Another specific indication for zygomatic implants could be maxillary reconstruction after maxillectomy in cancer patients. To assess the effects of zygomatic implants with and without bone augmenting procedures in comparison with conventional dental implants in augmented bone for the rehabilitation with implant-supported prostheses of severely resorbed maxillae. We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 17 June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 5), MEDLINE via OVID (1946 to 17 June 2013) and EMBASE via OVID (1980 to 17 June 2013). Personal contacts and all known zygomatic implant manufacturers were contacted to identify unpublished trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) including participants with severely resorbed maxillae, who could not be rehabilitated with conventional dental implants, treated with zygomatic implants with and without bone grafts versus participants treated with bone augmentation procedures and conventional dental implants, with a follow-up of at least one year in function. Two review authors would have extracted data from eligible studies and assessed their risk of bias independently and in duplicate. The results of included studies were to be combined in meta-analyses using random-effects models where there were more than four studies, and fixed-effect models where there were less than four studies. We would have expressed the estimate of the intervention effect as mean difference for continuous outcomes and risk ratio for dichotomous outcomes, with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. We did not identify any RCTs which were eligible for inclusion in this review. There is a need for RCTs in this area to assess whether zygomatic implants offer some advantages over alternative bone augmentation techniques for treating atrophic maxillae.

A laminated bone ring harvest technique for three-dimensional ridge reconstruction

Introduction: There are many described bone augmentation techniques for dentoalveolar ridge defects. Classical bone block augmentation increases the bone stock but does not necessarily regenerate the ridge in all dimensions with a sufficient cancellous scaffold. The bone ring harvest technique delivers a transplanted ring-shaped plug of mainly cancellous and a limited rim of cortical bone, often requiring additional allograft augmentation. We present a novel technique, which combines the harvest of a cancellous ring with a full-length cortical wall.

Vertical bone augmentation procedures: Basics and techniques in dental implantology

An appropriate bony situation is essential for dental implant placement and bony support of soft tissues (pink esthetic). Loss of teeth often results in complex horizontal and vertical alveolar ridge defects. They demand advanced bone augmentation techniques for reconstruction. We present the different techniques and materials used in complex bone augmentation. Clinical cases show the application of the methods in the clinical setting. We present current techniques and materials used in complex bone augmentations. Clinical cases show the application of the methods in the clinical setting. Applied techniques include stabilized-guided bone regeneration (GBR), autologous local block augmentation, modified techniques such as Gellrich shell technique including piezosurgery, pelvic bone blocks, complex materials such as graft-derived bone blocks and their unique handling problems. Successful basic principles are reduction of cortical bone healing due to long remodeling time and possible late loss; extended application of materials with interconnecting porous system and particulate material resulting in fast healing analogous to cancellous bone; mechanical stabilization of the augmentation to allow bony healing in vertical defect situations. GBR and autologous bone blocks with minimal cortical thickness and a high volume of particulated material are most favorable techniques.

A randomized clinical trial evaluating the efficacy of the sandwich bone augmentation technique in increasing buccal bone thickness during implant placement surgery

Sandwich bone augmentation (SBA) has been proposed to augment the width of edentulous ridges for implant placement. This study aimed to investigate the effect of a membrane on SBA for the regeneration of buccal implant dehiscence defects. Twenty-six healthy patients, each with a single defect, were randomly assigned into two groups. Both groups received an inner and outer layer of mineralized human cancellous and cortical particulate allograft. In the test group, a bovine pericardium membrane covered the bone grafts, while no membrane was placed in the control group. Cone beam computed tomography (CBCT) scans were taken before and immediately after implant placement and at 6months post-surgery. All implants placed were successfully osseointegrated at 6months. Clinical re-entry measurements showed significant buccal bone gain in the test group compared with the control group (P<0.05). The test group had 1.12, 2.21 and 2.44mm more buccal bone thickness at 2, 4 and 6mm below the bone crest. There were no significant differences in the mid-buccal vertical bone height, defect height and width reductions and bone fill between the two groups (P>0.05). Cone beam computed tomography analysis demonstrated significant buccal bone gain of 1.22mm in the test group. Radiographic vertical bone loss at 1-year post-surgery showed no significant differences between the groups. Sandwich bone augmentation is a predictable technique for regenerating buccal bone on implant dehiscence defects. Addition of a barrier membrane prevented significant horizontal buccal bone resorption as space was maintained more effectively when compared with sites treated without a membrane.

A Systematic Review of the Use of Growth Factors in Human Periodontal Regeneration

There is a large body of evidence using cells and animal models demonstrating the effectiveness of growth factors in periodontal regeneration. However, there appears to be minimal literature comparing the efficacy of growth factors in human periodontal regeneration compared to other techniques and procedures. Therefore, the aim of this study is to perform a systematic review of human studies using growth factors for periodontal regeneration and to compare the efficacy of these growth factors to other accepted techniques for periodontal regeneration. An electronic and manual search based on agreed search phrases between the primary investigator and a secondary investigator was performed to identify the use of growth factors in periodontics for the literature review. The articles that were identified by this systematic review were analyzed in detail, which included the study of their inclusion and exclusion criteria, outcome measures determination and analysis, risk of bias, adverse events, and conclusions or inference of the efficacy of growth factors to the general population. Five papers fulfilled the inclusion criteria. Two papers were identified that had sufficiently similar study design that a meta-analysis of their outcomes was possible. Most of the reported outcomes from the selected papers were descriptive. The articles demonstrated periodontal regeneration at least comparable to their respective positive controls, with only a couple of articles demonstrating significantly greater outcomes compared to their respective positive controls. Histologic evidence demonstrated greater periodontal regeneration when using growth factors compared to other regenerative techniques and an increased healing and bone maturation rate compared to other regenerative and bone augmentation techniques in these human studies. Within the limits of this systematic review, the use of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) led to greater clinical attachment level gain of ≈1 mm compared to an osteoconductive control, β-tricalcium phosphate (β-TCP). The use of rhPDGF-BB led to greater percentage bone fill of ≈40% compared to the osseoconductive control, β-TCP. Last, the use of rhPDGF-BB led to an increased rate of bone growth of ≈2 mm compared to the osseoconductive control, β-TCP.

Sandwich osteotomy for vertical and transversal augmentation of the posteriormandible: a review Sandwich osteotomy untuk augmentasi vertikal dan transversal pada posterior mandibula: sebuah tinjauan

The use of endosseous implants is directly related to the topography and quality of the patient’s residual bone. Severaltechniques have been tried to expand its application through implant design alterations and surgical techniques for boneaugmentation. This article reviews the sandwich osteotomy combined with an interpositional autograft for vertical andtransversal augmentation in the atrophic mandible prior to endosseous implant placement. In conclusion, segmentalmandibular sandwich osteotomy can be recommended to fulfill the dimensional requirements of preimplant boneaugmentation in atrophic posterior mandible.

Alveolar Distraction Osteogenesis for Dental Implant Rehabilitation Following Fibular Reconstruction: A Case Series

Alveolar distraction osteogenesis (ADO), a novel bone augmentation technique, is gaining acceptance in restoring the vertical bone discrepancy between the transplanted graft and the residual alveolar bone after mandibular reconstruction. This case series presents the outcomes of ADO in fibula-reconstructed mandibles rehabilitated with dental implants, with an emphasis on clinical indications, surgical protocol, clinical outcomes, histologic evidence, and complications. Five patients underwent fibula distraction procedures after undergoing mandibular reconstruction with a vascularized fibula bone graft. The indication for the application of ADO was for the correction of the vertical discrepancy between the top of the reconstructed fibula and the adjacent alveolar crest to achieve adequate vertical bone height before implant placement. The mean vertical bone height achieved was 13.58 mm. Twenty-two dental implants were placed in 5 patients. All patients were rehabilitated with implant-supported prostheses. Bone biopsies showed the distracted area was filled with newly formed, bony trabeculae between the transported fibula and the basal segments. The most common complication was transient infection around the distractor rod. ADO can be performed on fibula-reconstructed mandibles to achieve the restoration of alveolar height, which then can be rehabilitated with dental implant-supported prostheses. The procedure has a minor risk of infection associated with the distractor rod, which does not compromise the bone regeneration from distraction. Patients with mandibles reconstructed with fibulas can attain dental implant rehabilitation with ADO, achieving good esthetic and occlusal outcomes.