Bone Augmentation Techniques Research Articles

Osseodensified Crestal Sinus Window Augmentation: An Alternative Procedure to the Lateral Window Technique.

A novel minimally invasive technique, osseodensification, is proposed to facilitate maxillary sinus bone graft augmentation. The osseodensified crestal window overcomes the previous limitations of traditional crestal approaches with respect to residual bone height (RBH) of ≤1.5 mm as well as vertical height of augmentation (>10 mm). Three patients, healthy and non-smoking, with 3 distinct and difficult clinical situations requiring sinus augmentation and having a maximum of 1.5 mm RBH (0.4-1.5 mm) were selected for this procedure. Edentulous sections were large (entire posterior sextant, with and without sinus septa), and small (single hyperpneumatized maxillary molar site). All healing was rapid and uneventful with no instances of sinus membrane perforation or other complications seen. The vertical increase in sinus bone height ranged from 10.3 mm to 13.6 mm. The increase in bone height is comparable to that obtained with lateral window procedures. The osseodensified crestal sinus window technique may be thus be proposed as a possible alternative procedure for the lateral sinus window technique for maxillary sinus bone augmentation.

4482 Horizontal ridge augmentation in maxilla using bone expansion vs bone splitting techniques in adult patients: a prospective cohort

OBJECTIVES/GOALS: The objective of the study is to compare two horizontal bone augmentation techniques (bone expansion and bone splitting) that are currently used for horizontally deficient maxillary ridges. Bone expanded in millimeters (mm), implant stability, and patient satisfaction will be compared with each technique. METHODS/STUDY POPULATION: This pilot (prospective cohort) study will be divided in two sites, a private practice and the Oral and Maxillofacial Surgery (OMS) Clinic at the University of Puerto Rico, School of Dental Medicine. A total of 20 patients will be selected, 10 patients in each site. In both sites, pre-operative and post-operative Cone Beam CT radiographs will be taken to measure bone width. Implant stability will be measured using an Osstell. 2 weeks post-surgery, a patient satisfaction questionnaire will be given to patients. A two-sample T test will be used to compare techniques statistically. RESULTS/ANTICIPATED RESULTS: We anticipate that bone expansion will be as good as (non-inferiority) bone splitting in terms of bone expanded in millimeters to desire width, and implant diameter will not be compromised. We also expect that implants placed with the bone manipulation technique will have a higher implant stability at baseline and less pain, discomfort and swelling in terms of patient satisfaction. DISCUSSION/SIGNIFICANCE OF IMPACT: Our contributions here are expected to illustrate clinical and radiographic bone expansion techniques that will enhance implant placement treatment for implantologists and patient’s experience.

ПЛАНИРОВАНИЕ И ПРЕДОПЕРАЦИОННАЯ ПОДГОТОВКА ПРИ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВАХ НА ВЕРХНИХ ЧЕЛЮСТЯХ

При планировании будущей имплантации активно используется аугментация, показания к которой не всегда достаточно четко определены. На наш взгляд увеличение количества осложнений, связано с предоперационной подготовкой больного, при которой не были учтены индивидуальные особенности.Цель. Повышение эффективности реабилитации больных с отсутствием зубов во фронтальном отделе верхней челюсти.Материалы и методы. Обследовано 57 пациентов в возрасте от 35 до 45 лет. В предоперационной подготовке пациенты были разделены на 4 группы. В первую группу вошли пациенты с 2 типом костной ткани, толстым биотипом десны и прямым прикусом. Во вторую группу – пациенты с глубоким прикусом, 3 типом кости и тонким биотипом десны. В третью группу пациенты с ортогнатическим прикусом, 2 типом кости и средним биотипом десны, в четвертую группу с ортогнатическим прикусом, 3 типом костной ткани и средним биотипом десны. Изучение биотипа десны проводили путем визуального осмотра и зондированием. Оценивали тип костной ткани с помощью рентгенологического метода исследования. Исследование прикуса производилось клинически. Для оценки результатов лечения учитывали параметры костной ткани и продолжительность лечения, для оценки эстетического результата учитывали параметры мягких тканей.Результаты. В 1 и 3 группах исследования были выявлены параметры костного гребня, позволяющие провести дентальную имплантацию без применения методики аугментации костной ткани. Во 2 группе всем пациентам потребовалось применение методики аугментации мягких тканей. В 3группе в трех случаях, пациентам потребовалось проведение пластики мягких тканей.Заключение. Применение пластики костной и мягких тканей при проведении дентальной имплантации позволяет значительно повысить качество лечения и эстетический результат.

Preliminary Clinical Data and the Comparison of the Safety and Efficacy of Autogenous Bone Grafts Versus Xenograft Implantations in Vertical Bone Deficiencies Before Dental Implant Installation

Two different techniques of vertical bone augmentation were compared to apply them to immunocompromised patients. One of them used autogenous bone graft; the other used xenograft. Thirty patients were involved in the study. Fifteen received autogenous ring shape grafts harvested from the mental region, and 15 received xenograft vertical tunnel augmentation. They have a total of 60 implants placed in the posterior region of the mandible (2 for each patient). Fixed full ceramic crowns were delivered. Two-year follow-up appointments after implant placement were made. Both autogenous bone grafts and xenografts showed similar long-term clinical regeneration outcome of vertical bone defects. Using autogenous bone rings simultaneously fixed by dental implants, the total treatment time and cost were shortened, but the traumatic reactions and complication rates were higher when compared to xenograft vertical tunnel augmentation. Due to the less traumatic character of the procedure, smaller complication rates and higher safety for the patients receiving chronic immunosuppression should avoid bone block augmentation and reap the benefits from vertical tunnel bone augmentation using xenograft materials.

Alternativas para reabilitação com implantes dentários em mandíbula posterior atrófica

An adequate bone volume is mandatory for a favorable long-term prognosis in patients treated with dental implants. The vertical deficiency of posterior mandible is a common condition in partially edentulous patients, in which vertical bone augmentation procedures or inferior alveolar nerve transposition become necessary for the dental implant rehabilitation. Thus, the aim of this study was to discuss options of vertical bone augmentation techniques in atrophic posterior mandibles and to present, as case reports, alternatives for the rehabilitation of patients with this condition. So, three alternatives of treatment were presented: the use of Cytoplast titanium-reinforced membrane over autogenous and xenogenous particulate bone graft; sandwich osteotomy; and nerve transposition. In the three reported cases, the chosen surgical techniques showed to be appropriated and allowed the placement of longer implants. No significant complications were observed and all the patients were satisfied with the performed treatment. It is possible to conclude that the reconstruction of atrophic posterior mandible remains a challenge to the professionals, who must know the various existing techniques and choose the most suitable one to each patient.

A "Graft Less" Approach for Dental Implant Placement in Posterior Edentulous Sites.

Vertical bone augmentation techniques are more invasive than other procedures, and success rates often vary according to the surgical expertise of the clinician. As a result, there has been a trend over time towards minimally invasive treatment options in implant dentistry. This article discusses a "graft less" treatment philosophy that emphasizes the use of less-demanding augmentation techniques for the purpose of placing shorter implants in atrophic posterior sites, avoiding more complicated procedures for implant placement. In the posterior maxilla and mandible, the use of short implants (< 8.0 mm) can reduce the need for vertical bone grafting. Patients often prefer this strategy over more complex procedures that can cause complications, increase morbidity, and require longer treatment times with higher costs. When inadequate available bone is present for implant placement, planned bone augmentation procedures may be performed for the purpose of placing shorter implants; these procedures are less demanding, less invasive, and more predictable, allowing long-term outcomes for the implant-supported restoration.

Bone augmentation and simultaneous implant placement with autogenous bone – Case report

Background Dental implant implantation has become a routine procedure today. When bone support is inadequate for implant application, bone tissue is tried to be formed by various methods. Alveolar bone augmentation techniques include different surgical approaches such as guided bone regeneration, onlay grafting, interpositional grafting, distraction osteogenesis, ridge splitting, and socket preservation. Implant restoration needs to be surrounded by hard and soft tissue environment that is in harmony with the surrounding dentition. implant restoration needs to be surrounded by hard and soft tissue environment that is in harmony with the surrounding dentition. Aim/Hypothesis This case describes a surgical technique of applied maxillary incisor implant and autogenous bone graft in the form of ìbone ringî harvested from the symphysis. In this case, both vertical and horizontal direction bone gain was desired. Material and Methods A 62-year-old man presented with mobile lateral incisors after definite periodontal treatment. The panoramic radiograph showed moderate to severe bone loss around the tooth. The patient underwent extensive full mouth periodontal therapy including scaling, root planing, and oral hygiene instructions to control his periodontal problem. Extraction decision was taken because there was no decrease in mobility after periodontal treatment. When patients come to our clinic after 3 months we have seen it is not enough bone in the vertical as well as horizontal. We decided to use autogenous block ring grafts thinking about the healing potential. The symphysis was accessed through a genioplasty incision. The mental nerves were exposed and protected. Using an 8-mm trephine bur and drilled through the exposed symphysis. Bone rings outlined in the symphysis with the central osteotomies corresponding to the diameter for implants to be placed. Bone rings after removal from the symphysis. The bone ring were then used to guide the pilot drill over the socket and assist in their optimum prosthetic planned positions. The harvested bone rings were then fitted in the bone. Minor contour adjustments were necessary to ensure their adaptation and stability. Implants were then tapped through the ìbone rings,î achieving and even increasing the primary stability of ìbone ringî and implant to the alveolar bone. Periosteal scoring was then accomplished at the base of the flap to advance and expand the soft tissues and provide primary closure without tension. Results Implants was osseointegrated. We waited 6 months for bone healing and healing was well. Healing heads fitted for prosthesis. There are several advantages proposed by this technique, including a 3-D augmentation of the native alveolar ridge and the ability to provide additional stability of the implant at the crestal region of the implant. Conclusion and Clinical Implications In conclusion, the proposed technique offers multiple advantage of 3-D bone augmentation. Proper treatment planning and careful surgical execution are essential to ensure predictability.

Surgical Restorative Decision Algorithm for Edentulous Condition in Implant Dentistry With Emphasis on Bone Augmentation.

Ridge preservation and bone augmentation techniques in implant dentistry are designed to preserve and augment existing alveolar ridge to prepare it for implant treatment. Bone stock is an essential component for a long-term success of dental implants. This article provides a prosthetically driven step-by-step surgical restorative decision tree algorithm to diagnose and treat an edentulous condition in implant dentistry.

A Novel Approach for Horizontal Augmentation of Posterior Maxilla Using Ridge Split Technique.

Over the years, there have been a series of innovative approaches to the alveolar bone augmentation techniques. These have led to the modifications of the existing methods and the establishment of more efficient ways to obtain sufficient bone mass that is necessary for the implant procedure. The aim of this paper is to propose a novel augmentation technique, and to investigate its efficacy, particularly during the healing process of the maxillary alveolar bone prior to the implant treatment. During the application of the proposed methodology, first, the ridge-split technique was applied to the posterior maxilla. Then, a horizontal augmentation procedure was performed with an autogenous bone graft. Implants were placed at the second month of the surgery. Prosthetic rehabilitation was completed after the osseointegration of the implants. The technique was compared with the ridge-split method with simultaneous implant placement in 14 patients. The groups were divided into 2, the control group and the experimental group, each containing 7 patients. The aimed success criteria for the status of the endosteal implants were fulfilled and there were not any complications observed in the second year of follow-up.The basic practical innovation offered by the proposed surgical technique is to achieve the required horizontal dimension and to change the quality of the bone conveniently. The press-fit insertion leads to multipoint contact healing of the transported bone and the use of cortical block bone in posterior maxilla, led to a significantly advantageous higher stability level for both the placement and the survival of the implants.

Extra-short implants for rehabilitation of atrophic ridges: a retrospective study (1–5 year follow-up)

Background: The bone augmentation techniques suggested by literature including onlay bone grafts, guided bone regeneration (GBR), maxillary sinus elevation and distraction osteogenesis (DO) have been proved effective in regaining bone volume. Short implants could be a simpler, cheaper and faster alternative than augmentation procedures, if they can be shown to result in similar success rates. Recently the use of extra-short implants (6 mm) has been reported with good outcomes

Surgical Algorithm for Alveolar Bone Augmentation in Implant Dentistry.

Replacement of failing and ailing natural teeth with dental implants has become a mainstream treatment option since the discovery of osseointegration by P.-I. Brånemark in the 1960s. The techniques and the variety of methods for alveolar bone reconstruction have evolved to address a restoratively driven approach in implant dentistry. Modern 3D cone-bean computed tomography has helped with the diagnosis and treatment of bone deficiencies to idealize implant positioning. This article focuses on bone augmentation techniques, classified into horizontal and vertical ridge augmentation, and discusses block grafting, guided bone regeneration particulate grafting, distraction osteogenesis, and ridge-split expansion procedures.

Vertical Ridge Gain with Various Bone Augmentation Techniques: A Systematic Review and Meta-Analysis.

The aim of this systematic review was to determine the most effective alveolar augmentation technique for vertical bone gain. A systematic search to select clinical trials and retrospective studies done on patients with reduced vertical bone height was conducted. The intervention of interest was autogenous block graft done compared to procedures such as distraction osteogenesis (DO), particulate grafting, block plus particulate grafting with titanium mesh, and tent pole technique in systematically healthy adult patients age 18 and older. The following electronic databases were explored: PubMed, CINAHL, and Dental and Oral Science. A supplementary manual search of published full-text articles from January 2005 to December 2017 was done using Google Scholar. Grey literature was also sought using greylit.org. The review protocol was registered at the Prospero registry (CRD # 42017072432). The risk of bias of the included studies was assessed using EPOC criteria. Meta-analysis was performed using Review Manager for studies with quantitative data on mean values of vertical bone gain and bone resorption achieved with various bone augmentation techniques. Random effect model was used. Heterogeneity among studies was evaluated using the I2 statistic. A total of 2322 articles were found. After excluding the irrelevant papers, only 8 papers were finally selected for the detailed evaluation. Of these 8, 5 were clinical trials, and 3 were retrospective studies. Four studies were on DO, 2 on particulate grafting, 1 on autogenous block grafting plus particulate grafting, and 1 on tent pole grafting. The control group in all studies were autogenous block graft. Meta-analysis revealed no significant difference between DO and autogenous block grafting for vertical bone gain (mean difference 0.82 [-1.28, 2.91]). Similarly, no significant difference was observed in the 2 techniques for bone resorption (mean difference 0.38 [-0.23, 0.99]). DO was not superior to autogenous block grafting for vertical bone augmentation. Both techniques were associated with a number of complications. There was no difference in the bone resorption observed in the 2 techniques. No conclusive results can be drawn on other techniques on account of limited data.

Clinical Classification of Bone Augmentation Procedure Failures in the Atrophic Anterior Maxillae: Esthetic Consequences and Treatment Options.

Although the number of complications and failures in bone augmentation procedures is still relatively high, these problems remain poorly documented. Moreover, the literature concerning reconstructive techniques and the treatment of their complications in the anterior areas rarely considers the final esthetic result. The aim of this paper is to propose a new classification of bone augmentation complications in the esthetic area, providing treatment guidelines useful for the management of these cases. Failures of bony regeneration procedures can be mainly divided into partial failures and complete failures. A partial failure can be solved with a corrective surgical intervention: this second surgery can have success or may not be able to provide the desired esthetic result. When the bone reconstructive procedure fails totally, a complete failure occurs and the whole procedure has to be repeated. This new intervention can have success but also this new reconstructive surgery can fail in the same way as the first, causing important damage and a compromise solution that will hardly be acceptable from an esthetic point of view. Bone augmentation techniques are not completely predictable and are not always able to guarantee the expected result, especially in the atrophic anterior maxilla. Complications and failures can often occur and this possibility must always be clearly explained to those patients with high esthetic demands and expectations.

Treatment Planning of Dental Implants in the Anterior Maxilla; Risk Assessment and Review of Soft Tissue along with Bone Preservation and Augmentation Techniques for Successful Clinical Outcomes

The anterior maxilla continues to present with high potential risk for esthetic failure, and as a result, there is a clear need for modifications that would allow for natural-looking restorations that are harmonious with the rest of the mouth. A number of changes in protocol for placing implants such as using a restorative-driven protocol, the performance of a risk assessment and addressing factors that could compromise esthetics such as deficiencies in bone and soft tissue using bone and soft tissue grafts to ensure adequate tissue volume are necessary for dental implant overall success in the anterior maxilla. Understanding of timing with regard to implant placement has also contributed to achieving esthetic success in the region. This article reviews modifications made in implant placement in the esthetic zone and how they can contribute to functional and esthetic success in the anterior maxilla.

Classification of alveolar ridge configuration and the selection criteria of the bone augmentation techniques

骨造成の目的は咀嚼機能の回復に必要な骨量の獲得だけではなく，審美性や清掃性の向上のためにも行われる．この際，さまざまな骨造成法の中から欠損形態に適した手法を選択する必要がある．骨欠損形態は周囲が骨壁に囲まれた内側性の骨欠損，外側に骨造成が必要になる水平性と垂直性の骨欠損に大別することができる．水平性，垂直性の骨造成は内側性に比べ周囲骨からの骨形成細胞などの供給が得にくい．一方で，口唇圧や咀嚼圧などの外圧に影響をうけるため，造成時の形態を維持するための工夫が必要となる．本稿ではさまざまな骨欠損形態における骨造成法の選択基準について，症例提示と文献レビューを通して考察する．

Research progress in the application of implantoplasty in the treatment of peri-implantitis

Peri-implantitis is a kind of serious complication after tooth implantation. The absorption of alveolar bone lead to the exposure of rough implant surface, which would result in poor long-term therapeutic effect. Implantoplasty promises a better long-term therapeutic effect than bone augmentation technique. This article will introduce implantoplasty from two aspects: therapeutic effect and its influencing factor, safety and effectiveness.

Periosteal Envelope Flap as a Technique for Horizontal Bone Augmentation: A Case Series Study

Background:Following tooth extraction, the alveolar bone is typically subject to irrevocable and progressive changes that are collectively referred to as natural bone resorption. This process eventually results in a deficiency of the vertical and horizontal dimensions of the bone. Conventionally, various methods are used to repair alveolar defects resulting from tooth extraction, and to achieve vertical or horizontal bone regeneration. The aim of this study was to evaluate the influence of periosteal pocket flap on the enhancement of horizontal length in alveolar bone regeneration.Methods:Twenty-two patients (7 men, 15 women) aged 45–60 years were enrolled in this study. Periosteal envelope flaps and Cerabone were used to increase alveolar bone thickness. Ridge width was measured preoperatively and 4-6 months postoperatively using cone-beam computed tomography. The pre- and postoperative results were compared using the paired t-test.Results:An average of 2.53 mm (P&lt; 0.001) horizontal enhancement of the alveolar ridge was achieved.Conclusion:The results of this study suggest that the use of a periosteal pocket flap with xenograft material is an excellent method which increase more than 2 mm alveolar bone width. As the study sample was small, further clinical investigations with larger samples are recommended.

Apical U-shape splitting technique for undercut areas of the anterior alveolar ridge: a prospective non-randomized controlled study

The aim of this study was to investigate a novel apical U-shape splitting technique for horizontal bone augmentation in undercut areas and to compare its efficacy with that of guided bone regeneration (GBR). This was a prospective non-randomized controlled clinical trial. A total of 36 patients, who presented with a labial undercut that was not able to house a normally inclined implant, underwent the new technique or GBR. Radiographic and clinical data were obtained preoperatively, immediately after surgery, and 12 months after surgery. Pairwise comparisons of changes in ridge width gain, marginal bone loss, and pink aesthetic score were performed; correlations with pristine ridge morphology were investigated. The results showed similar marginal bone loss in the two groups. The overall ridge width gains in the new technique group (2.56±1.92mm) and GBR group (0.73±1.21mm) differed significantly (P<0.05). The pink aesthetic score was higher for the new technique group (11.75±1.22) than for the GBR group (9.25±1.86) (P<0.01). The morphology of the concavity had different impacts on regeneration in the two groups. The apical U-shape splitting technique, as a safe and effective alternative to GBR, provided a significant increase in bone volume gain where labial fenestration was inevitable during implant placement.

Custom‐made alloplastic and xenogenic scaffolds for bone augmentation – 1st year clinical outcomes

Background Severe maxillary bone loss influences the selection of implants and their locations, with consequences to the prosthetic rehabilitation. Different grafting strategies, such as the use of bone blocks, guided bone regeneration, bone distraction, among others, have been developed to overcome this problem. Presently, with the advances in CAD CAM technology it is possible to fabricate a custom-made scaffold from a xenogenic or alloplastic block, based on the CT scan of the bone defect. Aim/Hypothesis Custom-Made CAD CAM scaffolds can be considered an alternative bone augmentation technique. Material and Methods Dicom files obtained from the CT scan of the patient with a radiological guide from waxup was the starting point for graft design. Once introduced into a specific software (TailoredImplant), a 3D virtual model of the maxillary is created. Then we are able to choose the diameter, length and correct 3D position of the implants. Once established those, we were able to design, modulate and adapt the virtual scaffold, according to the bone needs for the implants location. Finally, 2 STL file were generated and sent to the manufacture. In the clinical cases presented, HA TCP and xenogenic custom-made scaffolds were used to graft two bilateral horizontal defects for later implant rehabilitation. A new CT scan was taken 6 months after 1st surgery and histological samples were collected during 2nd surgery (implants placement). Both patients received 2 MIS C1 implants and were rehabilitated with fixed prosthesis after 4 months. Results The histomorphometric results showed 17.8% and 19.9% of new bone formation, with alloplastic and xenogenic scaffolds respectively, at 6 months. The CT scan measures showed an average horizontal gain was 4.1 and 4.3 mm with xenogenic and alloplastic scaffolds respectively. Both scaffolds and implants have a 100% survival rate after 1 year. There were no complications during this follow-up period. Conclusions and Clinical Implications In conclusion, despite of the good results with a predictable bone volume augmentation and indicators revealed by these clinical cases, which agrees with the available literature, more cases and longer-term studies are needed to support this bone augmentation technique.

Steam Sterilization of Equine Bone Block: Morphological and Collagen Analysis.

Introduction The use of equine bone blocks is widely reported for bone augmentation techniques. The block must be shaped according to the form of the defect that should be regenerated. The shaping could be performed by hand before or during the surgery, in a sterile ambient, or using a CNC milling machine that could not be sterile. The aim of our study was to evaluate if a steam sterilization could provide a medical grade sterilization of the blocks and to evaluate if bone microstructure and collagen structures change after different steam sterilization protocols provided by mainstream autoclave. Materials and Method Two blocks of equine bone were divided into 16 samples. 1 sample was used as control and not submitted to any treatment. 15 samples were infected with a Streptococcus faecalis bacterial culture. The samples were singularly packed, randomly divided into 3 groups, and submitted to autoclave sterilization on the same device. The groups were submitted to a sterilization cycle (Gr. A: 121°C, 1,16 bar for 20′; Gr. B:134°C, 2,16 bar for 4′; Gr. C: 134°C, 2,16 bar for 3.30 min.). 2 samples for each group were evaluated for the sterility. 3 samples for each group were observed at SEM to notice the macro- and microstructure modification and to confocal microscope to observe the collagen. Results All samples were sterile. The SEM evaluation showed, in all groups, a preserved morphological structure. Confocal microscope evaluation shows that the collagen structure appears to be more uniform and preserved in group C. ConclusionData show that autoclave steam sterilization could be reliable to obtain sterilization of equine bone blocks.