Bone Augmentation Research Articles

Are Bone Expansion Techniques Effective for Implant Placement in Narrow Alveolar Ridges?

Because of the fact that sufficient alveolar ridge bone is essential for the success of implant placement, the authors often face a challenge with augmenting residual maxillary alveolar ridges. The aim of the study was to compare the amount of ridge gain by the Osseodensification method with the manual bone expanders method for healed edentulous sites in the maxilla at different time intervals (immdiate postoperative and 6mo postoperative). Two groups were equally and randomly divided with a total of 14 implants (Biohorizons) placed in the maxillary arch for 8 patients, osseodensification was used for 1 group (group 1), whereas manual threaded expanders (bone spreaders) was used for the other group (group 2). Results suggest that the expanders group (group 2) yielded greater immediate postoperative expansion at some points along the length of placed implants; however, most of the expansion gain at the immediate Post-operative stage underwent continuous remodeling 6 months postoperative. The authors recommend using expansion techniques only when other more predictable techniques for horizontal bone augmentation are not feasible.

Minimally invasive balloon-assisted sinus floor elevation vs. conventional transcrestal procedure in terms of new bone formation in a split-mouth Goettingen minipig model

PurposeCurrently, maxillary sinus floor (SF) elevation is based on off-the-shelf allogeneic, xenogeneic or synthetic bone augmentation materials (BAM) that are implanted via an open lateral sinus wall approach (OSFE). However, this invasive method is associated with postoperative complications caused by an inadequate blood supply of the alveolar ridge. Balloon-assisted procedures are minimal invasive alternatives with lower complication rates. The aim was to evaluate local new bone (NB) formation in the SF following the application of a particulate BAM (Easy graft) via two different SF elevation techniques in a split mouth mini-pig sinus augmentation model.Material and methodsSeven adult Goettingen minipigs were used for evaluation of a biphasic ceramic (PLGA/ß-TCP) BAM in the elevated SF region. Treatments were randomized to the contralateral sinus sites and included two procedures: OSFE (control group) versus minimally invasive SF elevation by a balloon-lift-control system (BLC) (treatment group). The animals were euthanized after 28 and 56 days for analysis of new bone (NB) formation.ResultsThe biphasic synthetic BAM implanted via BLC increased more NB formation (5.2 ± 1.9 mm and 4.9 ± 1.6 mm vs. 2.6 ± 0.5 mm) and osseointegration of the particles (18.0 ± 6.0% and 25.1 ± 18.2% vs. 10.1 ± 8.0%, p < 0.05) compared to the control.ConclusionsImplantation of a biphasic synthetic BAM enhanced NB formation in the mini-pig maxillary sinus at both time points and in both groups, although BLC resulted in a slightly better total NB formation compared to the control.Graphical abstract

The Role of Formononetin in Osteoblast Function and Mineralization Potential with Deproteinized Bovine Bone Material

Objectives: Dental bone formation involves various cellular and molecular mechanisms, and phytoestrogens such as formononetin (FORM) are promising because of their estrogenic, anti-inflammatory, and antioxidant effects. This study investigated the effect of FORM on osteoblast proliferation, differentiation, and mineralization in combination with spongiosa granulates (BO) in vitro. Materials and Methods: Human fetal osteoblast cells (hFOB1.19) were treated with increasing concentrations of FORM (1, 10, and 100 µg/mL), BO, or their combination. Cell proliferation was assessed using a MTT assay. Alkaline phosphatase (ALP) activity, intracellular Ca2+, and Pi levels were measured using ELISA. Vascular endothelial growth factor (VEGF) and osteocalcin expression levels were analyzed by western blotting. Results: Cell proliferation increased with FORM, with or without BO, after 6 days (p &lt; 0.001). FORM and BO had a synergistic effect on ALP activity (p &lt; 0.001). Intracellular Ca2+ and Pi levels were highest in the BO-FORM group, suggesting superior mineralization (p &lt; 0.05). VEGF and osteocalcin expression was significantly upregulated with FORM, alone and with BO (p &lt; 0.05), indicating improved angiogenesis and bone maturation over 9 days. Conclusions: FORM enhances osteoblast proliferation, differentiation, and mineralization potential, particularly in BO spongiosa granulates. These data support the in vitro potential of formononetin-phytoestrogen in promoting osteoblast differentiation and mineralization potential with BO. These findings suggest that FORM, combined with BO, could improve bone augmentation in clinical applications such as maxillofacial surgery. FORM shows valuable potential for clinical applications, such as maxillofacial surgery, by promoting faster and more effective healing.

Antibiotic prophylaxis in oral implant surgery in Germany: a cross-sectional study

PurposeProphylactic antibiotics are used in dental implants to reduce infection risk and implant failure, especially benefiting patients with risk factors. However, evidence suggests that using clindamycin or extending antibiotics postoperatively has an unfavorable risk–benefit ratio.MethodsThis national cross-sectional study analyzed antibiotic prophylaxis during implant insertion across Germany. Dentists from the German Society for Oral Implantology (DGOI) provided demographic information and data on the next 10 consecutive implant patients, including age, sex, risk factors, type of implantation, and antibiotic details.Results103 dentists participated, providing data on 1040 patients. Most dentists were male and aged 30–64. Patients were evenly split between genders, with an average age of 51 years. Antibiotics were administered in 87.6% of all cases, more frequently for patients undergoing bone augmentation (OR 7.01, p < 0.0001), immediate (OR 3.11, p = 0.002) or delayed (OR 5.30, p < 0.0001) implant insertion, and those with cardiovascular disease (OR 3.24, p = 0.009). 74.8% of implantologists tended to use antibiotic prophylaxis routinely, while the remaining implantologists decided on a case-by-case basis. Implantologists primarily used aminopenicillins for 63.8% of prescriptions and clindamycin for the remaining 35.6%. Additionally, 78.8% of patients with prophylaxis received postoperative, multi-day treatments.ConclusionsThe study reveals extensive antibiotic use for perioperative prophylaxis in implant surgery, often not justified by current recommendations, particularly concerning the choice of antibiotic (e.g., clindamycin) and duration (e.g., postoperative use). Specialized clinical guidelines and targeted training for dentists on antibiotic prophylaxis are needed.Graphical

Efficacy of bioresorbable mesh sheets made of 85:15 poly(lactic-co-glycolic acid) in the anterior maxilla for alveolar bone augmentation.

This study evaluated the efficacy of poly(lactic-co-glycolic acid) (PLGA) mesh sheets for alveolar bone reconstruction in the anterior maxilla with significant bone defects. This prospective case series included four male patients (mean age, 34.5 years; range, 20-49 years) with anterior maxillary bone defects. Bone augmentation was performed using a staged guided bone regeneration technique with PLGA mesh sheets as barrier membranes and a 1:1 mixture of autogenous and xenogeneic bone as grafting material. The effectiveness of bone augmentation was evaluated using preoperative and postoperative computed tomography data at 1-month and 6-month. Secondary outcomes included complications such as wound infection and dehiscence. The treatment of the four patients required seven PLGA mesh sheets and particulate bone, followed by nine implant placements. Wound healing was uneventful except for one, wherein wound dehiscence and graft loss were observed. One patient had an exposed PLGA mesh sheet during healing, necessitating its removal. The mean vertical bone gain was 2.3±0.5 mm, and the mean horizontal gain was 3.7±1.3 mm at 1 month postoperatively. Sites without wound dehiscence exhibited a bone decrease rate of 6.5%-21.1%, while successful bone height and width increases were observed across treated sites. Bone augmentation using PLGA mesh sheets proved effective in reconstructing horizontal and vertical alveolar bone dimensions. This technique provides adequate support for implant placement, demonstrating its potential utility in cases of substantial alveolar bone deficiency.

Effects of preparation technique on periosteal microcirculation after autologous bone augmentation in an animal model.

This controlled in vivo experimental study examines the impact of two periosteum preparation techniques on microcirculation during bone augmentation with isogenic bone grafts in rats. Twenty female Lewis rats were divided into two groups (n=10 each). In one group, the periosteum was prepared with a conventional periosteal elevator; in the other, a piezoelectric device was used. After graft implantation at calvarial sites, intravital microscopy was performed post-operation (day 0) and on days 3, 8, and 28 immediately to assess microvascular parameters: functional capillary density, blood flow velocity, and vessel diameter. Statistical analysis was conducted using ANOVA on ranks with p<0.05. The piezoelectric device group showed higher mean values for functional capillary density, blood flow velocity, and vessel diameter than the conventional instrument group, though differences were not statistically significant. This study suggests that periosteum preparation with a piezoelectric device does not significantly differ from conventional methods regarding microcirculatory outcomes. Either method appears viable for preserving microcirculatory integrity during bone augmentation. Further research in larger models and clinical contexts is recommended to confirm these findings.

The Use of the Facial Sinus Wall as Bone Shell Onlay Graft for Maxillary Posterior Ridge Reconstruction: A Retrospective Case Series.

To evaluate the performance and clinical outcome of vertical and horizontal bone augmentation (VHBA) in posterior maxillary regions combining lateral window sinus floor elevation (LWSFE) with a horizontal bone shell technique applying the maxillary facial sinus wall as a bone plate. In 18 patients, LWSFE was combined with a horizontal bone shield augmentation procedure utilizing the maxillary facial sinus bone wall as a lateral bone plate. Both the sinus cavity and the lateral bone box created were grafted with a mixture of autogenous bone/venous blood and bovine bone mineral. The primary aim was to assess the performance of combined techniques enabling subsequent implant placement. Using radiographic measurements (preoperative, after VHBA, at implant placement, and at follow-up), bone gain/reduction of augmented horizontal ridge width (HRW) and vertical bone height (VBH) were evaluated. Additionally, clinical outcome assessing implant survival/success rate, marginal bone loss (MBL), and implant health (mucositis/peri-implantitis) was evaluated. For the combined VHBA techniques, HRW and VBH increased significantly (p < 0.001) from preoperative 3.5 ± 1.4 mm/3.6 ± 2.1 mm to 9.7 ± 1.9 mm/18.0 ± 1.6 mm post-augmentation. However, HRW and VBH dimensions decreased up to 8.9 ± 1.8 mm/17.1 ± 1.4 mm at implant placement and 8.6 ± 1.7 mm/16.7 ± 1.3 mm at follow-up evaluation (3.8 ± 1.8 years; p < 0.001, respectively). Augmented bone reduction was significantly higher (-7.7%) between the augmentation procedure and implant placement than in the post-implant-placement period (-2.5%). All implants survived (100%) representing peri-implant MBL of -0.9 ± 0.7 mm, pocket depth of 3.4 + 1.8 mm, and prevalences of 5%/0% for peri-implant mucositis/peri-implantitis. The combination of horizontal bone augmentation using local bone shield transfer from the maxillary facial sinus wall with LWSFE enables sufficient reconstruction of maxillary posterior ridge.

Biomechanical Basis for Bone Healing and Osseointegration of Implants in Sinus Grafts.

A thorough comprehension of the mechanisms controlling new bone formation and implant osseointegration after maxillary sinus floor elevation is crucial for aligning our treatment choices with biological principles and enhancing clinical outcomes. The goal of bone regeneration in sinus lift procedures is to provide a sufficient amount of newly-formed tissue to support implant osseointegration. However, it is still unclear whether there is a minimum quantity of vital bone within the newly-formed tissue required for effective support, though it is generally assumed that vital bone is essential for this process. The source and integration of new bone in maxillary sinus floor elevation procedures remain debated. Most clinical studies suggest a paramount role for sinus floor and bony walls, with a centripetal pattern of new bone formation, while conflicting reports exist regarding the osteogenic role of the Schneiderian membrane. The influence of mechanical input on peri-implant bone formation, mineralization, and maturation is significant, with bone remodeling regulated by mechanical strains generated during loading. Defining optimal loading for implants, particularly in sinus lift procedures, is challenging, as early loading may damage interfacial tissue, interfering with osteogenesis. Differences in osseointegration dynamics between native and augmented bone may arise from biological and mechanical factors, but also from patient-specific factors which should be evaluated in treatment planning. Factors to consider include sinus anatomy, patient and site-specific regenerative potential, and the selection of graft material that matches the osteogenic and mechanical requirements. Tailored approaches integrating patient-specific considerations and refined implant strategies will enhance predictability and longevity of treatment.

Cone beam computed tomography outcomes in patients diagnosed with compromised bone health undergoing dental implant therapy and bone augmentation

Studies examining mid-term treatment outcomes of implant placement with bone augmentation in patients with compromised bone health are lacking. The purpose of this prospective, nonrandomized cohort study was to evaluate the cone bean computed tomography (CBCT) outcomes of implant placement with bone augmentation in postmenopausal women. For this best practice, standard of care study, 78 participants received 1 test implant along with 1 or a combination of 3 bone augmentation procedures: particulate graft, expansion, or block graft. Participants were categorized as healthy (n=49) or bone compromised (n=29). Using CBCT scans made preoperatively, immediately postoperatively, and 2 years postoperatively, the augmented alveolar ridge widths were measured in a buccolingual (BL) dimension 2mm and 6mm apical to the coronal aspect of the implant's rough surface. Additionally, peri-implant bone height was measured on the mesial and distal implant surfaces at the mid-alveolar aspect of the ridge using a coronal panoramic view. Both study groups exhibited an increase in horizontal BL measurements at the 2-mm and 6-mm landmarks from preoperative to immediate postoperative time points and a minimal decrease from intermediate postoperative to 2 years postoperative. The mean proximal height decreased over time in healthy participants but did not show a significant change in participants with compromised bone. The linear mixed effects model results revealed that the mean difference between groups significantly decreased over time at the 2-mm landmark (P<.05); however, no significant group-time interactions were found for the BL width at the 6-mm landmark and proximal height measurements (P=.627). Mid-term CBCT measurements showed significant bone augmentation immediately after surgery and 2 years after surgery and stable proximal bone adjacent to implants in postmenopausal women diagnosed with compromised bone health.

A Biodegradable Magnesium Alloy Promotes Subperiosteal Osteogenesis Via Interleukin-10-Dependent Macrophage Immunomodulation

In situ bone regeneration and vertical bone augmentation have been huge problems in clinical, always imposing a significant economic burden and causing patient suffering. Herein, MgZnYNd magnesium alloy rod implantation in mice femur results in substantial subperiosteal new bone formation, with osteoimmunomodulation playing a pivotal role. Abundant macrophages are attracted to the subperiosteal new bone region and proved to be the most important regulation cells for bone regeneration. Periosteum stripping, macrophage depletion, and interleukin-10 (IL-10) blockage effectively diminish the MgZnYNd alloy-induced subperiosteal osteogenesis. Mechanistically, the degradation products of MgZnYNd alloy promote M2 macrophage polarization and the secretion of anti-inflammatory cytokine IL-10, which enhances periosteum-derived stem cells (PDSCs) osteogenesis through the JAK1-STAT3 pathway. An anti-IL-10 neutralizing antibody or STAT3 inhibitor significantly inhibits M2 macrophage-mediated osteogenic differentiation of PDSCs. Transcriptomic and proteomics reveal that periostin is the core regulator of PDSCs osteogenesis differentiation. Furthermore, a novel clinical translation application of Mg-induced subperiosteal osteogenesis is developed, demonstrating its ability to preserve the height and width of the alveolar crest in rats and rabbits following tooth extraction. Collectively, these findings unveil a previously undefined role for Mg alloy-induced subperiosteal osteogenesis via macrophage-mediated osteoimmunomodulation, suggesting the therapeutic potential of magnesium alloy in bone regeneration and bone augmentation.

Digital Guides for Precise U-Shaped Splitting and Simultaneous Implant Placement With Minimal Surgical Trauma.

The aim of this report is to present the workflow of a surgical procedure involving U-shaped splitting in an envelope flap with simultaneous implant placement using two digital guides for patients with insufficient bone width and labial concavity. Two digital guides and an envelope flap are proposed in this report. An implant drilling guide and an osteotomy guide guarantee the precise execution of surgical procedures. Using an envelope flap enhances the integrity of the labial mucoperiosteum, minimizing surgical trauma and improving the effect of bone augmentation. With the assistance of two digital guides, precise U-shaped splitting in an envelope flap can minimize surgical trauma and have a significant effect on horizontal bone augmentation. This workflow considers the implant positions, the scope of osteotomy, and the kind of flap. It ensures minimal surgical trauma and excellent bone augmentation effect, which means predictable esthetic outcomes and stability in oral implantology, and provides a considerable solution for patients with insufficient bone width and labial concavity.

Microstructural Evaluation of Dental Implant Success Using Micro-CT: A Comprehensive Review

Micro-computed tomography (micro-CT) is an invaluable tool for the evaluation of dental implant success, whereby the assessment of bone microstructure is conducted. This review examines the role of micro-CT in evaluating bone microstructure in dental implants. A review of the current literature reveals that micro-CT enables the accurate measurement of bone volume, trabecular morphology, and connectivity density, all of which play a crucial role in implant stability. The high-resolution three-dimensional visualization capabilities of micro-CT are also beneficial for the analysis of osseointegration and the evaluation of bone augmentation biomaterials. Despite the existence of challenges such as imaging artifacts and limitations in in vivo applications, advancements in sub-micron resolution and artificial intelligence integration offer promise for improving diagnostic capabilities. Micro-CT provides valuable insights into bone microarchitecture and osseointegration dynamics, which have the potential to enhance pre-operative planning and clinical outcomes in dental implantology. Future research should prioritize the standardization of micro-CT analysis protocols and the exploration of direct clinical applications of this technology.

Survival and Success of 3D-Printed Versus Milled Immediate Provisional Full-Arch Restorations: ARetrospective Analysis.

To evaluate and compare the survival rates of 3D-printed and chairside milled resin polymethylmethacrylate (PMMA) immediate temporary provisional full-arch implant restorations using prosthetic survival as the primary outcome. Records of 335 routine patients receiving 443 temporary six-implant retained maxillary or mandibular prosthetic restorations between January 2019 and January 2022 at a private clinic (Dr Sobczak Clinical Centre, Radosc, Poland) were considered for this retrospective analysis. The analysis compared prosthetic and implant failure rates between printed and milled restorations as primary and secondary outcomes, respectively. Patient-related and treatment-related characteristics between groups were compared using the Chi-square test and Mann-Whitney U-test, respectively. Group-specific cumulative prosthetic survival was qualitatively and quantitively compared using Kaplan-Meier, generalized linear mixed models and univariate cox proportional hazard analyses. Prosthetic survival was set into context to implant survival using Chi-square tests. A multivariable cox proportional hazards model with frailty was used to identify confounding factors affecting prosthetic survival. Prosthetic failure rates of milled and printed temporary restorations were 13.01% and 11.25% over the average follow-up period of 307.7 ± 115.5 days, respectively. The corresponding 180-day cumulative prosthetic survival rates were 92.4% and 93%. Hazard ratios for the prosthetic failure of milled and printed restorations did not show a statistical difference (p = 0.794). Implant failure rates in restorations that experienced prosthetic failure (17.31%) were higher compared to restorations without failures (5.63%), with a 3.2 times significantly higher odds of failure for a prosthesis experiencing implant loss (p = 0.003). Gender, presence of teeth at treatment baseline, smoking, and bone augmentation were identified as confounding factors impacting prosthetic survival. Chairside 3D-printed restorations may represent an equivalent treatment modality to established chairside milled restorations for immediate full-arch therapy. Provisional prosthetic survival may impact implant survival and treatment success.

Regeneration of Chronic Alveolar Vertical Defects Using a Micro Dosage of rhBMP-2. An Experimental InVivo Study.

The objective of this study is to compare the effect of the location of recombinant human bone morphogenetic protein 2 (rhBMP-2) from the native bone and the periosteum for vertical alveolar bone augmentation. Mandibular, chronic, standardized, bilateral, and vertical defects in 12 beagle dogs were evaluated using four modalities: a xenograft alone (XENO; n = 6); rhBMP-2 alone (BMP; n = 6); a technique with rhBMP-2 close to the host bone covered by xenograft (SAN; n = 6); and a technique with rhBMP-2 close to the flap on top of the xenograft (LAS; n = 6). After 8 weeks, a series of invivo inspections, fluorescence microscopy, histologic and histomorphometric evaluations, and micro-CT analyses. After 8 weeks of healing, new bone formation correlated with proximity of rhBMP to the perforated membrane with BMP and LAS (p = 0.024). The highest total bone volume was found in the LAS group (45.1% ± 13.3%), followed by the SAN group (35.2% ± 6.7%), BMP group (33.1% ± 11.8%), followed by the XENO group (23.1% ± 6.5%). The SAN group demonstrated frequent seroma formation. Blood vessel formation was more pronounced in the LAS + rhBMP group, with a significant increase of 27.1% compared to the XENO group (p = 0.02). Micro-CT revealed a strong trend for higher bone volume in the BMP group (34.7%) compared to the XENO group (13.6%) (p = 0.06). Only rhBMP-2 groups demonstrated bone formation above the perforated membrane. The location of rhBMP-2 in relation to the biomaterial and periosteum influenced the effectiveness of vertical bone regeneration.

Bioactive Coatings on 3D Printed Polycaprolactone Scaffolds for Bone Regeneration: A Novel Murine Femur Defect Model for Examination of the Biomaterial Capacity for Repair

AbstractBone tissue engineering seeks to develop treatment approaches for nonhealing and large bone defects. An ideal biodegradable scaffold will induce and support bone formation. The current study examines bone augmentation in critical‐sized bone defects, using functionalized scaffolds, with the hypothesized potential to induce skeletal cell differentiation. 3D printed, porous poly(caprolactone) trimethacrylate (PCL‐TMA900) scaffolds are applied within a murine femur defect, stabilized by a polyimide intramedullary (IM) pin. The PCL‐TMA900 scaffolds are coated with i) elastin‐like polypeptide (ELP), ii) poly(ethyl acrylate) (PEA)/fibronectin (FN)/bone morphogenetic protein‐2 (PEA/FN/BMP‐2), iii) both ELP and PEA/FN/BMP‐2, or iv) Laponite nanoclay binding BMP‐2. Sequential microcomputed tomography (µCT) and histological analysis are performed. PCL‐TMA900 is robust and biocompatible and when coated with the nanoclay material Laponite and BMP‐2 induce consistent, significant bone formation compared to the uncoated PCL‐TMA900 scaffold. Critically, the BMP‐2 is retained, due to the Laponite, producing bone around the scaffold in the desired shape and volume, compared to bone formation observed with the positive control (collagen sponge/BMP‐2). The ELP and/or PEA/FN/BMP‐2 scaffolds do not demonstrate significant or consistent bone formation. In summary, Laponite/BMP‐2 coated PCL‐TMA900 scaffolds offer a biodegradable, osteogenic construct for bone augmentation with potential for development into a large scale polymer scaffold for clinical translation.

Connective Tissue Graft May Compensate for Residual Bone Defect of the Implant in the Esthetic Zone: A Case Report with 7-year Follow-up

The present case report aimed to demonstrate the case using a connective tissue graft (CTG) to compensate for a residual defect after guided bone regeneration (GBR) in the anterior maxillary area. An extensive number of studies have reported successful outcomes of horizontal bone augmentation, but it was also demonstrated that a complete resolution of the defect may not be achieved in all cases. In the present case report, the patient underwent implant placement simultaneously with GBR at the anterior maxillary area. After 4 months, partial regeneration of the initial defect was observed. To compensate for such residual defect, a CTG was applied. Other expectations by the CTG were to enhance tissue volume and phenotype. The final prosthesis was delivered after 3 months. Up to 7 years, favorable radiographic and clinical situations were observed. In conclusion, a CTG may compensate for residual bone defect of the implant in the esthetic zone.

Long-Term Clinical and Radiographic Outcomes of Hydrophilic Implants: A 10-Year Study in a Specialist Private Practice.

To report the 10-year clinical and radiographic outcomes of implants placed in grafted (GBR) and non-grafted (no-GBR) sites in a Swiss specialist private practice using hydrophilic implants with a low surface roughness flange. Fifty consecutively enrolled patients received 159 hydrophilic implants with a low surface roughness flange. A first re-evaluation was performed 1 year after delivery of restoration (T1). An additional examination was performed at the 10-year follow-up (T2) including the assessment of clinical (i.e., periodontal/peri-implant pockets probing depths (PPD) (mm), full-mouth bleeding score (%), implant survival rate, mid-buccal keratinized mucosa (KM) width in mm, and peri-implant phenotype), and radiographic (i.e., marginal bone level change [ΔMBL]) outcomes. Biological, mechanical and technical complications were also recorded. Out of the initial cohort, 22 patients (9/40.9% male and 13/59% female) and 63 implants (47 with GBR, 16 without GBR), could be re-examined at T2. Overall, ΔMBL (T2-T1) was -0.56 ± 0.96 mm. In the GBR group, ΔMBL were significantly higher at the distal sites compared to the no-GBR group (-0.75 ± 1.17 mm vs. -0.12 ± 1.29 mm, p = 0.045), however, in the GBR group MBL started at a higher level at T1 but were similar with the no-GBR group at T2. Implant survival was 100% with only very few technical complications (6.3%). Mean PPD amounted to 3.84 ± 1.00 mm with significantly higher values in the GBR group (3.98 ± 1.08 mm vs. 3.45 ± 0.60 mm; p = 0.016). Nineteen implants (30.1%) were diagnosed with peri-implant health while 44 (69.9%) presented with peri-implant mucositis. Within the limitations of this study, favorable clinical and radiographic conditions were recorded around hydrophilic implants with a low surface roughness flange placed in pristine and augmented bone after 10 years in function.

Microarchitectural Study of the Augmented Bone Following a Modified Ridge Splitting Technique: Histological and Micro-Computed Tomography Analyses.

Objectives: The aim of this matched prospective cohort study was to examine the microarchitecture of the augmented bone following a modified alveolar ridge splitting procedure and compare it to that of native bone. Methods: In the test group, patients underwent a modified ridge split osteotomy procedure to restore the width of the posterior segment of the mandible. Patients with sufficient bone width for dental implant placement in the posterior region of the mandible following 3-month-long spontaneous healing after tooth removal were included in the control group. In both study groups, bone biopsy samples were harvested and dental implants were placed. Histomorphometry and micro-CT analysis were performed. Results: Altogether, 15 patients were included in this study (7 patients in the test group, with 14 bone core biopsies harvested, and 8 patients in the control group, with 13 bone core biopsies harvested). Percentage bone volume (BV/TV) in the micro-CT analysis (22.088 ± 8.094% and 12.075 ± 4.009% for the test and control group, respectively) showed statistically significant differences between study groups. Conclusions: Based on histological and micro-CT analyses, the modified ridge splitting procedure with autologous bone block harvested from the retromolar area results in a dental implant recipient bone microarchitecture superior to that of the extraction sockets left to heal undisturbed for a 3-month-long healing period.

The influence of suturing and or gluing of perforated Schneiderian membrane during sinuslift procedure on the outcome: a retrospective study

The sinus lift procedure has become the most common method for maxillary bone augmentation. The most frequently observed intraoperative complication is the perforation of the Schneiderian membrane. Various treatment options have been proposed for managing these perforations, including the use of resorbable membranes, centrifugated blood products as PRF, or PRGF, suturing, and fibrin glue application. While long-term studies exist for the use of resorbable membranes to close perforations, there is limited data on the long-term outcomes of suturing or gluing the perforated sinus membrane. The aim of this retrospective study is to evaluate the long-term outcomes of suturing and/or applying fibrin glue to repair perforated sinus mucosa during sinus floor elevation procedures. Between 2005 and 2009, a total of 692 patients underwent 923 sinus lift surgeries, and Schneiderian membrane perforation occurred in 202 sinus floor elevations (21.98%) across 168 patients. The main documented causes of perforations, which ranged from 2 to 10 mm in diameter, were the presence of septa, followed by thin and adherent membranes. Of the perforations, 100 (49.5%) were treated with microsurgical suturing combined with fibrin glue, 78 (38.6%) were treated with fibrin glue alone, and 24 (11.9%) were treated exclusively with suturing. Sinus grafting was performed using autogenous bone in combination with a biomaterial, following the layering technique. All surgeries resulted in primary healing without complications, enabling all patients to undergo restoration as planned. The long term clinical and radiological evaluations of 44 randomly selected patients who followed the recall program up to 10 years post operative confirmed the effectiveness of this treatment approach.

Arthroscopic Congruent-Arc Distal Tibial Allograft Bone Augmentation With Cerclage Fixation for Anterior Shoulder Instability With Bone Loss

Glenoid bone loss is a common sequela of recurrent anterior shoulder instability. When treated surgically, a bone augmentation procedure is more likely to provide a good outcome with a lower risk of recurrent instability compared with a soft-tissue repair alone. There are several bone augmentation options to address glenoid bone loss, including coracoid transfer, iliac crest autograft, and distal tibial allograft (DTA). Both open and arthroscopic DTA techniques have been described using the lateral one-third of the distal tibia oriented with the anterior aspect placed superiorly on the anterior glenoid. This graft orientation places its concavity in the superior-to-inferior direction. It may be preferred to have this concavity maximized toward the anterior direction so that it can further resist anterior displacement. The posterior one-third of the distal tibia may provide a more optimal arc of resistance. However, no previous technique has used the posterior one-third of the distal tibia to reconstruct the “half-pipe” concavity of the anterior glenoid. We describe an all-arthroscopic technique for a posterior third DTA oriented with the posterior tibial edge placed anteriorly on the glenoid, termed the “congruent-arc DTA,” to address anterior shoulder instability with bone loss.