Bone Gain Research Articles

Modified Le Fort I interpositional grafting of the severe atrophied maxilla-a retrospective study of 106 patients over 10 years.

The objective of this study was to evaluate a modified Le Fort I interpositional grafting followed by dental implants for the rehabilitation of edentulous atrophied maxillae (Cawood classes IV and V). The surgical modification was a bilateral sinus floor augmentation prior to the osteotomy. This generated a closed recipient bed which allowed the use of particulated bone grafts (xenogenic bone mineral) and a reduced amount of autologous iliac bone grafts. A total of 106 patients with maxillary interpositional bone grafts were included in this retrospective analysis between 2006 and 2020. The panoramic radiographs and lateral cephalograms were analyzed to assess the gain and stability of the maxillary bone and the peri-implant bone loss. In addition, the observational period of up to 14years implant survival and success was evaluated. A stable vertical bone height with mean 0.63±1.41mm resorption over 5years after implant loading was observed. A mean of 0.20±0.37mm marginal bone loss was noted after 5years. The implant survival was 96.4% after 5years and implant success can be rated 91.7% in a mean follow-up period of 93months and 168months maximal observation time. Perioperative complications included sinus membrane perforation (59.43%), wound healing disturbances (25.47%), and transient primary complications (13.78%). All receded apart from two subtotal graft losses (1.8%). The modified Le Fort I osteotomy with interpositional bone grafts is a predictable procedure in terms of bone and implant stability. Patients with atrophic maxillae who are fit for surgery should be informed about risks and benefits of this treatment alternative.

Effect of an "Autogenous Leukocyte Platelet-Rich Fibrin Tooth Graft" Combination around Immediately Placed Implants in Periodontally Compromised Sites: A Randomized Clinical Trial.

Objective Autogenous tooth bone graft (ATBG) was suggested as a source for bone grafting materials, especially as they have similar chemical composition to bone. This study goal was to assess the clinical and radiographic consequences of ATBG with or without L-PRF on bone deposition around immediate implants placed in periodontally hopeless sites. Materials and Methods 26 patients, with periodontally diseased teeth, underwent random assignment to receive the surgical protocol either with L-PRF over ATBG around immediately inserted implants (test group) or without it (control group). Clinical examination was observed. Radiographically, bone changes horizontally and vertically to determine marginal bone loss (MBL) and mesiodistal bone changes were made at the base line and 6 and 9 months after implant insertion. Statistical analysis utilizing paired Student's t-test was used for comparing results within the same group, whereas an independent-sample t-test was used for intergroup variable comparison. Results All implants met the criteria of success without any complications at the follow-up period. Nonsignificant differences were detected between horizontal bone alterations in both groups at 6 and 9 months (P > .001). The test group showed statistically significant lower MBL than the control group (P < .001). The mesiodistal bone gain in the test group was significantly higher than that of the control group at the 6-month period (P < .001). The mesiodistal bone loss in the control group was significantly higher than that of the test group at the 9-month period (P < .001). Conclusion The ATBG- L-PRF combination therapy enhances new bone formation and appeared to be a favorable procedure with immediate implant placement, particularly in severe periodontitis cases.

Horizontal guided bone regeneration on knife-edge ridges: A retrospective case-control pilot study comparing two surgical techniques.

Studies evaluating guided bone regeneration (GBR) on knife-edge ridges using absorbable membranes with staged approaches have reported various horizontal bone gains. This study compared the horizontal bone gain obtained via a conventional technique of GBR and a recently-reported technique. Bone loss during the healing process was also measured. Consecutive patients who underwent GBR on knife-edge ridges via a conventional technique (control group) or the Sausage Technique (test group) were included in this study. GBR was performed using a collagen membrane and deproteinized bovine bone mineral combined with an autogenous graft at a 1:1 ratio. Cone-beam computed tomography (CBCT) was performed preoperatively, postoperatively, and after the patient healed. Horizontal bone width was measured on CBCT images 2 mm apical from the top of the crest. The preoperative CBCT and posthealing CBCT were superimposed to calculate the bone gain after healing, and the preoperative and postoperative CBCT scans were superimposed to calculate the bone gain after surgery. Bone loss during healing was calculated by subtracting the width of the ridge after healing from the postoperative width. The mean horizontal bone gain was significantly lower in the control group (2.7 ± 1.8 mm; 83.2%) than in the test group (5.3 ± 2.3 mm; 216.8%) (p=0.003). The average horizontal bone loss between regeneration and implant placement was 0.9 mm in the control group (27.9%) and 2.1 mm in the test group (29.4%). While the absolute bone loss was significantly different (p=0.012), the percentage of bone resorption was not (p=0.608). The new technique resulted in significantly more bone gain than a conventional GBR technique. The rate of graft resorption during healing was stable regardless of the amount of grafted material.

Radiographic assessment of deproteinized bovine bone mineral (DBBM) and collagen-stabilized DBBM for transalveolar sinus floor elevation: A 2-year retrospective cohort study.

Theoretically, collagen-stabilized deproteinized bovine bone mineral (DBBM-C) has better operability compared with DBBM. DBBM-C avoids dispersing during the transalveolar sinus floor elevation (TSFE) because of its block shape. To evaluate radiological changes of using DBBM-C in TSFE. Patients who received TSFE using DBBM (Bio-Oss®) or DBBM-C (Bio-Oss® collagen) with simultaneous implantation were recruited. Graft bone height apically (aGH), endo-sinus bone gain (ESBG), and crest bone level (CBL) were assessed through panoramic radiograph and cone beam computed tomography (CBCT). A total of 138 patients (138 implants) were retrospectively enrolled. After 2 years of implantation, the incidence of postoperative complications was 4.2% (95% CI: 0.9%-11.7%) and 4.5% (95% CI: 0.9%-12.7%) for DBBM and DBBM-C groups, respectively. Measured in panoramic radiograph, ΔaGH of DBBM-C (1.8 mm, SD: 1.4, 95% CI: 1.2-2.4, P=0.044) group was significantly higher than that of DBBM (1.2 mm, SD: 1.4, 95% CI: 0.7-1.7) after 24 months. No significant differences for ΔCBL were noted during the entire observation period. Measured through CBCT, ESBG was 5.0 (SD: 1.8, 95% CI: 4.1-5.8) mm in DBBM group and 4.6 (SD: 1.6, 95% CI: 3.9-5.3) mm in DBBM-C group 24 months after implantation. The aGH value of DBBM-C group was significantly higher compared with DBBM in CBCT (OR=1.4, 95% CI: 1.1-1.9, P=0.020). DBBM-C could achieve similar bone generation as DBBM in TSFE. Both materials could maintain aGH, ESBG, and CBL relatively stable 2 years after implantation.

Autologous Dentin Graft after Impacted Mandibular Third Molar Extraction to Prevent Periodontal Pocket Formation-A Split-Mouth Pilot Study.

This preliminary study aims to evaluate the efficacy of an autologous dentin graft in preventing periodontal defects after impacted or semi-impacted lower third molars’ (M3) surgical extraction. For this purpose, radiographic and periodontal evaluation of post-extractive sockets were performed. Ten patients were enrolled in the study: twenty M3 extraction sockets were treated with a split-mouth modality. After tooth extraction, the experimental sites were filled with autologous dentin graft obtained by the extracted M3, while the control sites were filled with blood clot alone. Flaps were closed by first intention to ensure the stability of the wounds. Post-extractive sites were monitored at days 15, 90 and 180. The healing was not affected by any complications associated with the use of the autologous dentine graft in all cases. The measurements recorded at six months showed a reduction of the probing pocket depth distal to the second lower molar (M2) at both surgical sites, with a greater reduction observed at the experimental sites. Radiographic evaluation also showed a greater amount of bone gain at the grafted sites compared to the control sites. The results of this preliminary study suggest that autologous dentin grafts can be useful in preventing the formation of periodontal defects distal to M2 after M3 surgical extraction.

The Notch pathway regulates the bone gain induced by PTH anabolic signaling.

Parathyroid hormone (PTH) signaling downstream of the PTH 1 receptor (Pth1r) results in both bone anabolic and catabolic actions by mechanisms not yet fully understood. In this study, we show that Pth1r signaling upregulates the expression of several components of the Notch pathway and that Notch signals contribute to the catabolic actions of PTH in bone. We found that constitutive genetic activation of PTH receptor signaling in osteocytes (caPth1rOt ) or treatment with PTH daily increased the expression of several Notch ligands/receptors in bone. In contrast, sustained elevation of endogenous PTH did not change Notch components expression. Deletion of the PTH receptor or sclerostin overexpression in osteocytes abolished Notch increases by PTH. Further, deleting the canonical Notch transcription factor Rbpjk in osteocytes decreased bone mass and increased resorption and Rankl expression in caPth1rOt mice. Moreover, pharmacological bone-targeted Notch inhibition potentiated the bone mass gain induced by intermittent PTH by reducing bone resorption and preserving bone formation. Thus, Notch activation lies downstream of anabolic signaling driven by PTH actions in osteocytes, and Notch pharmacological inhibition maximizes the bone anabolic effects of PTH.

Guided Bone Regeneration in the Edentulous Atrophic Maxilla Using Deproteinized Bovine Bone Mineral (DBBM) Combined with Platelet-Rich Fibrin (PRF)-A Prospective Study.

Background: Bone regeneration procedures represent a major challenge in oral surgery. This study aimed to evaluate a composite PRF/particulate xenograft in guided bone regeneration. Methods: Edentulous patients with horizontal ridge deficiencies in the anterior maxilla and candidates to an immediate-loading full-arch rehabilitation were included. Horizontal linear measurements indicating bone gain were assessed from computer beam computer tomography (CBCT) scans obtained at pre-surgery, post-surgery, and the 12-month follow-up. Mean bone values were presented as mean ± 95% CI. Non-parametric tests were used as appropriate, and the effect size was calculated with Cohen’s d repeated measures. Results: Eighteen patients were rehabilitated with 72 implants. The mean horizontal bone width was 4.47 [4.13–4.80] mm pre-surgically, 9.25 [8.76–9.75] mm post-surgically, and 7.71 [7.28–8.14] mm 12 months after. Conclusions: PRF associated with a xenograft seems to promote an effective horizontal bone gain. Randomized clinical trials are needed to confirm the benefits of this surgical approach.

Enamel matrix derivative does not affect osteoclast formation or bone resorption in cultures of mouse bone marrow macrophages or human monocytes

Objective Enamel matrix derivative (EMD) is widely used under the brand name Emdogain® to promote periodontal regeneration in surgical treatment of periodontitis and peri-implantitis. The molecular mechanisms are unclear, but it has been proposed that EMD has stimulatory effects on the root cementum and periodontal ligament cells. Since dental implants lack these structures, we hypothesized that EMD-induced bone gain involve interactions with osteoclast precursor cells, with consequent inhibitory effect on osteoclast formation and/or activity. The aim was to evaluate this hypothesis. Material and methods Primary mouse bone marrow macrophages (BMMs) and human peripheral blood monocytes were cultured in the presence of receptor activator nuclear factor-κB ligand (RANKL) to stimulate osteoclast formation. A purified Emdogain® fraction was added to the cell cultures and the effect on number and size of newly formed osteoclasts were evaluated. In cultures on natural bone slices, bioanalytical methods were used to assay osteoclast number and bone resorption. Results EMD had a negative effect on osteoclastogenesis in mouse cultures on plastic surface, whereas addition of EMD to osteoclast precursor cells on bone substrate did not affect osteoclast formation or bone resorption. Conclusions The results on natural bone matrix contradict a direct effect of EMD on osteoclast precursor cells.

Esthetic Evaluation of Maxillary Anterior Immediate Implant with Provisionalization with or without Bone Grafting

Immediate implant in the esthetic zone is a treatment of choice. However, much research regarding immediate implant provisionalization lacked in the literature. Hence, our study was conducted with an aim to assess the changes in the soft tissue, hard tissue, and esthetic outcomes following immediate implants with provisionalization with or without bone grafting. Twenty patients with a mean age between 18 and 55 years referred to the department of periodontology, for immediate implant placement in maxillary anterior region were included in the study. Patients were enrolled into two groups. Group I (test group) included patients with immediate implant placement with provisionalization with bone grafting. Group II (control group) included patients with immediate implant placement with provisionalization without bone grafting. Cement-retained provisional restoration was fitted over temporary abutment for 6 months of healing period. After 6 months of implant placement, definite crown was delivered. The results of our study showed the least resorption of buccal cortical plate and good amount of bone gain in both the groups in terms of horizontal alveolar dimensional changes. The mean amount of horizontal alveolar gain in group I was 1.12 mm at 2 mm, 1.08 mm at 4 mm, and 0.85 mm at 6 mm; in group II, it was 0.97 mm at 2 mm, 1.4 mm at 4 mm, and 0.93 mm at 6 mm. This study showed a significantly better outcome in both the groups in terms of all the parameters when compared from baseline but the mean differences between the two groups were not very significant. The study concluded that immediate implant with provisionalization with or without bone grafting has maintained stability of soft tissues as well as hard tissues and has also given better esthetic outcomes. The findings of this study proved that immediate implant placement with provisionalization with bone grafting is a predictable treatment modality that maintains the three-dimensional stability of alveolar bone and integrity of soft tissue and gives acceptable esthetics. Hence, this technique promises to fulfill both functional and esthetic concerns of the patient.

English

Acute onset of breathlessness and type 1 respiratory failure in young patients in the orthopaedic ward with traumatic pelvic or long bone fractures often raise suspicion of thromboembolic event, classic fat embolism and fat embolism syndrome (FES). However, in the era of the prevailing pandemic, the clinical presentation may cause suspicion of Covid-19 infection, creating a dilemma for diagnostic purposes, causing inadvertent delays in definitive management. Although clinically significant in 30 % of cases, FES in subclinical form is believed to be occurring in a large percentage of patients with long bone and pelvic fractures, secondary to a rise in intramedullary pressure and venous sinusoidal disruption. Debris of bone and fat gain access to the systemic and pulmonary circulation cause mechanical obstruction as well as multi-organ dysfunction syndrome. FES can be recognised by classic Bergman’s triad1 characterised by hypoxaemia, petechial rash and mental changes. We present a case of fat embolism syndrome that was reported in a tertiary care centre during the peak of the Covid19 pandemic.

Laser Treatment of Peri-Implantitis: A Systematic Review of Radiographic Outcomes.

(1) Background: This systematic review aimed to evaluate the effects of laser therapy on radiographic bone level (RBL) changes in peri-implantitis defects. (2) Methods: A literature search with defined inclusion criteria was performed. PubMed, Web of Science, Cochrane Library, and Google Scholar were searched through September 2020. The evaluated primary outcomes were RBL changes. In studies that reported RBL data, corresponding secondary clinical outcomes were probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL). (3) Results: Thirteen articles were selected for data extraction and risk of bias assessment. Eight studies showed evidence of RBL gain in the laser groups compared to baseline, but did not report the statistical significance. Eight of these 13 studies reported comparisons to control. Five of the eight studies did not show RBL gain in the laser groups compared to control. In the laser groups compared to baseline, 11 of 13 reported reduced PD, and 6 of 13 reported significantly reduced BOP. Compared to the control, eight of the eight reported reduction of PD, and three of six reported significantly reduced BOP. Statistical significance was not consistently reported. (4) Conclusions: Within the limits of this systematic review, laser treatment may promote bone gain in peri-implantitis defects, may reduce BOP and PDs, and may be comparable to mechanical therapy. However, definitive conclusions can only be made with statistically significant data, which were found lacking in the currently available studies. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42020207972.

3D-based buccal augmentation for ideal prosthetic implant alignment-an optimized method and report on 7 cases with pronounced buccal concavities.

ObjectivesScrew-retained restoration of implants is advantageous for biological and esthetic reasons. Due to buccal concavities, however, this preferred type of restoration can only be used in about half of the anterior indications. Based on case series, an optimized method for the treatment of such indications is to be described; the clinical reliability is to be ascertained by means of measurements (before and after augmentation) and assigned to the current literature.Material and methodsA case series of seven cases with buccal concavities of the anterior alveolar ridge were treated with optimized method, which is presented step-by-step until the prosthetic restoration. The depths of the bone concavities were measured and related to the bone gain after augmentation procedure respectively after implantation.ResultsLinear measurements of the buccal concavities showed an average undercut of 4 mm [SD ± 1.13]. After healing period of six months, the buccal concavities could be compensated bony to such an extent that implants could be inserted in correct position and angulation. On average, there was a horizontal bone gain of 3.7 mm [SD ± 0.59]. Even after implantation and another six months of healing, stable bone dimensions could be assumed with an average of 4.3 [SD ± 0.83] mm of bone gain compared to baseline. In six of the seven cases, the favorite screw-retained, one-piece full-ceramic restoration could be fixed on the implants. Due to the implant axis, one case had to be treated with a cemented two-part full-ceramic system.ConclusionsWith the described optimized method the most favorable screw-retained restoration can also be used in situations with unfavorable concavities of buccal bone. Especially for this indication, a special form of the horizontal deficit, the customized bone regeneration with titanium meshes is highly reliable in terms of healing and extent of augmentation. However, long-term results and a study/control group are required to evaluate the effectiveness of the presented protocol.Clinical relevance.Since these situations require an augmentation that is up to 5 mm thick and a procedure that is as minimally invasive as possible appears to be necessary in the visible area, an optimized method is described in this publication.

Healing complications and their detrimental effects on bone gain in vertical-guided bone regeneration: A systematic review and meta-analysis.

Guided bone regeneration (GBR) utilizes a barrier membrane to allow osteogenic cells to populate a space by excluding epithelial and connective tissue cells. The purpose of this systematic review was to investigate the ratio of means (RoM) of vertical bone gained (Outcome) in vertical GBR procedures with healing complications (Intervention) and in vertical GBR procedures without healing complications (Comparison) in patients with vertically resorbed edentulous ridges that require dental implant placement (Population). A further aim was to investigate the incidence of complications after vertical GBR, and the influence of the timing of implant placement and regenerative devices on complications. MEDLINE (through PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched in duplicate up to, and including, November 2020 for randomized and controlled clinical trials and prospective and retrospective case series. Outcomes included patient-level and site-level RoM of vertical bone gain between healing complications and uneventful healing, and incidences of complications that occurred after vertical GBR. Random-effects and fixed-effects meta-analyses were performed where appropriate. This study was registered on PROSPERO (CRD42021226432). A total of 31 publications were selected for the qualitative and quantitative analyses. The RoM of vertical bone gained was 0.65 [95% CI=0.47, 0.91] and 0.62 [95% CI=0.45, 0.85] when membrane exposure without suppuration and abscess formation without membrane exposure occurred respectively, in comparison to uneventful healing. The overall incidence proportion of healing complications occurring at the augmented site at a site- and patient-level was 11.0% [95% CI=7.0, 15.6] and 10.8% [95% CI=6.6, 15.7]. At a patient-level, there were no significant differences between a simultaneous or staged approach, or with the regenerative device used. The site-level incidence proportion of membrane exposure without suppuration, membrane exposure with suppuration, and with abscess formation without membrane exposure was 8.7% [95% CI=4.2, 14.2], 0.7% [95% CI=0.0, 2.9], and 0.5% [95% CI=0.0, 1.7], respectively. The site-level weighted mean incidence proportion of neurologic complications occurring at the donor site was 0.8% [95% CI=0.0, 5.3]. There is a significant reduction in bone gain when healing complications occur. However, healing complications are relatively uncommon surgical complications after vertical GBR.

The granulation tissue preservation technique in regenerative periodontal surgery-a randomized controlled clinical trial.

ObjectivesTo investigate if the application of the granulation tissue preservation technique (GTPT) in regenerative therapy of infrabony periodontal defects results in more clinical attachment level (CAL) gain and more radiographic bone gain (RBG) than the conventional resective approach 12 months after surgery.Materials and methodsForty patients exhibiting at least one infrabony defect with a probing pocket depth (PPD) ≥6 mm and a radiographic infrabony component (INFRAX‐ray) ≥3 mm were randomly treated with the GTPT (test group) or the double‐flap approach with resection of the defect‐filling granulation tissue (control group). Enamel matrix derivatives were applied in both groups. Clinical and radiographic parameters were recorded at baseline (t0), 6 months (t1), and 12 months (t2) after surgery. The primary outcome variable was CAL gain between t0 and t2.ResultsWhen all patients were considered, ΔCALt0–t2 did not differ significantly between the two groups (p = .160). Significant PPD reduction (test group: 4.38 ± 1.36 mm; control group: 4.06 ± 2.38 mm), CAL gain (test group: 3.75 ± 1.24 mm; control group: 2.88 ± 2.09 mm), and RBG (test group: 3.06 ± 1.74 mm; control group: 3.27 ± 2.19 mm) were achieved at t2 in both groups. Using multivariate linear regression, PPDt0 and group were identified as variables with the greatest influence on ΔCALt0–t2. PPDt0 and INFRAX‐ray were identified as variables with the greatest influence on RBGt0–t2. Patients with a defect angle >22° showed significantly more CAL gain in the test group (t0–t1: 3.08 ± 1.38 mm; t0–t2: 3.62 ± 0.96 mm) than in the control group (t0–t1: 1.77 ± 1.54 mm; t0–t2: 2.18 ± 1.83 mm).ConclusionsRegarding all patients, the study failed to show significant differences between the test and control groups. However, the GTPT appears to lead to more CAL gain in noncontaining infrabony defects.

Informative title: Guided bone regeneration with and without rhBMP-2: 17-year results of a randomized controlled clinical trial.

ObjectivesTo assess long‐term outcomes of implants placed in conjunction with guided bone regeneration (GBR) with or without recombinant human bone morphogenetic protein‐2 (rhBMP‐2).Materials and MethodsEleven patients with at least two lateral bone defects (split‐mouth design) received a total of 34 implants. The defects were treated with a xenogenic bone substitute with (test) or without (control) rhBMP‐2 and covered with a collagen membrane. Eight patients could be reexamined after at least 17 years. Wilcoxon signed‐rank tests were performed to assess differences between test and control groups.ResultsThe implant survival rate was 100% for all test and control sites. Mean marginal bone levels were 2.51 mm (SD ±1.64) (mesial test), 1.83 mm (SD ±0.93) (mesial control) (p = .055), 2.36 mm (SD ±1.70) (distal test), and 2.13 mm (SD ±0.84) (distal control) (p = 1.000). Compared with the mean values at baseline, a mean bone loss of 1.16 mm (SD ±1.60) (test) and 0.70 mm (SD ±1.02) (control) was found. The mean buccal bone gain after 17 years was 5.38 mm (test) and 3.14 mm (control) based on the comparison between the measurements at the cone beam CT after 17 years and the data from the intraoperative measurements at baseline. Further, mean values for (i) bone thickness ranged from 1.36 to 3.09 mm (test) and 1.18 to 3.39 mm (control) and for (ii) mucosal thickness of 1.24 mm (test) and 1.26 mm (control).ConclusionImplants placed in conjunction with GBR applying a xenogenic bone substitute and a collagen membrane with and without the addition of rhBMP‐2 demonstrate excellent clinical and radiographic results after at least 17 years.

Endospanin Is a Candidate for Regulating Leptin Sensitivity.

The hypothesis advanced is that endospanin, a highly conserved vesicle traffic protein in vertebrates, regulates leptin sensitivity in bone signaling. The effects of leptin on bones are well-studied but without consensus on whether the increases in leptin signaling stimulate bone gain or loss. The bone response may depend on leptin sensitivity, and endospanin is an established modulator of leptin sensitivity. An argument is advanced to develop zebrafish models for specific leptin signaling pathways. Zebrafish have well-developed molecular tools (e.g., CRISPR) and the advantage of non-destructive sampling of bones in the form of scales. Using these tools, experiments are described to substantiate the role of endospanin in zebrafish bone dynamics.

Intraoral onlay block bone grafts versus cortical tenting technique on alveolar ridge augmentations: a systematic review.

Background To review systematically the bone gain and superficial resorption rate of the onlay block bone grafts versus the cortical tenting technique, as well as secondarily study the postoperative complications, implant survival and success rates, and peri-implant marginal bone loss.Material and Methods Following the recommended methods for systematic reviews and meta-analyses (PRISMA), an electronic search was performed in the PubMed (MEDLINE), EMBASE and the Cochrane Library of the Cochrane Collaboration (CENTRAL) databases to identify all relevant articles published up to March 2021 on onlay block bone grafts and cortical tenting technique.Results Eighteen papers complied with the inclusion criteria. In onlay grafts, the vertical bone gain mean was 4.24 mm, and resorption 20.91%; and 4.29 mm in the horizontal augmentation with a resorption of 10.28%. The complication rate was 14.8%. The implant survival and success rates were 100% and 92%; and the mean peri-implant bone loss ranged from 0.6 to 1.26 mm.In cortical tenting technique, the vertical bone gain mean was 6.17 mm and the resorption of 9.99%; and 5.55 mm in the horizontal augmentation with a 6.12% of resorption. The complication rate was 24.6%. The implant survival and success rates were 96.63% and 100%; and the mean peri-implant bone loss ranged from 0.27 to 0.77mm.Conclusions Despite the limitations, both techniques offer a predicTable way to reconstruct atrophic alveolar ridges, though the cortical tenting technique seems to achieve a greater bone gain and a lower surface resorption. Current evidence is still limited due to the inadequate follow-up, lack of information referred to methodological quality and sample attrition. Key words:Onlay graft, cortical graft, intraoral bone, augmentation procedure.

Efficiency of guided bone regeneration in vertical bone augmentation with titanium-reinforced PTFE membrane and platelet-rich fibrin

Objective: Guided bone regeneration (GBR) for vertical bone augmention is an easy-to-implement approach and has a good prognosis. However, there are many different procedures that lead to different clinical outcomes. The use of platelet-rich fibrin (PRF) can improve outcomes in regenerative treatments. Therefore, this study aimed to evaluate the effectiveness of vertical bone grafting by guided bone reconstruction with titanium-reinforced PTFE membrane combined with PRF. Materials and Methods: Nine patients who come to the Department of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, have a need for implant treatment and have mild to moderate vertical bone deficiency. Patients are treated with bone grafting by GBR technique: using a mixture of bone grafts including autogenous bone and deproteinized bovine bone (Geistlich Bio-Oss) at a ratio of 1:1, mixed with injectable form PRF in the form of sticky bone. The vertical bone defects were protected by a titanium-reinforced d-PTFE membrane and covered by an A-PRF+ membrane. The bone gain was measured using a cone-beam computed tomography at baseline and after a period of 8 months. Results: Analyzing the research results on 9 patients, 15 research units corresponding to 15 bone grafting sites, the GBR procedures an increase in bone height (p &lt; 0,05) after treatment. In the two-staged approach, the vertical bone gain was 3.97 ± 0.92 mm; in the group of simultaneous one-staged procedure, the vertical bone gain was 3.89 ± 1.13 mm. In general, the bone height of the study sample achieved an average of 94.16 ± 10.7% compared to the ideal bone height. Conclusion: GBR technique using a mixture of particulate autogenous bone and xenogenous bone and PRF is effective for vertical bone augmentation in maxillary and mandibular regions, ensuring favorable bone morphology, permitting sufficient bone gain to future implant placement and prosthetics.

Cirurgia de levantamento de seio maxilar pela técnica da janela lateral: relato de caso

ABSTRACT The loss in height of the alveolar bone crest after tooth extraction makes rehabilitation of the posterior maxilla challenging due to low bone density and atrophy, in addition to pneumatization of the maxillary sinus. Maxillary sinus lift surgery prior to implant placement makes implant-supported rehabilitation feasible. This study aimed to describe a case report of maxillary sinus surgery using the side window technique prior to rehabilitation with a prosthesis supported by dental implants, highlighting the importance of planning to minimize intraoperative complications. This is a clinical case report of a 59-year-old male patient who was assisted at a private higher education institution complaining of edentulous spaces and the desire for rehabilitation with implants. He underwent rehabilitation planning, including the surgical treatment of maxillary sinus lifting using the side window technique. Bone gain was confirmed using cone beam computed tomography six months after the surgical approach to the maxillary sinus. The planning of rehabilitation of the posterior maxilla and careful sinus lift surgery using the side window technique is a predictable therapeutic option for clinical cases with bone gain in height of the posterior region of the maxilla prior to the installation of dental implants. The clinical case presented demonstrated success in the gain of bone volume in the posterior region of the maxilla, without postoperative complications, and the patient was still satisfied with the proposed treatment, awaiting complete implant-supported rehabilitation.

How efficacious is the combination of substitute bone graft with autogenous bone graft in comparison with substitute bone graft alone in the horizontal bone gain? A systematic review and meta-analysis

BackgroundA systematic review (SR) was conducted to answer the following focused question based on PICO strategy: In patients who were submitted to horizontal guided bone regeneration, “how efficacious is the combination of substitute bone graft with autogenous bone graft in comparison with substitute bone graft alone, in terms of bone gain?” Material and MethodsMEDLINE (PubMed), Scopus, Embase, Web of Science databases were searched, and hand searches were made up to June 2021, to find randomized clinical trials comparing the clinical effects of autogenous bone graft + substitute bone graft versus substitute bone graft alone in the treatment of horizontal guided bone regeneration. ResultsFour trials representing 109 individuals were included. All studies included in this SR used allogeneic bone graft. The meta-analysis did not show any statistically significant difference between the groups, for horizontal bone gain at a distance of 0 mm (MD: -0.46; 95%CI: -1.03 – 0.11) or at a distance of 4 to 5 mm from the top of the crestal alveolar ridge (MD: 0.17; 95%CI: -1.08 – 1.42). ConclusionsWithin limitations of this systematic review, it was concluded that the addition of autogenous bone graft to the allogeneic bone graft did not significantly increase the quantity of regenerated bone. Key words:Bone graft, bone regeneration, allograft.