Chin Bone Graft Research Articles

Evaluation of platelet-rich fibrin versus collagen membrane for enhancing healing of secondary grafted alveolar cleft: a randomised controlled trial

The purpose of this study was to compare the efficiency of using autologous platelet-rich fibrin versus a resorbable collagen membrane in secondary alveolar bone grafting. Patients were randomly allocated to the three treatment groups: Group 1 - twelve children in whom the nasal layers of the alveolar clefts were repaired using autologous platelet-rich fibrin with autogenous chin bone; Group 2 - twelve children in whom the nasal layers of the alveolar clefts were repaired using bovine collagen membrane type I (Colla-D) with autogenous chin bone; and Group 3 - twelve children in whom the bony alveolar clefts were grafted with autogenous chin bone after construction of a watertight nasal floor had been completed. The study population comprised 36 patients with alveolar clefts, ranging in age from seven to 12 years. At the last follow-up period all groups had stable healing conditions and good radiological outcomes in terms of the alveolar bone height bordering the teeth (both mesially and distally) and the incorporation of grafting material with the surrounding bone. The use of either a PRF membrane and a collagen membrane as an interpositional layer between the nasal layer and the autogenous chin bone graft enhanced bone formation and density in alveolar clefts compared with the control group.

Comparison of vertical bone resorption following various types of autologous block bone grafts

BackgroundThis study aims to measure and compare the differences in vertical bone resorption after vertical augmentation using different types of autologous block bone.MethodsData were collected from 38 patients who had undergone vertical ridge augmentation using an autologous block bone before implant insertion. The patients were divided into three groups based on the donor sites: ramus bone (RB), chin bone (CB), and iliac crestal bone (IB).ResultsThe surgical outcome of the augmentation was evaluated at the follow-up periods up to 60 months. In 38 patients, the mean amount of vertical bone gain was 8.36 ± 1.51 mm in the IB group, followed by the RB group (4.17 ± 1.31 mm) and the CB group (3.44 ± 1.08 mm). There is a significant difference in vertical bone resorption between the groups (p < 0.001), and the RB group demonstrated significantly lower resorption than the CB and IB groups (p = 0.011 and p < 0.001, respectively). The most common postoperative complications included neurosensory disturbance in the CB graft and gait disturbance in the IB graft. Out of the 92 implants inserted after augmentation, four implants were lost during the study period, resulting in an implant success rate of 95.65%.ConclusionsThe RB graft might be the most suitable option for vertical augmentation in terms of maintaining postoperative vertical height and reducing morbidity, although the initial gain was greater with the IB graft compared to other block bones.

Cone-beam computed tomographic comparison of chin symphysis bone particles and allograft versus iliac crest bone graft alone for reconstruction of alveolar bone defects in cleft patients.

ObjectivesThe aim of this study was to compare morbidities and duration of surgery, as well as bone formation in alveolar defects reconstructed with symphysis bone combined with allograft and iliac crest bone graft in patients with cleft palate.Patients and Methods This randomized clinical trial was performed with 22 patients with unilateral alveolar cleft with a follow-up period of 12 months. In 12 patients, alveolar defects were reconstructed with chin bone graft plus allograft (Group A), while for the other 10 patients, iliac bone crest was used as donor site (Group B). Duration of surgery as well as occurrence of morbidities and complications were recorded. In addition, cone-beam computed tomographic (CBCT) scans were performed before surgery and 12 months after surgical procedures in order to compare bone formation between the two groups.ResultsPostoperative CBCT demonstrated a mean bone fill percentage of 76.9% of the alveolar defect in Group A, compared with 77.0% in Group B. Paresthesia in the lower lip or chin did not occur in any patients of Group A. The mean duration of the surgical process was significantly shorter for Group A (40 minutes vs 76 minutes, P<0.001). In addition, patients in Group A regained normal gait faster than patients in Group B (1 day vs 9.5 days).ConclusionMandibular symphysis bone graft in combination with allograft results in favorable outcomes in patients with unilateral alveolar clefts.

Bone marrow aspirate versus two bone autograft types in reconstruction of alveolar cleft: A histomorphometric analysis

Objectives: The aim of this study was to compare histomorphometrically between bone marrow aspirate on a collagen carrier with autogenous bone grafts harvested from two different donor sites in alveolar cleft defect repair.Materials and Methods: eighteen patients with alveoalar cleft defect were included in the study. Twelve out of eighteen patients were reconstructed with auotogenous bone graft; six patients grafted with illium bone graft and six patients grafted with chin bone graft. The remaining patients out of eighteen were reconstructed using bone marrow aspirate implanted on a collagen carrier. Six months after grafting, bone specimens from augmented alveolar ridge sites were retrieved by trephine burs for histomorphometric analysis. Results: Good consolidation of the grafts have been observed, this was demonstrated by intense osteogenesis indicating an active remodeling process. In all groups, the improvement in bone quality of the receptor site was clear with no statistical significance between the groups, however, the autografts presented better bone quality.Conclusions: From this study it was possible to conclude that quality of bone repair using autogenous bone graft is superior to bone marrow aspirate. The time needed for bone maturation is less when chin or iliac autogenous grafts have been used in comparison to the bone marrow aspirate.

Dental arch expansion after alveolar cleft repair using autogenous bone marrow derived mesenchymal stem cells versus autogenous chin bone graft

Alveolar cleft repair is well established, with bone grafting in mixed dentition phase. Mesenchymal derived stem cells were applied to different kinds of bone substitute and compared in different animal models..This study aimed to evaluate the bone quality and quantity at the alveolar cleft sites that were repaired with autogenous mesenchymal stem cell and its effect on orthodontic dental arch expansion and compare these results with cases treated with autogenous chin bone graft. Patients and methods:16 patients (14 left and 2 right, 9 males and 7 females)with unilateral alveolar cleft were included in this study. The age range was 7-12 yearswithmean age was 9.5 years. The alveolar cleft was repaired surgically and the patients were divided into 2 groups ( 8 patients in each one)according to surgical technique of repair. Group I ( 5 males and 3 females) : surgical repair was done by using autogenous bone marrow derived mesenchymal stem cells. Group II (4 males and 4 females): surgical repair was done by using autogenous chin bone grafting. The patients were undergo to orthodontic dental arch expansion and followed up to 18 months clinically and radiographically to evaluate and compare the effect of grafting types on arch expansion.Results: The results of this study revealed that the patients in group I who treated by stem cell technology have a clinical results superior than the patients in group II who treated with chin bone grafting. Radiographic results revealed that in group I the bone quality and quantity were superior than that in group II.Conclusion: The autogenous bone marrow derived mesenchymal stem cells is a good technique in repair of alveolar cleft as it promote the bone healing capacity with high quantity and quality as well as enhance orthodontic arch expansion.

Sandwich Bone Augmentation (SBA) in immediate implant placement post dentoalveolar trauma: a case report

Objective: Reporting the application of SBA procedure with titanium mesh as an alternative solution for immediate implant placement in socket with dentoalveolar trauma-induced buccal bone defect.Methods: An 18-year-old female patient visited our department, with a history dentoalveolar trauma and a loss of tooth 21. Clinical examination during the implant placement procedure exposed a socket with buccal bone defect. SBA with autogenous chin bone graft combined with DFDBA allograft and stabilized with titanium mesh (Ti-Mesh) for buccal defect on which flap reposition was done with tension free primary closure.Results: Ti-Mesh was removed after 3 months which no sign of inflamation appeared, implant was in a stable condition and new bone formation was observed. Subsequently, healing abutment was placed. A one-year observation suggested a good clinical retention with no luxation observed, along with decent functional and esthetic results. CBCT evaluation showed buccal bone thickness preserved.Conclusion: Sandwich bone augmentation with stabilized titanium mesh provides a satisfying result in treating horizontal buccal bone defect.

A Prospective Study of Chin Bone Graft Harvesting for Unilateral Maxillary Alveolar Cleft During Mixed Dentition

The chin is a common donor site for alveolar cleft bone grafting. The amount of bone available at this site can be limited, because conservative harvesting with mixed dentition must consider the incisive nerve, the unerupted mandibular canine, and the integrity of the inferior mandibular border. Patients with nonsyndromic unilateral alveolar cleft in the mixed dentition stage were selected for this study. The volume of bone obtained from the mandibular symphysis (symphysis menti), degree of alteration in lower lip sensation, anterior tooth vitality, remaining bone in the alveolar cleft, and bone defects at the donor site 1year after surgery were evaluated. Eighteen patients were enrolled in this study. The mean volume of bone harvested from the symphysis was 2.1mL (range, 1.6 to 2.3mL). For all cases, the bone volume harvested from the symphysis was insufficient to fill the alveolar cleft defect, and allograft had to be added to completely fill the cleft. Allograft was admixed in the range of 0.5 to 1mL with autogenous bone harvested from the mandible. Lower lip sensation and vitality of the anterior teeth of the mandible were within the normal range 1year after surgery in all cases. Fourteen of 18 patients (77.8%) had normal bone height or bone height at least three fourths of the expected height in the grafted alveolar cleft after 1year; only 10% of the defect remained in the mandible. The amount of bone yielded by conservative monocortical bone harvest from the mandibular symphysis during the mixed dentition stage for unilateral alveolar cleft bone grafting is not sufficient in volume and should be mixed with allograft. However, donor site morbidity is low with this approach.

Changes in the lower lip soft tissue after bone graft harvesting from the mandibular symphysis

Following the surgical release of the mentalis muscle, lip incompetence and/or an increase in lower incisor exposure may be seen due to undesirable attachment of the muscle fibres. The aim of this study was to evaluate the extent of lip ptosis, lower incisor exposure, and other soft tissue changes following bone graft harvesting from the mandibular symphysis when the mentalis muscle is reapproximated precisely to its original position. Seventeen consecutive patients who underwent bone graft harvesting from the mandibular symphysis were included in this study. The mentalis muscle was isolated, identified, marked, and reapproximated precisely during the bone harvesting operation. Digital lateral cephalograms obtained preoperatively and at 6 months postoperative were analyzed and compared by paired samples t-test to determine the horizontal and vertical soft tissue changes in the lower lip and chin. Although the soft tissue thickness at soft tissue point B and at soft tissue pogonion had increased significantly at 6 months after chin bone graft harvesting, there were no significant changes in lower incisor exposure or other positional alterations of the lower lip (P<0.05). Precise reattachment of the mentalis muscle in its original position helps to avoid significant vertical positional changes in the lower lip. Increases in soft tissue thickness can be observed following bone graft harvesting from the mandibular symphysis.

Alveolar Cleft Reconstruction Using Chin Bone and Autogenous Tooth Bone Graft Material: Reports of 5 Cases

Purpose: To report the successful results of using chin bone graft and autogenous tooth bone graft material (AutoBT) in alveolar cleft patients. Materials and Methods: Five patients with alveolar cleft defects underwent alveolar bone grafting. Three patients were treated using chin bone graft, and the other two patients underwent AutoBT graft. After implant site development using chin bone graft in the fi rst three cases, endosseous implant restorations were placed. In case #4 and 5, AutoBT graft material was placed to guide the normal eruption of partially impacted maxillary right canine and to the upper docking site after distraction osteogenesis. Result: Successful implant restorations with closure of the oronasal fistula were achieved in alveolar cleft defect reconstruction using either chin bone graft (Case #1, 2, 3) or AutoBT graft material (Case #4, 5). Case #4 showed enlarged follicle of the right maxillary canine, indicating a normal eruption guide pattern. Conclusion: Both chin bone graft and AutoBT graft showed favorable outcomes in reconstructing alveolar cleft defects. Autogenous tooth bone graft opens up the possibility of avoiding harvesting autogenous bone graft with complications and morbidities.

Tope precondíleo, una alternativa quirúrgica para el tratamiento de la luxación crónica mandibular Modificación a la técnica de Norman Experiencia en 12 pacientes

AimThe aim of the present article was to describe use of chin bone graft to increase articular eminence as preferred treatment for mandibular chronic luxation. Patients and methodsThe present study was undertaken with 12 patients, average age 44 years. Patients had been diagnosed as suffering from chronic mandibular luxation (dislocation), with pain symptomatology rating 8 or more in the Analogous Visual Scale (AVS). Patients had experienced an average 1.5 year evolution and 55 mm or more oral opening. Patients had been conservatively treated for at least three months, with no visible improvement. Patients were then treated following a modified Norman technique, in which an articular eminence augmentation is performed with a chin bone graft placed through pre-auricular approach. ResultsNone of the patients presented new dislocation events during the 18 month follow up period after surgery. ConclusionsThe present study showed the fact that mandibular chronic dislocation correction with placement of precondylar stop with chin bone graft is an effective and safe technique.

Evaluation of Patients’ Perceptions of Alterations After Chin Bone Graft Harvesting

To evaluate patients' perceptions of alterations occurring after chin bone harvesting. Thirty patients were evaluated subjectively by visual analog scale-related sensitivity, facial aesthetics, eating, speaking, and lower lip movement, during 12 months. Objective analysis used the static light touch neurosensorial test. The statistical analysis was executed with Friedman test with P < 0.05 for both samples. Subjective analysis revealed no alterations (1) to facial aesthetics, eating, speaking or lower lip movement but sensitivity of the mental region went from a lot of alteration initially (5) to little at the end of the study (3). Objective analysis results showed normal sensitivity (1) in the region after 12 months. The discrepancy between subjective and objective analyses may be indicative of the limited precision of clinical testing for subjective impressions assessment.

Safe zone for bone harvesting from the interforaminal region of the mandible

The mandibular incisive nerve can be subjected to iatrogenic injury during bone graft harvesting. Using cone beam computed tomography (CBCT), this study aims to determine a safe zone for bone graft harvesting that avoids injuring this nerve. Sixty CBCT examinations of patients were included in this study. The examinations were taken using the i-CAT CBCT imaging system, applying a standardized exposure protocol. Image reconstruction from the raw data was performed using the SimPlant dental implant software. The distances of mandibular incisive canal (MIC) to the inferior border and the labial and lingual cortices of the mandible were measured at 3, 5, 7 and 9 mm mesial to the mental foramen. The MIC was visible in all (100%) CBCT images. The median distance and interquartile range from the lower border of the mandible was 9.86 (2.51) mm, curving downwards toward the inferior mandibular border at the symphysis menti. It was located closer to the buccal border of the mandible (3.15 [1.28] mm) than lingual cortex (4.78 [2.0] mm). The MIC curves toward the lingual side at the symphysis menti. There was gender difference in a number of these measurements. Current recommendation for chin bone graft harvesting can be applied to Asian subjects. While acknowledging that there is human variability, this study provides an accurate anatomic location of the MIC, which in turn helps to determine a safe zone for chin bone graft harvesting. This information can become a useful guide in centers where CBCT is not available.

Prospective study of soft tissue contour changes following chin bone graft harvesting

This study sought to evaluate changes in the soft tissue contour after chin bone graft harvesting. Thirty selected patients underwent chin bone graft harvesting and evaluations were made using lateral cephalograms preoperatively and postoperatively at 30 and 180 days. Fixed points and lines were established on cephalometric tracings and used to measure the selected vertical and sagittal parameters. Results showed statistically significant alterations to the vertical position values of the vermilion (V-VPV) which increased from 9.70 to 11.01 and the exposure of lower incisors (V-ELI) which increased from 1.85 to 3.5, showing an increase in their distance from the plane of reference and a lowering of their position, the clinical equivalent of a labial ptosis condition. None of the sagittal parameters analysed showed any statistically significant variation in the final evaluation. The study concluded that the alterations to patients’ soft tissue contours resulted mainly from failure to ensure precise reattachment of the mentalis muscles and identified the need for further investigation of that aspect.

Application of ultrasound in bone surgery: Two case reports

The present study describes some of the applications of ultrasound in bone surgery, based on the presentation of two clinical cases. The Piezosurgery® ultrasound device was used (Tecnología Mectron Medical, Carasco, Italy). In one case the instrument was used to harvest a chin bone graft for placement in a bone defect at level 1.2, while in the other case a bony window osteotomy was made in the external wall of the maxillary sinus, in the context of a sinus membrane lift procedure. The Piezosurgery® device produces specific ultrasound frequency modulation (25-29 kHz), and has been designed to secure increased precision in application to bone surgery. This instrument produces selective sectioning of the mineralized bone structures, and causes less intra- and postoperative bleeding. One of the advantages of the Piezosurgery® device is that it can be used for maxillary sinus lift procedures in dental implant placement. In this context it considerably lessens the risk of sinus mucosa laceration by preparing the bony window in the external wall of the upper maxilla, and can be used to complete the lifting maneuver. The use of ultrasound in application to hard tissues can be regarded as a slow technique compared with the conventional rotary instruments, since it requires special surgical skill and involves a certain learning curve.

Secondary Bone Graft for Cleft Lip and Palate

Autogenous iliac particulate cancellous bone and bone marrow (PCBM) grafts have been widely used for secondary bone graft of the alveolar cleft sites. However, harvesting bone from iliac crest bone of the small body often affects surgical damage and demands limitation of motion. Therefore, chin bone graft would be good choice in terms of those problems. Bone volume of harvestable from unerupted canine-chin area, however, is always less than required. An absorbable bone substituting material, beta-tricalcium phosphate (β-TCP), is often utilized to restore the non-congenital bone defects in orthopedic surgery, and can be a candidate material with bone grafting.

Bone quality at the implant site after reconstruction of a local defect of the maxillary anterior ridge with chin bone or deproteinised cancellous bovine bone

The purpose of this study was to investigate the quality of bone at grafted implant sites in the anterior maxilla. Grafting of these sites was necessary because of insufficient bone volume in a buccopalatinal direction (width at the top of the crest 1–3 mm). Reconstruction was performed with chin bone ( N = 5), chin bone and a resorbable Bio-Gide ® GBR membrane ( N = 5) or Bio-Oss ® spongiosa granules in combination with a Bio-Gide ® GBR membrane ( N = 5). Biopsies were taken prior to implantation, i.e. 3 months after grafting with chin bone, and 6 months after grafting with Bio-Oss ®. Evaluation was done by assessing the histological and histomorphometric characteristics of full-length biopsies taken from the actual implant site. Both areas with non-vital bone and areas with apposition of bone and remodelling phenomena were observed in the chin bone group at the time of placement of the implants. Similar results were observed at implant sites reconstructed with a chin bone graft covered by a membrane. In the chin bone group without and with a GBR membrane, the mean total bone volume (TBV) was 55.2 ± 6.8% and 57.7 ± 11.5%, respectively; the marrow connective tissue volume (MCTV) was 44.8 ± 6.8% and 42.3 ± 11.5%, respectively. Remnants of the resorbable GBR membrane were not detected. In the Bio-Oss ® group, at implant placement some newly formed bone was observed in the connective tissue surrounding the Bio-Oss ® particles (mean TBV (newly formed bone) 17.6 ± 14.5%), but most particles were surrounded by connective tissue. No convincing signs of remodelling were observed (mean remaining Bio-Oss ® volume 40.5 ± 9.3%; mean MCTV 41.9 ± 13.1%). No implants were lost during follow up (12 months). At the time of placement of the implants the grafting material (either chin bone or Bio-Oss ®) is still not fully replaced by new vital bone. In case of Bio-Oss ®, most of the grafting material is even still present. Despite these differences, the 1-year clinical results were very good and comparable between the various grafting techniques applied.

Morbidity of chin bone harvesting.

The chin is a very common donor site for autogenous bone grafts. The aim of this retrospective study was to evaluate long-term morbidity of the donor site following chin bone graft harvesting. One to three years after grafting of local bone defects of the anterior maxilla with chin bone, 21 patients were recalled for objective assessment of any residual morbidity at the harvesting area. Morbidity as well as satisfaction of the patients were evaluated by a survey of the medical record, a mail-in questionnaire, and a standardized physical examination. The outcome of this study showed that there was good acceptance of the chin bone harvesting procedure. The objective morbidity was low, but subjectively almost half of the patients reported a changed (decreased) sensibility in the harvesting area. This subjective change in sensibility did not result in noteworthy complaints or discomfort by the patients, however. Although bone harvesting from the chin is generally considered as a good option for reconstruction of local bony defects, the patients should be informed about the potential hazard of a changed sensibility in the chin region.

The chin as a donor site in early secondary osteoplasty: a retrospective clinical and radiological evaluation

26 unilateral cleft palate patients received an autogenous bicortical chin bone graft for early reconstruction of the alveolar process. In the evaluation of the donor site, 4% of the anterior teeth showed a negative pulpal sensibility, less than 1% a peri-apical granuloma and 12% pulp canal obliteration. The tooth buds of the canines showed developmental disturbances in 6%. Exposure of unerupted canines should be avoided, and a 5 mm safety margin is advised. Based on its architecture, topographic accessibility, minimal post-operative morbidity and absence of visible scars, the chin can be considered to be a very useful donor site in bone grafting procedures.