Horizontal Bone Augmentation Research Articles

New titanium mesh design method in customized bone regeneration of the jaws: preliminary study on a sample of 11 patients

The aim of this study is 1) to present a new method of virtually-designed custom made scaffolds to be employed in customized bone regeneration (CBR) for segmental jaw atrophies and 2) to evaluate long-term clinical results in terms of bone regeneration success and implant rehabilitation success. A total of 11 patients with edentulousness and bone atrophy in a localized area of the mandible or the maxilla were recruited for the study. To fulfill the research inquiries, CT images of the pre-regeneration mandibular or maxillary arch of each patient were collected. A dedicated Mevislab 2.4 software was employed to virtually design custom bone regeneration meshes designed to fit the atrophic sector of each patient's mandible or maxilla. Subsequently, a second Meshmixer software was used to refine the margins of each of the designed meshes. All patients underwent oral surgery, during which a mixture of autologous and heterologous bone in a 1:1 proportion was grafted into the atrophic site, a custom-made mesh was placed, and a resorbable membrane was inserted. The mesh was removed after this procedure, and implant rehabilitation was performed. All patients underwent the bone regeneration procedure, with eight undergoing titanium mesh removal. A total of seven patients completed implant rehabilitation. Average horizontal bone augmentation was 3.525 ± 1.36 mm; average vertical bone augmentation was 4.45 ± 2.22 mm. Implant survival was 92.85%. During the healing phase, complications occurred in 9.09% of patients. The use of dedicated software, Mevislab 2.4 and Meshmixer, for titanium mesh design is an accurate, predictable, effective, and quick-to-use method. The learning curve for design is uncomplicated and rapid. Mesh exposure does not necessarily lead to bone graft failure; this complication can be treated by chlorhexidine aids.

A narrative review on the use of autologous platelet concentrates during alveolar bone augmentation: Horizontal (simultaneous/staged) & vertical (simultaneous/staged).

This review aimed to answer the general question of whether autologous platelet concentrates (APCs, an autologous blood-derivative) can improve the outcome of alveolar bone augmentation. Three clinical scenarios were assessed: horizontal/vertical bone augmentation in combination with implant placement (simultaneous approach), horizontal bone augmentation in a staged approach, and vertical bone augmentation in a staged approach. An electronic literature search strategy was conducted for each review from the outset to July 1st, 2023. The titles and abstracts (when available) of all identified studies were screened and imported into a database. If articles appeared to meet the inclusion criteria or their title and abstract had insufficient data, the full text was obtained to make the final decision. All studies that met the inclusion criteria underwent data extraction. Moreover, the references of the identified papers were screened for additional studies. After title and abstract screening and selection criteria application, 14 clinical studies were included for the qualitative analysis: seven for horizontal/vertical bone augmentation in a simultaneous approach, five for horizontal bone augmentation in a staged approach, and two for vertical bone augmentation in a staged approach. There is scarce literature regarding the added value of APCs in bone augmentation, and most studies had small sample sizes, a lack of standardized protocols, and different outcome variables, which makes comparisons between studies difficult. Out of the 14 studies, four were well-designed randomized clinical trials, where we could find better results for the APCs groups. Most studies, particularly comparative and well-designed studies, demonstrated beneficial and promising results of using APCs in alveolar bone augmentation. However, before high-level evidence-based conclusions can be drawn, more randomized clinical trials must compare the benefits of adding APCs to the gold-standard approach.

Higher solubility and lower onset temperature of protein denaturation increase the osteoconductive capacity of collagen membranes: A preclinical invivo study.

Collagen membranes are extensively used for guided bone regeneration procedures, primarily for horizontal bone augmentation. More recently, it has been demonstrated that collagen membranes promote bone regeneration. Present study aimed at assessing if structural modifications of collagen membranes may enhance their osteoconductive capacity. Twenty-four adult Wistar rats were used. Bilateral calvaria defects with a diameter of 5 mm were prepared and covered with prototypes of collagen membranes (P1 or P2). The P1 membrane (positive control) presented a lower onset temperature of protein denaturation and a higher solubility than the P2 membrane (test). The contralateral defects were left uncovered (NC). After 1 and 4 weeks, the animals were euthanized. A microcomputed tomography analysis of the harvested samples was performed within and above the bony defect. Undecalcified ground sections were subjected to light microscopy and morphometric analysis. Bone formation was observed starting from the circumferential borders of the defects in all groups at 1-week of healing. The foci of ossification were observed at the periosteal and dura mater sites, with signs of collagen membrane mineralization. However, there was no statistically significant difference between the groups. At 4 weeks, remnants of the collagen fibers were embedded in the newly formed bone. In the P2 group, significantly more bone volume, more new bone, and marrow spaces compared to the NC group were observed. Furthermore, the P2 group showed more bone volume ectocranially then the P1 group. Bone formation subjacent to a P2 membrane was superior than subjacent to the P1 membrane and significantly better compared to the control. Modifications of the physico-chemical properties may enhance the osteoconductive competence of collagen membranes, supporting bone formation outside the bony defects.

Case Report: The Sausage Technique using Anorganic Bovine Bone Mineral for Horizontal Bone Augmentation at the Crestal Part of a Posterior Mandibular Ridge: A Case Report.

Following tooth extraction, the alveolar bone goes through a natural remodeling process resulting in a significant bone resorption which may complicate dental implant placement without prior bone augmentation treatment. The sausage technique is a modified guided bone regeneration (GBR) method that has been successfully used for horizontal bone augmentation. This technique was developed to increase the bone growth at the alveolar crest. Although the sausage technique uses a combination of autograft chips and xenograft particles with a native collagen membrane, several studies have questioned whether adding autograft chips is essential for bone formation with guided bone regeneration. Moreover, harvesting the bone graft may increase the donor site morbidity and patient discomfort. This case report aimed to investigate the bone gain radiologically when the sausage technique was applied to treat a healthy, thirty-year-old patient with a horizontal defect in the posterior mandibular region using anorganic bovine bone mineral (ABBM) particles with Jason membrane, assess the implant primary stability in the augmented ridge, and present the surgical procedure steps in details. After nine months of healing, the cone-beam computed tomography (CBCT) revealed approximately 4.32 mm of bone gain at the alveolar crest in the buccal-lingual direction. The graft particles were well integrated into the newly formed bone. Two implants were inserted with an insertion torque of 35 N/cm. The ISQ values were 76 for the most anterior implant and 78 for the posterior implant. Within the limitations of this case report, the sausage technique using ABBM particles without autograft chips was an effective approach in achieving the prerequisite bone width at the crest in cases with horizontal bone defects.

Utilizing Individualized Titanium Frames for Protected Alveolar Bone Augmentation: A Feasibility Case Series.

Despite the various treatments proposed with barrier membranes, one of the main challenges for guided bone regeneration (GBR) is maintaining space for large defects and ensuring an adequate blood supply. The presented feasibility case series aims to introduce an original titanium frame (TF) design, customized for each defect, as a modification of well-known principles and materials for GBR to achieve an enhanced and more predictable horizontal and vertical bone augmentation. Three patients with significant horizontal defects were treated with pre-trimmed TFs to create needed space, and then a 50/50 mixture of autograft and bovine xenograft was placed and covered with a collagen membrane. After 8 months of healing, the sites were reopened, and the titanium screws were removed with the frame. An average of 8.0 ± 1.0 mm of horizontal and 3.0 ± 0.0 mm of vertical bone gain were achieved at the time of reentry and implant placement surgery. Bone core biopsy sample was obtained during the implant placement. Histomorphometric analysis revealed that 42.8% of the sample was new vital bone, 18.8% was residual bone graft particles, and 38.4% was bone marrow-like structures. After 3 to 4 months from implant placement, the implants were restored with provisional crowns and then finalized with zirconia screw-retained crowns. This case series suggests that GBR utilizing TFs with or without collagen membranes can be considered a suitable approach for horizontal and vertical bone augmentation. However, based on only three reported cases, the results should be carefully interpreted.

Histologic evaluation of edentulous alveolar ridge horizontal bone augmentations using a xenogeneic bone substitute and autologous platelet concentrates: a case series.

This case series aimed to assess the efficacy of a novel horizontal ridge augmentation modality using histology. Combinations of "sticky bone" and tenting screws without autologous bone were used as augmentative materials. Five individuals presenting healed, atrophic, partially edentulous sites that required horizontal bone augmentation before implant placement were enrolled. Patients underwent the same augmentation type and 5 months of postoperative reentry procedures. The first surgery served as implant site development, whereas the biopsy and corresponding implant placement were performed during reentry. The bone was qualitatively analyzed using histology and histomorphometry and quantitatively evaluated using CBCT. Four individuals healed uneventfully. Early wound dehiscence occurred in one case. Histology showed favorable bone substitute incorporation into the newly formed bone and intimate contact between de novo bone and graft material in most cases. Histomorphometry revealed an average of 48 ± 28% newly formed bone, 19 ± 13% graft material, and 33 ± 26% soft tissue components. The CBCT-based mean alveolar ridge horizontal increase was 3.9 ± 0.6 mm at 5 months postoperatively. The described augmentation method appears suitable for implant site development resulting in favorable bone quality according to histology. However, clinicians must accommodate 1 to 2 mm of resorption in augmentative material width at the buccal aspect.

CLINICAL AND RADIOGRAPHIC ASSESSMENT OF BOND APATITE IN HORIZONTAL BONE AUGMENTATION AROUND DENTAL IMPLANTS: A RANDOMIZED CONTROLLED TRIAL

Background:Bond apatite is a composite graft, composed of two-thirds biphasic calcium sulfate and one-third hydroxyapatite granules of various sizes and shapes. Oral implants are used to secure dental prostheses in cases of partial or total edentulism. The outcomes of correctly completed dental-implant procedures result in high rates of success and survival of dental prostheses. Objective:The aim of this study was to assess Bond Apatite use in horizontal bone augmentation around dental implants, clinically and radiographically. Materials and Methods:This research included sixteen patients, six men and ten women, with an average age of thirty years having missing maxillary anterior or premolar teeth with insufficient horizontal bone. The patients were divided into two groups: group I patients (N=8) received dental implants with Bond apatite, while group II patients (N=8) received dental implants with Bio-Oss bone graft material and pericardium bioresorbable membranes. All patients were evaluated clinically usingthe modified plaque index (MPI), modified gingival index (MGI) and probing depth (PD) and radiographically to assess bone width dimensions. Results: There was a statistically significant difference between groups regarding MGI(p = 0.038)andperi-implant buccal PD [mm](p = 0.026). There was no statistically significant difference between the tested groups regarding age(p = 0.608), sex(p = 0.123), MPI(p = 0.608),orperi-implant palatalPD [mm](p = 0.118). There was no statistically significant difference between the two groups regarding postoperative bone width (p = 0.187). Conclusion:Bond apatitemay be used as one of the materials of choice for horizontal bone augmentation around dental implants with similar promising results compared to Bio-Oss. Finally, the use of Bond apatite preparation is a straightforward, affordable, and considered successful bone graft material that could be used in osseous defect reconstruction procedure. Trial registration:The study is listed on www.clinicaltrials.gov with registration number (NCT06043258) 22/09/2023. The study was conducted in accordance with the seventh revision of the Helsinki Declaration in 2013 and approved by the Institutional Review Board (IRB) (M07061119) of the Faculty of Dentistry, Mansoura University, Egypt.

Orthodontic Implant Site Development Using Labial Root Torque: A Case Series with CBCT Analysis.

This case series assessed the efficacy of Orthodontic Implant Site Development with Labial Root Torque (OISD-LRT) as a nonsurgical technique for addressing labial bone deficiencies in seven patients. The procedure involved strategically placing a multi-bracket of 2-3 mm apically on the hopeless teeth, gradually shifting them with Ni-Ti wires at the rate of 2 mm per month and maintaining overcorrection for 2 months before extraction. OISD-LRT consistently augmented tissue for flapless guided implant surgery, with an average treatment duration of 404Å}311.7 days. Cone-beam computed tomography (CBCT) scans at various stages revealed increases in both vertical and horizontal bone dimensions, especially in the sockets with complete labial bone loss. Despite inevitable post-extraction reductions in bone height and width, sufficient dimensions were maintained to ensure long-term implant stability. This case series highlights the effectiveness of OISD-LRT as a valuable method for horizontal bone augmentation, particularly in patients with labial bone deficiency. This approach provides a robust foundation for subsequent implant placement, showcasing its success in addressing challenging anatomical conditions and contributing to the broader field of implant dentistry.

Horizontal ridge augmentation in the maxillary aesthetic region using the autogenous circular cortical-lamina anchoring technique: A case series study.

This case series aimed to evaluate the effectiveness of the autologous circular cortical lamina-anchoring (CCA) technique for horizontal bone augmentation in the maxillary aesthetic region. A total of 25 patients with 28 implants underwent horizontal bone augmentation using CCA followed by implant placement and crown delivery. The primary outcome measures were alveolar ridge width (ARW) and buccal bone thickness (BBT), whereas the secondary outcome measures included marginal bone loss (MBL), mid-facial mucosal margin loss (MML), clinical assessment of peri-implant and aesthetic parameters, patient-reported outcome measures (PROMs), and implant survival rates. All 25 patients with 28 implants completed the treatment, no dropouts occurred. After CCA, the mean ARW at 1, 2, and 4 mm below the alveolar crest significantly increased from 2.38 ± 0.48, 2.85 ± 0.51, and 3.21 ± 0.53 mm to 6.80 ± 0.48, 6.99 ± 0.50, and 8.08 ± 0.52 mm, respectively. At the 3-year follow-up, the mean BBT0, BBT2, and BBT4 slightly decreased from 2.51 ± 0.26, 2.63 ± 0.31, and 2.75 ± 0.29 mm to 2.43 ± 0.27, 2.51 ± 0.30, and 2.64 ± 0.28 mm, respectively. Although the overall MBL was <0.15 mm, the results were statistically significant. The mean MML at the 3-year follow-up was 0.02 mm. All implant sites showed acceptable peri-implant and aesthetic outcomes. Incisions healed without complications, and no significant differences in PROMs observed at any time point. The 3-year follow-up showed a 100% implant survival rate. The autologous CCA technique is a useful method for increasing ARW and maintaining BBT in the maxillary aesthetic region.

Multidimensional 3D-Printed Scaffolds for Ridge Preservation and Dental Implant Placement: A Systematic Review

Background: Regenerative medicine in dentistry involves tissue engineering applications suitable for the unique oral environment. In this regard, advances in computer-aided technology have facilitated the creation of 3D scaffolds using cone beam computed tomography (CBCT). This review aimed to investigate whether 3D-printed scaffolds can be effectively used to achieve ridge preservation and/or predictable vertical and horizontal bone augmentation, ensuring successful outcomes for dental implant placement. Methods: A comprehensive search was conducted across six electronic databases (PubMed, Scopus, ScienceDirect, Google Scholar, Web of Science, Ovid) to identify relevant studies according to specific eligibility criteria, following the PRISMA guidelines. Two independent reviewers screened and selected studies, performed data extraction, and assessed the risk of bias using the Cochrane tool for randomized clinical trials and the Newcastle–Ottawa Scale for non-randomized clinical trials. Results: The initial search yielded 419 articles, which were subsequently screened to remove duplicates. After evaluating 293 articles based on title and abstract, 10 studies remained for full-text assessment. Ultimately, only three studies met all the pre-established eligibility criteria. Conclusions: The studies included in this systematic review showed that the use of multidimensional customized scaffolds appears to promote dental implant placement. Nevertheless, despite the positive reported effects, further well-designed randomized clinical trials are necessary to determine the special characteristics of the optimal 3D-customized scaffold.

Multidisciplinary approach for treating vertical ridge defect: case report

Background: The outcomes of trauma may have a ridge defect, and it would be hard to replace it with a simple dental implant treatment technique. In some cases, horizontal and vertical bone augmentation therapy is needed for implant placement. Case Presentation: The case report described a 24-year-old female diagnosed with a severe bony defect and was managed in collaboration with an orthodontic and periodontic treatment plan. Alveolar bone augmentation was approached using Misch’s fashion, an autogenous block graft harvested from intra-oral (ramus). Moreover, Khoury’s split bone block technique was applied to reconstruct the seat. Conclusion: For complicated abnormalities, autogenous bone is still the best choice. Autogenous bone is the gold standard for bone grafting due to its biocompatibility, absence of antigenicity, and osteoconductive and osteoinductive qualities. Further graft extenders or growth factors may result in better outcomes.

Multidisciplinary approach for treating vertical ridge defect: case report

Background: The outcomes of trauma may have a ridge defect, and it would be hard to replace it with a simple dental implant treatment technique. In some cases, horizontal and vertical bone augmentation therapy is needed for implant placement. Case Presentation: The case report described a 24-year-old female diagnosed with a severe bony defect and was managed in collaboration with an orthodontic and periodontic treatment plan. Alveolar bone augmentation was approached using Misch’s fashion, an autogenous block graft harvested from intra-oral (ramus). Moreover, Khoury’s split bone block technique was applied to reconstruct the seat. Conclusion: For complicated abnormalities, autogenous bone is still the best choice. Autogenous bone is the gold standard for bone grafting due to its biocompatibility, absence of antigenicity, and osteoconductive and osteoinductive qualities. Further graft extenders or growth factors may result in better outcomes.

The efficacy of alveolar ridge split on implants: a systematic review and meta-analysis

ObjectivesTo evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate.Materials and methodsElectronic searching was performed in six electronic databases (Pubmed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, and SIGLE) from January 1, 2010, to November 1, 2023. Two authors performed study selection, data extraction, and study qualities (ROBINS-I and RoB 2.0) independently. Meta-analysis was performed by Comprehensive meta-analysis 3.0.Results24 included studies were observational, and 1 study was a randomized controlled trial (RCT). 14 studies investigated the gained width of the horizontal alveolar ridge, and 17 examined the implants’ survival rate. For assessment of risk of bias, nine studies were high risk of bias and 16 studies were moderate risk of bias. Meta-analysis demonstrated that the pooled gained alveolar ridge width was 3.348 mm (95%CI: 4.163 mm, 2.533 mm), and the implant survival rate was 98.1% (95%CI: 98.9%, 96.9%). Seven studies showed seven different complications including exposure, infection, bad split, dehiscence, fracture, paresthesia and soft tissue retraction.ConclusionRecent ARS technique seems to be an effective method of bone augmentation with enough gained width and a high implant survival rate. Further long-term and RCTs research remains needed to enhance the study quality.Clinical relevanceThe ARS technique could generate sufficient bone volume, and implants had a high-level survival rate. Therefore, ARS has been proposed to be a reliable horizontal bone augmentation technique that creates good conditions for the implantation of narrow alveolar crests.

Observation on the effect of plasmatrix bone block applied on alveolar horizontal bone augmentation

A retrospective case series was used to evaluate the effect of plasmatrix bone blocks on bone augmentation at the level of the alveolar ridge. From January 2021 to April 2022, a total of 25 patients who underwent horizontal alveolar ridge level bone augmentation in the Department of Implantology, Wuhan Dazhong Stomatological Hospital were included. Autologous bone chips, deproteinized bovine bone matrix and plasma matrix were used to make plasma matrix bone blocks, combined with absorbable collagen membrane and plasma matrix membrane for guided bone regeneration. Three-dimensional reconstruction was performed on the cone beam CT data before operation and 6 months after operation, and the bone width and alveolar bone volume at 2 and 8 mm from the alveolar crest were measured. The paired t test was used to compare the differences between two time points of the same measurement item. The results showed that compared with preoperative [(5.5±3.4) mm] bone width, the bone width [(9.5±2.5) mm] at 2 mm from the alveolar crest was significantly increased at 6 months after operation (t=3.40, P˂0.001); there was no significant difference in the bone width at the level of 8 mm from the alveolar crest between pre-and 6 months post-operation (t=3.13, P=0.050). The volumes of alveolar bone at 2 and 8 mm from the alveolar crest were (5 114±3 883) and (3 329±2 874) mm3 before operation, respectively, and these increased significantly to (5 999±4 318) and (4 042±3 260) mm3 (t=5.69, P˂0.001; t=5.689, P˂0.001) 6 month post-operation. The results from this study has shown that the use of plasmatrix bone blocks+absorbable collagen membrane+plasma matrix membrane for horizontal bone augmentation in guided bone regeneration has a promising bone augmentation outcome.

Barbell Technique: A Novel Approach for Bidirectional Bone Augmentation: Clinical and Tomographic Study.

Horizontal bone augmentation is a common surgical procedure used in implant therapy to achieve adequate bone volume to permit dental implant placement. However, most current techniques are focused on unidirectional bone reconstruction (grafting only on the buccal side). This study was carried out to validate a new device that will permit bidirectional bone augmentation. Ten patients of both sexes (7 women and 3 men), with ages ranging from 29 to 62 years, who needed a bidirectional horizontal bone augmentation in maxilla were separated in accordance with the horizontal alveolar change (HAC) classification published by Pelegrine et al (2018). The patients classified as HAC 3 (ie, containing remaining cancellous bone at the recipient bed) received the Barbell device with xenogeneic biomaterial and a collagen membrane, whereas HAC 4 patients (ie, with no remaining cancellous bone at the recipient bed) received the Barbell device with a mixture of autogenous bone chips and xenogeneic biomaterial covered by a collagen membrane. For each patient, two computerized tomography scans were performed (T0 at baseline and T1 at 6 months postoperative examinations). Mean bone thickness (T0) in the studied sites were 3.25 ± 0.35 in HAC 3 and 1.98 ± 0.5 in HAC 4 patients. The mean bone thickness achieved after 6 months was 7.70 ± 0.89 mm and 8.62 ± 0.89 in HAC 3 and 4, respectively. All grafted sites were able to receive dental implants in adequate prosthetic positions. Based on these results, the use of this novel device permits bidirectional horizontal bone augmentation.

Guided bone regeneration in implant dentistry: Basic principle, progress over 35 years, and recent research activities.

Bone augmentation procedures are frequent today in implant patients, since an implant should be circumferentially anchored in bone at completion of bone healing to have a good long-term stability. The best documented surgical technique to achieve this goal is guided bone regeneration (GBR) utilizing barrier membranes in combination with bone fillers. This clinical review paper reflects 35 years of development and progress with GBR. In the 1990s, GBR was developed by defining the indications for GBR, examining various barrier membranes, bone grafts, and bone substitutes. Complications were identified and reduced by modifications of the surgical technique. Today, the selection criteria for various surgical approaches are much better understood, in particular, in post-extraction implant placement. In the majority of patients, biodegradable collagen membranes are used, mainly for horizontal bone augmentation, whereas bioinert PTFE membranes are preferred for vertical ridge augmentation. The leading surgeons are using a composite graft with autogenous bone chips to accelerate bone formation, in combination with a low-substitution bone filer to better maintain the augmented bone volume over time. In addition, major efforts have been made since the millenium change to reduce surgical trauma and patient morbidity as much as possible. At the end, some open questions related to GBR are discussed.

Vertical and horizontal bone augmentation with three-dimensional-printed biodegradable membrane: a case report

Vertical and horizontal bone augmentation with three-dimensional-printed biodegradable membrane: a case report

Comparison of Guided Bone Regeneration with Periosteal Pocket Flap Technique Versus Autogenous Bone Block Graft for Horizontal Bone Augmentation: A Clinical Trial Study

The aim of this study was to assess changes in the horizontal dimension of the alveolar ridge when the autogenous bone block (ABB) or periosteal pocket flap (PPF) techniques were performed prior to implant placement. This randomized trial study was conducted on 25 patients in need of horizontal bone augmentation, who were randomly divided into two groups as follows: 13 patients underwent ridge augmentation using ABB, allograft, and a collagen membrane, while the remaining 12 underwent horizontal bone augmentation via the PPF technique. For all patients, radiographic examinations via CBCT were performed both before and 26 weeks after the operation. Following the surgery, dimensional changes in the ridge width were measured both within and between the two groups in the three regions of 0, 3, and 5 mm from the top of the alveolar crest. A total of 11 patients in the ABB group and 12 patients in the PPF group successfully completed the study. Statistical analysis showed that the increase in alveolar ridge width in each group was significant, but not significantly different between the two groups at any of the measured spots (0 mm from the crest, P = .25; 3 mm, P = .38; and 5 mm, P = .73). However, more postoperative complications were observed with the ABB technique. According to the results of the present study, there was no statistically significant difference between the PPF and ABB techniques in terms of horizontal bone gain.

Shell Technique with a Xenogeneic Cortical Bone Lamina and Particulate Bone Graft for Horizontal Ridge Augmentation: A Case Series

The aim of this prospective case series was to evaluate the efficacy and safety of a xenogeneic cortical bone lamina utilized as a "shell" on the buccal aspect of narrow alveolar ridges for horizontal bone augmentation. Fifteen patients requiring multiple implant restorations at sites with moderate to severe horizontal bone deficiency were consecutively enrolled. Horizontal bone augmentation was performed using a xenogeneic cortical bone lamina (XCBL), that was fixed on the buccal aspect of the ridge using titanium screws, and a mixture of particulate autogenous bone graft and porcine hydroxyapatite. Cone-beam computed tomography (CBCT) scans were taken at baseline and 6 months after bone augmentation. The healing was uneventful, with no intra- or post-operative complications. Twenty-seven dental implants were placed in the augmented sites. The calculated average horizontal bone gain from CBCT scans was 4.79 ± 1.64 mm, 5.59 ± 1.51 mm, and 5.79 ± 2.53 mm at 1-, 3- and 5-mm reference points apical to the buccal bone crest, respectively. The present case series demonstrated that the shell technique with the xenogeneic cortical bone lamina and particulate bone graft can be an effective approach for horizontal bone augmentation prior to implant placement.

A New Concept of Horizontal Bone Augmentation Using Collagen Bovine Bone Blocks Without Membrane at Implant Placement: A Preliminary Study.

A buccal bone thickness (BBT) of at least 1.8-2mm is necessary to ensure long-term implant stability, and a bone grafting procedure is commonly needed to restore this BBT. This study aims to prove the effectiveness of a novel bone augmentation technique in which minero-organic bone substitutes are solely used to restore adequate BBT, excluding the need for coverage membranes. Fifty partially edentulous patients having a residual bone width ranging between 5 and 6mm were enrolled in this study. The horizontal buccal defects were grafted simultaneously at implant placement. Minero-organic collagen bovine bone blocks (CBBB) were placed on the outer side of the buccal bone wall, and adapted to the defect morphology through slow compressive movements. The grafted sites were not covered with any type of membrane nor stabilized with fixation pins. Cone-beam computed tomography scans were obtained pre-operatively, immediately post-surgery, and four months later. Scans were superimposed on the ITK-Snap software to measure the amount of bone gain and assess the percentage of CBBB resorption. Measurements were effectuated at four different levels apically to crestal level. Radiographic findings showed BBT increase and CBBB resorption in all cases, four months post-grafting. A mean horizontal bone gain of 1.39mm was calculated at a crestal level. Based on these findings, it appears that this novel and user-friendly bone grafting technique can achieve positive outcomes from both clinical and radiographic perspectives.