Horizontal Defects Research Articles

Radiographic Assessment of Buccolingual Dimension of Allogenic Bone Ring When Used Simultaneously with Dental Implant Placement

Purpose: This study aimed to evaluate the use of allogenic bone ring technique to restore the bucco-lingual dimension of the alveolar bone defects combined with simultaneous dental implant placement. Subjects and methods: Ten patients requiring bone augmentation horizontally or both horizontally and vertically at the time of implant placement were included in this retrospective study. All patients received simultaneous bone augmentation surgery and implant placement with allogenic bone ring grafts. Postoperative efficacy of the technique was evaluated using CBCT as a radiographical parameter. Results: Survival rates of implants were 100%. Cone-beam computed tomography revealed that the allogenic bone ring graft had significantly sufficient horizontal bone augmentation below the implant neck platform to 0 mm, 1 mm, 2 mm, and 3 mm. It could also provide an excellent peri-implant tissue condition during the 6 months’ follow-up after loading. Conclusion: The bone ring technique with allogenic bone ring graft could increase and maintain horizontal bone mass in the region of the implant neck platforms in serious horizontal bone defects.

Treatment of a complex restorative case by proposing a new prognostic index: A clinical case report with 3 years’ radiological follow-up

ABSTRACT Elderly patients with multiple missing teeth, failed restoration, retained roots, and vertical and horizontal bone defects are very challenging to treat. This type of case needs strategic planning. A new index is proposed to assess the prognosis of individual teeth. Treatment planning is done for each quadrant and later conceptualized as a single entity. Diagnostic wax-up is an important step to educate and visualize the future restorative plan. The health of an individual tooth determines its usefulness in restorative rehabilitation. The osseous defect can be resolved by proper occlusal load distribution without the use of a bone graft. A 3-year radiological follow-up is done to assess the health of the tooth and endosseous implant. The patient’s health and quality of life were significantly improved.

Defect Detection inside a Rail Head by Ultrasonic Guided Waves

Early detection of defects inside a rail is of great significance to ensure the safety of rail transit. This work investigated the ability of ultrasonic guided waves (UGWs) to detect internal defects in a rail head. First, the model of UGW propagation in rail, which has an irregular cross-section, was constructed based on the semi-analytical finite element (SAFE) method. Fundamental characteristics, such as wavenumber, phase or group velocity, and wave structure inside the rail, were then calculated. Following modal and vibration energy distribution analysis, a guided wave mode that is sensitive to transverse fissure (TF) defects was selected, and its excitation method was proposed. The effectiveness of the excitation method was confirmed by simulations performed in the ABAQUS software. According to the simulation data, the dispersion curve calculated by using the two-dimensional Fourier fast transform (2D-FFT) coincided well with that of the SAFE method. After that, the sensitivity of the selected mode to internal rail defects was validated and its ability to locate defects was also demonstrated. Finally, the effects of excitation frequency, defect size, and vertical and horizontal defect depth on the reflection waveforms were investigated.

P-002 PREOPERATIVE USE OF BOTULINUM TOXIN A FOR COMPLEX ABDOMINAL WALL HERNIAS: SIMPLIFICATION OF ANATOMICAL RECONSTRUCTION AND REDUCTION OF COMPONENT SEPARATION TECHNIQUES

Abstract Aim Botulinum toxin A (BTA) may facilitate abdominal wall reconstruction for giant abdominal wall hernias. Complications after preoperative conditioning of the abdominal wall with BTA and subsequent surgical treatment have been poorly studied. Methods From 2018 to 2021, 31 patients with complex abdominal wall hernia were enrolled. Data were analyzed descriptively, risk factors, comorbidity, operative procedure, surgical site occurrences, and especially BTA-associated complications were documented. Key points were adverse effects, the rate of anatomical reconstruction, and reduction of component separation techniques. Results 23 male and 8 female patients with a mean age of 62.7 years were included. The mean body mass index was 27.8 kg/m2. 61% had an ASA-Score over 3. The median duration of hospital stay was 11.6±5.2 days. The mean horizontal hernia defect was 13±5 cm, and the mean hernia gap area was 181.7±116 cm2. 83% were medial hernias with more than 10 cm hernia gap. Surgical reconstruction was performed using component separation techniques (CS) with mesh augmentation (61%), retromuscular sublay with CS (20%), and hybrid procedure (VAMOS) (9%). Complete closure of the anterior fascia was achieved in 100%. Anterior CS was necessary for 19%, and posterior CS was needed in 61%. The surgical site occurrences rate was 19%, with no BTA-associated complications. No hernia recurrence occurred during the follow-up period to date since 2018. Conclusion Preoperative conditioning of the lateral abdominal muscles with BTA seems to be a safe and effective method to facilitate tension-free anatomic reconstruction of the abdominal wall under the reduction of component separation.

Custom-made computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) synthetic bone grafts for alveolar ridge augmentation: A retrospective clinical study with 3 years of follow-up

PurposeTo report on the results obtained with computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) custom-made synthetic hydroxyapatite/beta-tricalcium-phosphate (HA/beta-TCP) bone grafts in alveolar ridge augmentation for dental implant placement. MethodsThe procedure included: (1) cone-beam computed tomography (CBCT) of the bone defect; (2) virtual design of the custom-made onlay bone grafts; (3) milling of grafts from a pre-formed block of synthetic HA/beta-TCP; and (4) bone reconstructive surgery. Implants were placed 8 months later. The patients were followed for 3 years. The study outcomes were: (1) intra- and immediate post-operative complications; (2) 8-month vertical and horizontal bone gain; (3) implant survival; (4) implant-crown success; and (5) peri-implant marginal bone loss (MBL). ResultsTwenty-six patients underwent ridge augmentation with custom-made CAD/CAM HA/beta-TCP onlay grafts. Eight months later, these patients were rehabilitated with dental implants. During surgery, 25/26 (96.1%) of the grafts adapted well to the bone defect. Immediate post-operative complications were pain and swelling (2/26 patients: 7.6%), and bone graft exposure (3/26: 11.5%); one exposure led to infection, removal of the graft, and failure of the procedure. Excellent integration of the other grafts was observed 8 months after the regenerative procedure, with mean vertical and horizontal bone gains of 2.10 mm (± 0.35) and 2.96 mm (± 0.45), respectively. Twenty-five implants were placed and restored with single crowns. Three years later, all implants were in function. The 3-year implant crown success rate and peri-implant MBL were 92.0% and 0.7 mm (±0.19), respectively. ConclusionsWith custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts reconstruction of small vertical and/or horizontal defects of the alveolar ridge was obtained; this enabled implant placement, with high implant-crown success rate after 3 years. Further studies are needed to validate this technique. Statement of Clinical RelevanceCustom-made CAD/CAM synthetic HA/beta-TCP onlay grafts may represent an option for regeneration of small bone defects prior to implant placement.

Customized Titanium Mesh for Guided Bone Regeneration with Autologous Bone and Xenograft.

The augmentation of the alveolar crest after the loss of one or several teeth can be carried out using different bone augmentation techniques. These techniques include bone distraction, ridge expansion, bone block grafts, etc. Guided bone regeneration is an alternative to increase the volume of the hard tissues for the subsequent placement of the implants in the optimal three-dimensional position. The objective of this paper is to show a case report of the use of customized titanium mesh for posterior vertical bone regeneration. Case report and Results: A 59-year-old woman comes to rehabilitate edentulous spaces with implants. After taking the anamnesis and the intra and extraoral exploration, a vertical and horizontal bone defect is observed in the third quadrant. After the radiological study with CBCT, a bone height of 6.04 mm to the inferior alveolar nerve and a width of the bone crest of 3.95 mm was observed. It was decided to carry out a regeneration with a preformed titanium mesh (Avinent®, Santpedor, Spain) and four microscrews (Avinent®, Santpedor, Spain). The flap was closed without tension. Regular check-ups were performed without complications. At 7 months, the mesh was removed and two osteoingrated implants (Avinent®, Santpedor, Spain) were placed with a torque greater than 45 N/cm and an ISQ of 82 and 57 N/cm, respectively. The bone gain obtained was 1.84 and 1.92 mm in width and 4.2 and 3.78 mm in height for positions 3.5 and 3.6. The newly formed bone, obtained by trephine, was well-structured and histologically indistinguishable from the previous bone. Conclusion: The use of a customized pre-formed titanium mesh together with the mixture of autologous bone and xenograft is a feasible and predictable technique for vertical bone regeneration.

Custom Bone Regeneration (CBR): An Alternative Method of Bone Augmentation-A Case Series Study.

We performed this clinical study in order to evaluate the reliability of the Guided Bone Regeneration (GBR) surgical technique through the use of customized CAD CAM titanium meshes (Yxoss CBR® Reoss) in order to show an alternative method of bone augmentation. Materials and methods: Nine patients presenting 10 bone defects were referred to solve oral dysfunction due to edentulous atrophic ridges. Guided bone regeneration was performed with titanium meshes combined with autogenous bone grafting and heterologous bovine bone mineral grafting, and exclusively a “poncho technique” soft tissue approach for all the cases. After a mean 9 months of graft healing (range 6–12 months), titanium meshes were removed, and implant surgery was subsequently performed. The results we obtained were positive in terms of volumetric increases in height, length and thickness of the atrophic ridges without biological complications detectable before implant surgery. Results: Out of nine, one site met titanium mesh exposure: however, in all 10 sites a three-dimensional volumetric bone implementation was obtained. The statistical results were estimated by uploading and superimposing cbct scans before and after CBR surgery for each patient, so it was possible evaluate the maximum linear vertical and horizontal bone gain through dedicated Cad Cam software (Exocad GmbH®). The average horizontal gain was 6.37 ± 2.17 mm (range 2.78–9.12 mm) and vertical gain was 5.95 ± 2.06 mm (range 2.68–9.02 mm). A total of 18 implants were placed into the grafted sites with a 100% survival rate (clearly they are relative percentages to be compared to the short time elapsed). Conclusions: The results we obtained in this study suggest that this CBR procedure (Yxoss® by Reoss) is reliable and safe for bone regeneration to allow implant-prosthetic restoration in horizontal, vertical and combined bone defects. The soft tissue management is diriment: all the cases were managed with a “poncho” flap approach to decrease exposure complication.

Peri-Implant Marginal Bone Changes around Dental Implants with Platform-Switched and Platform-Matched Abutments: A Retrospective 5-Year Radiographic Evaluation.

Preserving the marginal bone level (MBL) is essential for the long-term success of dental implant therapy, and bone remodeling around dental implants is considered to vary with time. Numerous studies comparing the platform-switching (PS) and platform-matching (PM) dental implants have indicated that PS dental implants showed a lesser reduction for the MBL, and the majority of them had a relatively short period. This study aimed to evaluate vertical and horizontal bone defects by using digital periapical radiographs to examine the changes in MBL around PM and PS dental implants over 5 years after functional loading. The vertical MBL (vMBL) was measured from the implant–abutment junction to the first bone-to-implant contact. The horizontal MBL (hMBL) was measured from the implant–abutment junction to the bone crest. All data were presented as means ± standard errors. Paired and independent t-tests with Welch’s correction were used to analyze the data. A total of 61 dental implants in 38 patients after 5 years of functional loading were evaluated. Over time, PS dental implants were more likely to gain bone; by contrast, PM dental implants were more likely to lose bone during the observation time. Changes in vMBL for PS dental implants were significantly less than those for PM dental implants at 1-year (p = 0.045), 3-year (p = 0.021), and 5-year (p = 0.010) loading. Likewise, changes in hMBL for PS dental implants were significantly smaller than in those for PM dental implants at 3-year (p = 0.021) and 5-year (p = 0.006) loading; however, the changes were minimal in both approaches. PS dental implants had a significant increment in the percentage of bone integration, whereas that for PM dental implants dropped over time, with no significance. In PS dental implants that occlude with natural teeth, vertical and horizontal bone gain was observed, and it was significant at 3 years (p = 0.023). A significant horizontal bone gain was observed in the opposing natural teeth at 3-year (p = 0.002) and 5-year loading (p = 0.002). The PS concept appears to preserve more MBL around dental implants by stabilizing the vMBL and hMBL over a 5-year period. A minimal marginal bone change was detected in both concepts. The opposing natural teeth at PS dental implants showed a favorable effect on marginal bone tissues.

A multi-centre randomized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the buccal aspect of single implants: 1-year results.

To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of increase in buccal soft tissue profile (BSP) at 1year when applied at single implant sites. Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi-centre randomized controlled trial. All sites had a bucco-palatal bone dimension of at least 6 mm, received a single implant and an immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX) to increase buccal soft tissue thickness. The primary outcome was the increase in BSP at 1year when compared with the pre-operative situation based on superimposed digital surface models. The changes in BSP over time were registered at a buccal area of interest reaching from 0.5 mm below the soft tissue margin to 4 mm more apical. Secondary outcomes included patient-reported, clinical and aesthetic outcomes. Thirty patients were included per group (control: 50% females, mean age 50.1; test: 53% females, mean age 48.2). The increase in BSP at 1year was 0.98 mm (98.3% confidence interval [CI]: 0.75-1.20) for CTG and 0.57 mm (98.3% CI: 0.34 to 0.79) for CMX. The mean difference of 0.41 mm (98.3% CI: 0.12 to 0.69) in favour of CTG was significant (p < .001). Based on an arbitrarily chosen threshold for success of 0.75 mm increase in BSP, 89.7% of the patients in the control group and 10% of the patients in the test group were successfully treated (odds ratio=77.90; 95% CI: 13.52 to 448.80; p < .001). Sites treated with CMX demonstrated 0.89 mm (98.3% CI: 0.49 to 1.30) more shrinkage between postop and 1year than sites treated with CTG. In addition, CMX resulted in significantly more marginal bone loss (0.39 mm; 95% CI: 0.05 to 0.74; p=.026) than CTG. There were no significant differences between the groups in terms of patients' aesthetic satisfaction (p=.938), probing depth (p=.917), plaque (p=.354), bleeding on probing (p=.783), midfacial recession (p=.915), Pink Esthetic Score (p=.121) and Mucosal Scarring Index (p=.965). CTG remains the gold standard to increase soft tissue thickness at implant sites. Clinicians need to outweigh the benefits of CMX against considerable resorption of the graft. This study was registered in ClinicalTrials.gov (NCT04210596).

Correlative Assessment of Interdental and Interradicular Bone Loss in Horizontal and Vertical Bone Defects In Chronic Periodontitis: A Clinical and Radiographic Study

It is important to treat periodontitis before involvement of furcation areas because of their complex anatomy and difficulty of access. Literature confirms that it is difficult to accurately determine the relationship of the amount of bone loss in the interdental areas associated with the interradicular areas and correlate them with the clinical periodontal status. The aim of this study was therefore to assess the existence of such an association, if any, in subjects with chronic periodontitis. The threshold of alveolar bone loss associated with progression of periodontal destruction and involvement of interradicular areas of the furcations is not clearly defined in the literature. The aim of this study was to investigate a correlation, if any between interdental and interradicular bone loss and clinical parameters in patients with chronic periodontitis. Periapical (IOPA) radiographs of mandibular molars were obtained from 193 sites in 33 males and 21 females between the age group of 25 and 55 years having chronic periodontitis. These were then scanned and digital measurement of linear distances was performed using dicom software of height and width of defect (horizontal and vertical), bone defect angle and interradicular bone loss. These measurements were correlated to pocket depth (PD) and clinical attachment loss (CAL) using One-way ANOVA followed by Tukeys HSD post hoc tests. Bone height significantly correlated with probing depth and CAL in horizontal defects (p&lt;0.005) with hardly any furcation involvement (1.55%)whereas both bone height and width showed significant correlation with probing depth and CAL in vertical defects(P&lt;0.001) with nearly 77% of sites showing furcation defects. A strong correlation of clinical parameters with bone defect dimensions suggests that early diagnosis and management of interdental bone loss may be critical to prevent furcation involvement.

The “Sling” Technique for Horizontal Guided Bone Regeneration: A Retrospective Case Series

The aim of this retrospective case series was to present a new technique, called the “sling technique”, for massive horizontal alveolar ridge augmentation through the innovative use of an expanded polytetrafluoroethylene (e-PTFE) membrane to reduce the risk of biological complications related to membrane exposure. Materials and Methods: Eligible patients for implant rehabilitation with a horizontal bone defect were enrolled in our study. All patients were treated with our new GBR approach, called the “sling technique” (ST), which consisted of covering the vestibular side of the bone defect with a stretched e-PTFE membrane. This technique allowed the amplification of the membrane surface as long as the compression and the immobilization of the underlying graft material remained (1:1 autologous bone and bovine xenograft). The membrane was placed far from the surgical incision of the mucosa to avoid infective complications. Pre- and post-regenerative surgery CBCT scans were used to assess the tissue gain amount after the GBR. Results: A total of 10 patients (4 females, 6 males; age range: 45–60 years old) were enrolled in our study and 33 implants were placed in regenerated bone. An average of 4 mm bone gain was achieved using the ST. No membrane exposures or biological complications were registered during the post-operative healing period. After a 24-month follow-up, a 100% implant survival rate was observed without hard or soft tissue dehiscence. Conclusion: The e-PTFE membrane positioned with the “sling technique” gave satisfactory results in horizontal bone augmentation. Considering the small sample, further confirmations with larger studies are needed.

P‐117: AI Analysis of HOP Circuit Failure and Improvement

AMOLED's HOP(hybrid of Oxide semiconductor and Polysilicon TFT) technology was born to meet the market's demand for low power consumption. Also, the IGZO oxide process was introduced with new driving technology to support the low driving frequency operation. However, this new GC circuit of oxide TFT driving caused new and randomly appearing horizontal defects which do not exist in LTPS circuits. To solve this issue, we studied to find the design parameters using pipelined deep learning models composed of CGAN(Conditional Generative Adversarial Network), VGM(Variational Gaussian Mixture), and XAI(eXplainable Artificial intelligence) technologies to figure out what causes these defects. We collected HOP panel design information to achieve the given goal and confirmed the degree of defect per HOP model. Since the number of HOP models is limited, XAI analysis might also be negligible. We solve this issue by generating data using CGAN and VGM in sequence. After, ALE(Accumulated Local Effects), a popular XAI technique, is applied to find affected design parameters and change‐related circuit designs to help verify the proposed algorithm's performance. As a result of this design change, we identified that the related defect rate decreases from 15000ppm to less than 500 ppm, in which XAI plays a significant role in solving a newly introduced defect issue. That was believed for a long time a challenging problem to analyze using the legacy SPICE tool in the OLED circuit field. Our result also suggests that even predicting the defect rate of future HOP models becomes feasible with our proposed deep learning architecture.

Horizontal Mandibular Augmentation with Split Bone Block Technique: A Case Report

The purpose of this paper is to report a clinical case which a split bone block (SBB) technique has been used to graft a horizontal mandibular defect for latter dental implant-supported prosthesis rehabilitation. The surgical procedure was described in this article as well as a discussion. Case Report: A 50-year-old female was referred for an implant-supported prosthetics rehabilitation in the right inferior premolar area. Due to the bone defect, a horizontal bone augmentation was performed previously to implantation using Split bone block Technique. Conclusion: The Split bone block technique has been proven to be a suitable and predictable technique for osseous augmentation due the use of the gold standard grafting material.

Horizontal ridge augmentation in the anterior maxilla with in situ onlay bone grafting: a retrospective cohort study.

This study aimed to introduce a digitally guided in situ autogenous onlay grafting technique and compare its effectiveness with the conventional (ex situ) onlay technique in augmenting horizontal bone defects of the anterior maxilla. This retrospective cohort study included 24 patients who had received autogenous onlay bone grafts combined with guided bone regeneration (GBR) in the anterior maxilla. Fourteen patients were recruited into the in situ onlay grafting group (EG), and 10 were recruited into the ex situ onlay group (CG), defined by the donor sites. The clinical parameters, radiographic changes, micro-CT, and histological processes were evaluated after a mean follow-up period of 1.7years. The horizontal bone width reflected significant bone modeling over time (p < 0.001) in the first 6months. Multivariable analysis showed that the treatment modality (grouping) was a critical factor positively associated with vertical bone height alteration. However, neither the alteration rate of horizontal bone width nor the bone volume was associated with the treatment modality. The number of periosteal screws per graft positively affected horizontal contour maintenance (p < 0.05). No significant differences were observed between the groups in the clinical parameters (complications, success rate, and peri-implant parameters). The micro-CT and histological outcomes were similar between the groups. Despite the limitations of this study, in situ onlay grafting combined with GBR was an effective and reliable approach for horizontal bone augmentation in the anterior maxilla and appeared to demonstrate better stability in vertical bone remodeling. This study introduces a modified and minimally invasive technique of onlay grafting for horizontal bone augmentation. This in situ onlay grafting demonstrates superior stability in vertical bone remodeling. The trial registration number is ChiCTR2100054683.

Autogenous dentin block versus bone block for horizontal alveolar ridge augmentation and staged implant placement: A randomized controlled clinical trial including histologic assessment.

This study aimed to compare the dentin block (D-group) harvested from impacted wisdom teeth with autogenous ramus bone block (A-group) for horizontal alveolar ridge augmentation. Forty-two patients with anterior missing teeth and horizontal ridge defect were randomly assigned to two groups (n=21 per group) to receive either dentin block group or autogenous bone block. Six months after the augmentation, dental implants were placed in all patients, and a core biopsy was performed for histological evaluation in addition to clinical and radiographic evaluation using cone beam computed tomography. The primary outcome was the mean overall clinical ridge width gain (CRWG) after 6months of augmentation. Secondary outcomes were the overall radiographic ridge width gain (RRWG) after 6months of augmentation and descriptive histological analysis with histomorphometric assessment of bone fraction %. All sites healed uneventfully, and the mean overall CRWG 6months after augmentation was 3.52±0.56mm and 2.24±0.86mm in the D and A groups, respectively, with statistically significant difference between them (P≤.001). The overall mean RRWG was 3.61±0.61mm and 3.41±1.15mm in D and A groups, respectively, without any statistically significant difference between them (p=.062). The histomorphometric analysis of the bone area fraction was 42.6% and 41.3% in D and A groups, respectively, without any statistically significant difference between the two values (p=.89, Student's t-test). Histological evaluation in the D-group revealed new bone formation, viable cells, and matrix formation on the dentin block periphery, in addition to well-organized woven bone that suggests dentin block remodeling and supports new bone deposition. The present clinical study revealed that dentin block may serve as an alternative graft to support horizontal alveolar ridge augmentation. Dentin blocks showed less resorption than autogenous bone blocks.

Vertical Bone Augmentation with GBR Pocket Technique: Surgical Procedure and Preliminary Results

Nowadays, guided bone regeneration (GBR) is a predictable technique in both vertical and horizontal bone defects treatment. GBR Pocket Technique is an original surgical approach adopted in order to reduce the invasiveness of traditional procedures. The aim of this work is to describe the surgical procedure of GBR Pocket Technique in vertical bone augmentation and to compare the clinical outcomes of this technique with the results reported in literature of vertical bone augmentation and crestal bone remodeling achieved after 1 year after implants insertion. Twenty-eight patients were recruited for this study and received 28 GBR procedures in the posterior region due to vertical and horizontal defects. A 50/50 mixture of autologous bone component and heterologous bone of equine origin was then made with the use of a bone scraper tunnel with internal reservoir. A PTFE-d membrane with titanium reinforcement was then fixed to the residual bone structure with screws in order to maintain the graft in place. Radiographic checks were made before graft procedures and implants insertion, then 6 months later and 1 year after implants placement. The average bone augmentation after surgery seems to be aligned, or even better, than the average reported in literature with alternative surgical approach; in addition, the mean crestal remodeling after 1 year and the rate of complications are aligned with other previous surgical techniques with a vertical bone augmentation of 8.78 mm ± SD 2.39 and a bone remodeling after 1 year of 0.59 mm ± SD 0.29. The advantages of this technique are preservation of blood circulation and consequently risk of flap necrosis, dehiscence, and graft exposure. This technique also reduces mucosal healing times even if it takes longer surgical time. GBR Pocket Technique is the use of a minimal-invasive surgical wound to reduce patient morbidity and compliance.

Immediate implants in maxillary anterior region with guided bone augmentation

Aim: This case is a combination of vertical and horizontal defect in maxillary anterior region accompanied with absence of facial soft tissue which rehabilitated following extraction of tooth was rehabilitated by guided bone regeneration (GBR) and immediate implant Background: Loss of the labial bony wall during extraction of maxillary anterior teeth is a commonly encountered conundrum. During planning for an immediate implant placement in such a compromised area, guided bone regeneration (GBR) is a well-accepted method for bone and soft tissue reconstruction. Case Description: In the presented case report, a combination of vertical and horizontal defect of more than 2 mm accompanied with absence of facial soft tissue following extraction of tooth was rehabilitated by GBR and immediate implant. The follow - up was performed 36 months after final loading with good esthetic outcome and bone graft well apposed to native bone in CBCT evaluation with no obvious complications. Conclusion: The vertical and horizontal ridge volumetric alterations positively can be achieved by simultaneous GBR with immediate implant placement. Clinical Significance: The purpose of discussing this case report is to portray the efficacy of GBR along with immediate implant in case with both vertical and horizontal bone defects.

Guided Bone Regeneration for The Treatment of Different Types of Bony Defects: A Literature Review

&lt;p&gt;Horizontal and vertical bone resorption after tooth extraction can adversely affect the success of a dental implant. Therefore, several ridge augmentation techniques, such as guided bone regeneration (GBR), bone block grafting, and ridge expansion, have been developed to provide sufficient bone volume around the implant and improve its stability and position. GBR is the most widely used technique for bone augmentation. However, because of the numerous surgical procedures and materials available, it is difficult to choose the most appropriate treatment. Efficient and effective surgical procedures and materials with low complication rates have been recommended for different types of bony defects, such as intra-alveolar, dehiscence, fenestration, horizontal, and vertical bony defects. This review summarizes the results of studies on various GBR techniques published in the English literature and discusses the most appropriate and predictable GBR techniques that can be used for the different types of bony defects.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Periosteal Pocket Flap technique for lateral ridge augmentation. A comparative pilot study versus guide bone regeneration

BackgroundImplant rehabilitation of posterior mandibular defects is frequently associated to a horizontal bone loss. There exist several regenerative techniques to supply this bone deficiency, one of which is the Periosteal Pocket Flap Technique (PPF) proposed by Steigmann et al. to treat small horizontal bone defects. The present study proposes a modification of this technique based on the concurrent use of PPF with the use of xenogeneic and autologous bone and Plasma Rich in Growth Factors (PRGF). The aim of this study is to evaluate clinical and radiographic outcomes of the PPF with the use of xenogeneic and autologous bone and PRGF in comparison with conventional Guided Bone Regeneration (GBR) procedures. MethodsNine patients were enroled in the study (7 women and 2 men, mean age: 53 ± 2.74 years) and allocated to PPF or GBR. In both groups implant placement was performed simultaneously to bone regeneration. Preoperative CBCT scans were performed for each patient. Surgical time and postoperative pain were recorded, as well as tissue healing. Moreover, horizontal bone gain (mm), graft surface area (mm2) and graft volume (mm3) were evaluated. ResultsNine surgeries were performed: 6 PPF and 3 GBR. Regarding clinical outcomes, operative time was significative greater in GBR group than in PPF group (51.67 ± 3.51 min vs. 37 ± 5.69 min; p = 0.008). Postoperative pain was higher in GBR compared to PPF (p = 0.011). Regarding radiographical results, there were not significant differences in horizontal bone gain (PPF: 9.43 ± 1.8 mm; GBR: 9.28 ± 0.42 mm), surface area (PPF: 693.33 ± 118.73 mm2; GBR: 655.61 ± 102.43 mm2), and volume (PPF: 394.97 ± 178.72 mm3; GBR: 261.66 ± 118 mm3) between groups. ConclusionsThis prospective study demonstrates that the combination of autograft/xenograft and PRGF in PPF technique is a simpler, cheaper, and faster technique than GBR technique for achieving moderate lateral bone augmentation in implant treatment. Future randomised clinical studies are needed to confirm the results.

Data on the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians.

Grade II furcation defect has a great potential for regeneration. Attempts have been made to regenerate lost periodontium in furcation defects through variety of approaches. A total of 22 patients with Grade II furcation defect were examined. The patients were sequentially grouped into three groups namely, (Group A) subepithelial connective tissue graft as a barrier membrane, (Group B) bovine bone graft material Bio-OssTM and (Group C) with the combination of the two. The treatment modalities show that there was a strong improvement in the resolution of the grade II furcation defects. The reduction in horizontal furcation defect measurement was 20.63% for group A. The change was found to be moderate (p=0.023*). The % change is 20.97% for group B and it is statistically significance (p = 0.001**). The % change was 20.78% in Group C with a good statistical significance (p=0.003**). Complete obliteration of the defect clinically and radio-graphically was observed for grade II furcation defect. Thus, the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians is documented in this report.