Mean Vertical Bone Gain Research Articles

Long-term apical bone gain after implant placement combined with internal sinus-floor elevation without graft

BackgroundTo assess changes in apical bone height/bone gain over up to 8 years after implant placement combined with simultaneous internal sinus-floor elevation (ISFE) without use of graft.Methods217 implants were placed in combination with graft-free ISFE and successfully healed in the posterior maxilla of 138 patients. Radiographs after surgery across an evaluation time of up to 8 years were analyzed. Changes in apical and marginal bone height related to the implants were measured. Differences in bone height over the study period were evaluated by use of Wilcoxon tests. To identify possible influencing factors on apical bone gain and marginal bone loss, backward linear regression variable selections and linear mixed regression models were performed.ResultsAt the apical aspects of the implants, significant mean vertical bone gain of 2.4 mm (mesial) and 2.6 mm (distal) was observed after 6 months (p < 0.05). Radiographic analysis yielded additional bone gain of up to approximately 3.5 mm over the study period. Small initial bone height was crossed with more pronounced apical bone gain (p < 0.05).ConclusionsIf implants are placed combined with graft-free ISFE, significant vertical bone gain, especially in the first year post-op, can be expected. Smaller initial bone height is associated with a higher likelihood for greater bone gain.

Assessment of 3-dimensional bone augmentation of severely atrophied maxillary alveolar ridges using patient-specific poly ether-ether ketone (PEEK) sheets.

This study aimed to analyze the effectiveness of virtually designed polyether-ether ketone (PEEK) sheets to delineate and maintains the three-dimensional patient's maxillary alveolar ridge. Fourteen patients (34 implants) with severely atrophied anterior maxillary alveolar ridges underwent rehabilitation using custom-made CAD/CAM PEEK sheets acting as a containment system for interpositional mix of particulate autogenous and xenogeneic bone graft, fixed by mono-cortical screws. Radiographic Assessment included measurements of linear changes in the vertical and horizontal dimensions on cross-sectional cuts of computed tomography (CBCT) using special software. Wound healing was uneventful for all the patients except one patient that showed wound break down 2 weeks postoperatively, which did not affect the outcome of the procedure. CBCT scans were interpreted to compare the quantity of both vertical and horizontal bone preoperatively and 6 months postoperatively. Statistical analyses demonstrated a significant difference between the results of both time intervals, with a mean vertical and horizontal bone gain was 3.47 mm(±1.46) and 3.42 (±1.1) with a P-value of (.0001). The customized sheets were removed 6 months postoperative with the successful placement of dental implants. The virtual planning of three-dimensional maxillary alveolar ridge augmentation utilizing patient-specific PEEK sheets deemed successful to restore the deficient ridge and to accommodate suitable size dental implants.

Assessment of vertical ridge augmentation and marginal bone loss using autogenous onlay vs inlay grafting techniques with simultaneous implant placement in the anterior maxillary esthetic zone: A randomized clinical trial.

Bony reconstruction and dental rehabilitation of patients with posttraumatic anterior maxillary alveolar defects is a very complicated procedure. The aim of this study is the assessment of vertical ridge augmentation using autogenous onlay vs inlay bone grafting techniques in the anterior maxilla. Sixteen patients (40 implants) with vertically deficient anterior maxillary alveolar ridges were equally allocated into two groups; Autogenous block bone graft was harvested from the chin with simultaneous implant placement was done either onlay (control) or inlay (study). Radiographic assessment was performed preoperatively, 1 week and 6 months postoperatively. Assessment included measurements of linear changes in the vertical height on cross sectional cuts of cone beam computed tomography (CBCT) using special software. Finally, the amount of vertical gain and marginal bone loss in each group was compared to that of the other. Wound healing was uneventful for all cases except three cases of the onlay group showed wound breakdown and graft loss. The mean vertical bone gain in the control group was -0.02 mm while in the study was 3.34 mm. While the mean of the crestal bone loss of the control group was 4.77 mm and that of the study group was 1.65 mm. The final vertical bone gain was statistically significant in the study group, so the inlay bone grafting technique with immediate implant placement could be used successfully for vertical alveolar ridge augmentation in the esthetic zone.

Simultaneous sinus floor elevation and implant placement using leukocyte- and platelet-rich fibrin as a sole graft material.

Sinus floor elevation (SFE) and simultaneous implant placement is predictable and reproducible. However, the graft material for the antral cavity remains a topic of debate. Considering the high osteogenic potential of the sinus membrane, most graft materials are generally accepted. This study aimed to assess the outcome of simultaneous SFE and implant placement, using leukocyte- and platelet-rich fibrin (LPRF) as a sole graft material. This study was designed as a single cohort prospective study. Clinical and radiographic measurements (cone beam computed tomography [CBCT]) were performed immediately after implant placement and at abutment connection (6 months later). The amount of newly formed bone was linearly recorded on cross-sectional images. Four measurements (mesial, distal, buccal, palatal) were registered with the axis of the implant as reference. Six lateral and 22 transalveolar SFEs were performed in 26 patients with simultaneous implant placement. Six months after surgery, 27/29 implants were clinically integrated. The mean vertical bone gain was 3.4 ± 1.2 mm and 5.4 ± 1.5 mm for transalveolar SFE and lateral SFE, respectively. The level of the new sinus floor was in all cases in continuation with the apex of the implant, and the peri-implant crestal bone height was stable. L-PRF as a sole graft material during simultaneous SFE and implant placement proved to be a practical, safe, and economical subsinus graft material, resulting in natural bone formation.

Clinical Success of Dental Implants Placed in Posterior Mandible Augmented With Interpositional Block Graft: 3-Year Results From a Prospective Cohort Clinical Study

The purpose of the present cohort study was to investigate the 3-year efficacy and clinical performance of implant-supported rehabilitations in posterior mandibles augmented with the sandwich osteotomy technique. Twenty-three partially edentulous patients who developed atrophy of the posterior mandible (residual ridge height, 3 to 7mm) were treated (32 surgical sites) with vertical bone augmentation using interpositional equine cancellous bone blocks and porcine corticocancellous bone particulate. All implants were placed 4months after augmentation and were loaded with fixed dental prostheses. One side per patient was selected and followed for 3years, and the patient was the unit of analysis. Linear radiographic vertical bone gain and peri-implant marginal bone loss were assessed; secondary outcomes-complication rates after surgery, prosthesis and implant failure rates, width of keratinized mucosa, and patient satisfaction-were evaluated. All patients reported postoperative paresthesia that resolved over a period of 2months after the augmentation procedure. The mean vertical bone gain was 5.6mm after 4months. Ninety-one dental implants were positioned into the augmented areas. The global 3-year survival rate was 95.5%. The mean peri-implant marginal bone loss around implants was 1.06±0.37mm 3years after loading, whereas the width of keratinized mucosa had an overall increase of 0.39±0.36mm. The results of the present 3-year study suggested high success rates for implants placed in areas augmented with the osteotomy sandwich technique. This surgical approach could be helpful in the presence of a low residual vertical height in the posterior mandible before implant placement.

Sandwich osteotomy for the reconstruction of deficient alveolar bone

Alveolar bone deficiency is a very common problem encountered by the practitioner when planning dental implants. The severity of the deficiency is variable. Many practitioners perform augmentation using the method they feel comfortable with and do not necessarily use the most appropriate method. This is a retrospective study on 21 patients between the ages of 25 and 63 years exhibiting moderate vertical alveolar bone deficiency and treated by the sandwich technique. Mean vertical bone gain was 7.5mm. Sixty-one dental implants were inserted showing a survival rate of 96.7% with a median of 3.1 years follow-up. Main advantages of the method include minimal relapse, single operation and preservation of the native cortical bone in the occlusal surface. We believe the surgeon should maintain the capability of using different augmentation techniques and utilize them appropriately for different severities of deficiency. We wish to establish a paradigm for using different augmentation methods We recommend using the sandwich technique in the moderate deficient cases as described in this work, using alveolar distraction osteogenesis for the severe cases as described in our previous work, where lack of soft tissue for proper closure is a major limitation, and using guided bone regeneration for minor deficiencies.

Occlusive Titanium Barrier for Immediate Bone Augmentation of Severely Resorbed Alveolar Sockets with Secondary Soft Tissue Healing: A 2-Year Case Series.

This case series evaluated bone dimensional changes following the application of an occlusive titanium barrier on severely resorbed fresh extraction sockets to achieve bone regeneration. Six extraction sites with buccal bone loss were filled with a xenograft and covered with a titanium plate fixed by two miniscrews and left intentionally exposed. No infection occurred. After 4 months of healing, sufficient hard tissue had formed to allow implant insertion. Mean vertical bone gain was 7.3 ± 2.2 mm at the buccal side and 4.2 ± 1.2 mm at the lingual side. The average bone width augmentation was 23 ± 1.0 mm. At 24 months, all implants were clinically successful. Based on these preliminary findings, occlusive titanium barriers without primary closure may be successfully used in immediate alveolar reconstruction procedures.

Graft-Free Maxillary Sinus Floor Elevation: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aims to investigate survival rates of dental implants placed simultaneously with graft-free maxillary sinus floor elevation (GFSFE). Factors influencing amount of vertical bone gain (VBG), protruded implant length (PIL) in sinus at follow-up (PILf), and peri-implant marginal bone loss (MBL) are also evaluated. Electronic and manual searches for human clinical studies on simultaneous implant placement and GFSFE using the lateral window or transcrestal approach, published in the English language from January 1976 to March 2016, were conducted. The random-effects model and mixed-effect meta-regression were used to analyze weighted mean values of clinical parameters and evaluate factors that influenced amount of VBG. Of 740 studies, 22 clinical studies were included in this systematic review. A total of 864 implants were placed simultaneously with GFSFE at edentulous sites having mean residual bone height of 5.7 ± 1.7 mm. Mean implant survival rate (ISR) was 97.9% ± 0.02% (range: 93.5% to 100%). Weighted mean MBL was 0.91 ± 0.11 mm, and it was significantly associated with the postoperative follow-up period (r = 0.02; R2 = 43.75%). Weighted mean VBG was 3.8 ± 0.34 mm, and this parameter was affected significantly by surgical approach, implant length, and PIL immediately after surgery (PILi) (r = 2.82, 0.57, 0.80; R2 = 19.10%, 39.27%, 83.92%, respectively). Weighted mean PILf was 1.26 ± 0.33 mm (range: 0.3 to 2.1 mm). Within limitations of the present systematic review, GFSFE with simultaneous implant placement can achieve satisfactory mean ISR of 97.9% ± 0.02%.

Radiographic Evaluation of Crestal Bone Level in Split-Crest and Immediate Implant Placement: Minimum 5-Year Follow-up.

This study aimed to evaluate the radiographic bone level changes of implants positioned via the split-crest procedure both in the maxilla and mandible at a long-term follow-up. Seventy-one patients were retrospectively enrolled in the study. The placement of 137 dental implants was performed in the edentulous premolar or molar region after a split-crest ridge expansion procedure. Implants followed a delayed loading protocol. Intraoral digital radiographs were performed at baseline, upon implant placement, at 70 days (following placement of the provisional prosthesis), and on a yearly basis during followup. Crestal bone levels were evaluated at the baseline, upon provisional prosthesis placement, at 12, 36, and 60 months, and at the long-term follow-up of healing from implant placement. The patients underwent a mean follow-up of 6.54 ± 1.32 years, from which the implant survival rate was reported at 98.54%. Within the first year from implant placement, a bone loss resulted at a mean value of -1.11 ± 0.44 mm. After almost 3 years from implant placement, a mean bone gain of +0.89 ± 0.39 mm was reported, which was statistically significant compared with 12-month values (P < .05). From this point, bone levels remained stable, reporting similar values over time, with no significant differences (P > .05). A mean vertical bone gain of +0.89 ± 0.39 mm was observed after almost 36 months after implant positioning.

Inlay osteotome sinus floor elevation with concentrated growth factor application and simultaneous short implant placement in severely atrophic maxilla.

Sinus floor elevation with simultaneous implant placement in severely atrophic maxilla is challenging. The aim of this retrospective study was to evaluate the short-term performance of modified osteotome sinus floor elevation (OSFE) with concentrated growth factor (CGF) application and concurrent placement of a short implant in cases with residual bone height (RBH) of 2–4 mm. Twenty-five short implants were installed in 16 patients with mean RBH of 3.23 mm using modified OSFE with CGFs from January 2012 to April 2014. Postoperatively, the implants were clinically evaluated, and vertical bone gain (VBG) was measured using cone beam computed tomography. The mean duration of follow-up was 19.88 months (12–32 months). All the implants were stable with an overall survival rate of 100%. The mean VBG immediately after surgery was 9.21 mm. Six months later, significant reduction of alveolar bone height (2.90 ± 0.22 mm) was found (P < 0.05). During the second 6-month period, further alveolar bone resorption (0.14 ± 0.11 mm) was noted but without significance (P > 0.05). Within the limits of this study, modified OSFE with CGF application and simultaneous short implant placement could yield predictable clinical results for severely atrophic maxilla with RBH of 2–4 mm.

Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients.

Purpose. To present a computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) technique for the design, fabrication, and clinical application of custom-made synthetic scaffolds, for alveolar ridge augmentation. Methods. The CAD/CAM procedure consisted of (1) virtual planning/design of the custom-made scaffold; (2) milling of the scaffold into the exact size/shape from a preformed synthetic bone block; (3) reconstructive surgery. The main clinical/radiographic outcomes were vertical/horizontal bone gain, any biological complication, and implant survival. Results. Fifteen patients were selected who had been treated with a custom-made synthetic scaffold for ridge augmentation. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. A few patients experienced biological complications, such as pain/swelling (2/15: 13.3%) and exposure of the scaffold (3/15: 20.0%); one of these had infection and complete graft loss. In all other patients, 8 months after reconstruction, a well-integrated newly formed bone was clinically available, and the radiographic evaluation revealed a mean vertical and horizontal bone gain of 2.1 ± 0.9 mm and 3.0 ± 1.0 mm, respectively. Fourteen implants were placed and restored with single crowns. The implant survival rate was 100%. Conclusions. Although positive outcomes have been found with custom-made synthetic scaffolds in alveolar ridge augmentation, further studies are needed to validate this technique.

A minimally invasive technique for lateral maxillary sinus floor elevation: a Bayesian network study.

To describe a minimally invasive technique for lateral maxillary sinus elevation and to identify the relationship between the involved factors. This is a retrospective study on patients treated with an original minimally invasive technique for lateral maxillary sinus elevation in a private dental clinic from 2008 to 2013. Failures, complications, and radiographic measurements were registered 9 months after surgery at the provisional prosthesis delivery. The relationship between demographic and clinical factors was investigated using Bayesian network analyses. One hundred and twenty-four patients (147 maxillary sinuses) were treated, and 242 implants were placed. Seven patients dropped out. A total of two implants in two patients failed. Perforation of the sinus membrane occurred in seven patients (6%). Five different complications in five patients were observed. Mean peri-implant marginal bone level 9 months after surgery was 1.10 ± 0.74 mm. Mean vertical bone gain was 7.44 ± 1.95 mm. Perforation was more frequently observed in patients that did not undergo the sedation procedure. Complications (excluding perforation and including implant failure) were more frequent in cases where only bone substitutes were used. This technique can be considered noninvasive, with a low early failure and early complication rate.

A New Technique for Sandwich Osteoplasty with Interpositional Bone Grafts for Fixation

To present a new technique for sandwich osteoplasty in the posterior mandible and to evaluate its feasibility as part of dental implant treatment. A retrospective study of sandwich osteoplasty in the posterior mandible was conducted. No osteosynthetic material was used to stabilize the osteotomy. Fixation was achieved with the interposition of two bone blocks harvested from the retromolar region. Eighteen patients with 26 sites of severe atrophy of the posterior mandible were treated. After a healing period of 4 months, 53 dental implants were inserted into the augmented region. The implants were loaded with single crowns or fixed dental prostheses 3 months after placement. The mean vertical bone gain after 4 months of healing was 4.2 mm (standard deviation 1.4 mm). The average bone loss between augmentation and implantation was 2.3 mm (35.4%). All implants osseointegrated and showed no clinical signs of peri-implantitis. In three subjects, the elevated bony segment perforated the lingual mucosa near the adjacent teeth after excessive elevation (> 6 mm) but healed without any sequelae. An alternative method for vertical alveolar ridge augmentation of the posterior mandible is presented. No osteosynthetic material is required for fixation, and related complications can be avoided. Further prospective clinical studies are required to demonstrate the feasibility of this technique versus the conventional sandwich osteoplasty.

Ridge Preservation using Dermis Allograft Tissue Matrix Membrane vs Connective Tissue Graft

ABSTRACTPurposeThe purpose of this study was to compare extraction socket healing and alveolar ridge preservation using autogenous bone covered with connective tissue graft (CT) or acellular dermal matrix (ADM).Materials and MethodsSixteen nonsmoking, healthy patients with 18 nonmolar teeth requiring extraction participated in the study. Following extraction, the sockets were debrided, measured, and grafted with autogenous bone, then covered with either CT or ADM. Measurements of alveolar ridge width and height were made at baseline and after 16 to 20 weeks post extraction. Soft and hard tissue biopsies of the extraction sites were evaluated histomorphometrically.ResultsThe mean buccolingual ridge width loss was 0.19 mm for both CT and ADM groups. The mean vertical bone gain was 1.08 mm bone for the CT group and 0.82 mm for the ADM group. Histologic evaluation revealed a mean bone fill of 40.67 and 50.76% for CT and ADM group respectively. Student t-tests did not reveal significant difference between the two groups.ConclusionThe overall results of the study suggest that the use of bone graft covered with either CT or ADM is useful for ridge preservation.How to cite this articleTomlin EM, Kerns DG, Rossmann JA, Beach MM, Al-Hashimi I, Abraham CM, Solomon ES, Kessler HP. Ridge Preservation using Dermis Allograft Tissue Matrix Membrane vs Connective Tissue Graft. J Contemp Dent 2014;4(1):10-16.

Clinical and Histologic Evaluation of Calcium Carbonate in Sinus Augmentation: A Case Series

The aim of this case series was a clinical, histologic, and histomorphometric evaluation of calcium carbonate in sinus elevation procedures. Sinus augmentation was performed in the atrophic maxillae of 24 subjects using calcium carbonate. Six months after the regeneration procedures, 68 implants were placed and clinically followed for 1 to 5 years, depending on the placement timing. At the last implant placement procedure, 8 bone cores were harvested and processed for histology. After a 6-month healing period, sinuses grafted with calcium carbonate showed a mean vertical bone gain of 6.93 ± 0.23 mm. The histomorphometric analysis revealed 15% ± 3% residual grafted biomaterial, 28% ± 2% newly formed bone, and 57% ± 2% marrow spaces. The implant survival rate was 98.5%. It can be concluded that calcium carbonate was shown to be clinically suitable for sinus elevation procedures after 1 to 5 years of follow-up and histologically biocompatible and osteoconductive.

Radiographic Evaluation of Crestal Bone Levels of Delayed Implants at Medium-Term Follow-up

The aim of this study was to evaluate the radiographic bone level changes after delayed implant placement at medium-term follow-up, with three elements kept constant: keratinized gingiva thickness, implant axes perpendicular to the opposing occlusal surface, and implants with a collar of 2 mm. Patients treated in a private practice setting were retrospectively enrolled in the study. They underwent delayed placement (4 to 8 weeks after extraction) of dental implants in edentulous premolar or molar regions. Implants followed a delayed loading protocol. Crestal bone levels were measured at baseline; at provisional prosthesis placement; at 1, 3, and 5 years; and at medium-term follow-up of healing from implant placement. One hundred twenty patients received 135 implants (one or two implants per patient); 3 implants were lost. After a mean follow-up period of 9.71 ± 4.88 years, a survival rate of 97.76% was reported. At 1 year after implant placement, mean bone loss of -1.5 ± 0.62 mm was found. At almost 3 years post-implant placement, a mean bone gain of +1.20 ± 0.49 mm was seen, which was statistically significantly different compared with 1 year. After this point, the bone levels remained stable; similar values were reported over time, with no significant differences. The mean vertical bone gain of +1.20 ± 0.49 mm seen at almost 3 years after implant placement in this study may be supported by both clinical parameters as presence of sufficiently thick keratinized gingiva (3 mm), implants with a 2-mm collar, and the axis of implant insertion perpendicular to the opposing occlusal surface.

Alveolar Sandwich Osteotomy in Resorbed Alveolar Ridge for Dental Implants: A 4-Year Prospective Study

To answer whether severe vertical alveolar defects can be resolved using the sandwich osteotomy technique with xenograft material as filler and to evaluate the predictability of this procedure. Ten graft sites (5 mandibular and 5 maxillary) in 9 patients treated at the Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, were included in the present study. The patients underwent vertical bone augmentation using the sandwich osteotomy technique filled with xenograft material. The degree of bone augmentation was analyzed clinically at surgery and 4 to 6 months later from the computed tomography images taken just before the sites had been rehabilitated using dental implant insertion. A trephine histologic analysis was performed during implantation at 1 maxillary site. The mean vertical bone gain in the interval between the sandwich osteotomy and implementation was 6 mm (range 4 to 10), and it remained stable after 4 to 6 months. In 2 cases, additional horizontal bone augmentation was needed. All graft sites were rehabilitated using dental implants with satisfactory results. In 3 cases, gingival porcelain was required for the final prosthesis. Histologic examination revealed vital segmentized bone and remodeling of the filled gap. The interpositional alveolar bone graft using xenograft filler appears to be a viable and predictable alternative to block grafting or guided bone regeneration, resulting in good final results, with substantial vertical bone gain, even for challenging cases.

Effect of pulverized natural bone mineral on regeneration of three-wall intrabony defects. A preclinical study

The objective of this study is to evaluate the effects of a paste-like bone substitute material with easy handling properties and improved mechanical stability on periodontal regeneration of intrabony defects in dogs. Mandibular and maxillary first and third premolars were extracted, and three-wall intrabony defects were created on second and fourth premolars. After a healing period of 3 months, acute type defects were filled with a paste-like formulation of deproteinized bovine bone mineral (DBBM) (particle size, 0.125-0.25 mm) in a collagenous carrier matrix (T1), pulverized DBBM (particle size, 0.125-0.25 mm) without the carrier (T2), or Bio-Oss® granules (particle size, 0.25-1.00 mm) as control (C). All defects were covered with a Bio-Gide® membrane. The dogs were sacrificed after 12 weeks, and the specimens were analyzed histologically and histometrically. Postoperative healing of all defects was uneventful, and no histological signs of inflammation were observed in the augmented and gingival regions. New cementum, new periodontal ligament, and new bone were observed in all three groups. The mean vertical bone gain was 3.26 mm (T1), 3.60 mm (T2), and 3.81 mm (C). That of new cementum was 2.25 mm (T1), 3.88 mm (T2), and 3.53 mm (C). The differences did not reach statistical significance. The DBBM particles were both incorporated in new bone and embedded in immature bone marrow. The results of this preclinical study showed that the 0.125-0.25-mm DBBM particles in a powder or paste formulation resulted in periodontal regeneration comparable to the commercially available DBBM. Osteoconductivity, in particular, was not affected by DBBM size or paste formulation. The improved handling properties of the paste-like bone substitute consisting of small DBBM particles embedded in a collagen-based carrier hold promise for clinical applications.

Vertical Distraction Osteogenesis Combined With Bilateral 2-Step Osteotomy for Preprosthetic Rehabilitation of Edentulous Mandible

The aim of the current study was to appraise the effectiveness of distraction osteogenesis combined with bilateral 2-step osteotomy for the vertical augmentation of atrophic edentulous mandibles. To verify the predictability of this technique, we evaluated bone density and vertical bone gain of a cohort of 27 patients. The intraoral alveolar distractor was placed in the symphyseal area; then, it was left in situ for 2 months after surgery to consolidate the newly formed bone. A total of 189 implants were inserted. The main complications' issue was tied up to the neurosensory disturbances of the inferior alveolar nerve, which disappeared few months after the surgery.At the end of the distraction osteogenesis, a mean vertical bone gain of 10.5 mm evaluated by comparing preoperative and postoperative computed tomography was reached. Three months after the surgery, the radiologic data indicated that the difference in the mean bone density, recorded in Hounsfield units (HU), between the distracted bone and the preexisting mandibular bone was not statistically significant (P > 0.05). The last measurements done showed that the osseous density in the distraction chamber was higher than the original medullary bone density: the regenerated bones were more dense (876.8 [205.9] HU) than the preexisting medullary bone (312.1 [142.3] HU) and less dense than the preexisting cortical bone (1721.1 [170.4] HU) at the ninth month.In conclusion, this approach appeared to be a viable solution for the improvement of vertical volume in atrophic mandibles.

Magnesium-Substituted Hydroxyapatite Grafting Using the Vertical Inlay Technique

The reconstruction of a severely atrophic left posterior mandible using inlay magnesium-substituted hydroxyapatite grafting is described. Three months after reconstruction, a bone specimen was retrieved, and two dental implants were placed. A mean vertical bone gain of 4.9 mm was measured at the time of implant placement, and no problems were recorded at delivery of the provisional and definitive prostheses 4 and 8 months after implant placement, respectively. Histologic analysis revealed residual grafted material infiltrated by newly formed bone. In this clinical case, Mg-hydroxyapatite was demonstrated to be an effective grafting material for reconstruction of the posterior mandible using the inlay technique.