Ridge Augmentation Research Articles

Does diabetes mellitus affect guided bone regeneration outcomes in individuals undergoing dental implants? A systematic review and meta-analysis

ObjectivesThis systematic review aimed to verify if diabetes affects vertical and horizontal ridge augmentation in individuals undergoing dental implant treatment with guided bone regeneration (GBR).MethodsFive databases were systematically screened up to September 2023, according to predefined eligibility criteria. The methodological risk of bias of included studies was assessed using the ROBINS-I tool, and GRADE was used to evaluate the certainty of evidence. Random-effects pairwise meta-analyses were used to compare changes in vertical (height) and horizontal (width) alveolar bone dimensions between individuals exposed and unexposed to diabetes, through standardized mean differences (SMDs).ResultsThree non-randomized controlled trials met the inclusion criteria, all of which showed a serious risk of bias. The results showed, with overall very low certainty on evidence, that individuals with diabetes did not exhibit a significant difference in horizontal (SMD = −0.41, 95% CI: −0.92–0.10) and vertical (SMD = 0.06, 95% CI: −0.43–0.56) ridge augmentation compared to the those without diabetes.ConclusionsThe available evidence, albeit of very low certainty, suggests that diabetic individuals with moderate or good glycemic control undergoing dental implants and GBR show comparable horizontal and vertical bone gains to their unexposed counterparts. Systematic Review Registrationhttps://osf.io/bpx3t.

Retrospective analysis of augmentation procedures with umbrella screws, a novel tenting technique: a consecutive case series in 279 patients.

The consecutive case series accesses the results and experiences of ridge augmentation using an umbrella screw tenting technique. In total, 279 patients were treated between 26 May 2015 and 16 June 2021, including horizontal and vertical ridge defects. Sex, age, smoking behavior, jaw, graft material, soft tissue thickness, extent of horizontal/vertical augmentation, resorption rate, and occurrence of early/late exposure were evaluated. Bone gain was determined by resorption at the screw head. Only cases without premature screw removal were evaluated metrically (n = 201). All other augmentations were evaluated according to whether implantation was possible with or without further augmentation (n = 27). A target performance index was calculated, which should enable evidence-based comparability of different augmentation methods in future. In total, 54 wound dehiscences (39 early, 15 late exposures) occurred, which corresponds to 24.08% of the augmented sites; 42 umbrella screws were removed prematurely. In all cases an implantation was possible at the desired position afterwards. Cases with a vertical augmentation component showed a higher prevalence of exposure (early, P = .000; late, P = .024). The extent of the vertical augmentation was only relevant for early exposure (P = .048). Mean bone gain of 4.23 ± 1.69 mm horizontally and 4.11 ± 1.99 mm vertically could be achieved. Regression analysis showed that there was no limit in horizontal/vertical direction. Mean percentage target performance index was 75.90 ± 20.54 for vertical and 82.25 ± 16.67 for horizontal portions. The umbrella technique is an effective augmentation method, which can be applied to any defect morphology.

Comparative analysis of horizontal alveolar ridge augmentation: Guided bone regeneration versus screw-tenting techniques - A systematic review

The aim of this study was to systematically review bone volume changes obtained via the use of the Guided Bone Regeneration Technique (GBR-T) versus the Screw-Tenting Technique (ST-T) in horizontally defective alveolar ridges. In addition to review and compare rates of complications pertaining to post-operative dehiscence with membrane exposure, graft exposure, graft loss or other unforeseen complications and rates of implant placement into grafted sites. PRISMA protocol was used for systematic reviewing, electronic and manual searches of primary and secondary objectives were performed using the National Library of Medicine (MEDLINE via PubMed), EMBASE (Ovid), and EBSCO Host up to and including the 1st May 2023. Three articles qualified under the stipulated inclusion and exclusion criteria. Regarding GBR-T, the mean horizontal ridge bone gain was 2.47±3.16 mm with a mean complication rate of 16.50%, a mean graft loss rate of 11.70% and a mean implant placement rate of 91.30%. Regarding ST-T, the mean horizontal ridge bone gain was 4.76.02±2.57 mm with a mean complication rate of 9.30%, a mean graft loss rate of 2.80% and a mean implant placement rate of 98.10%. Both techniques are predictable in achieving horizontal ridge bone gains with low complication/failure rates leading to high second stage implant placement rates. The adjunctive use of tenting screws appears to be effective, offering additional benefit to the mechanism of space maintenance. Current evidence is however limited and of moderate risk-of-bias with heterogeneity within and between studies. Different interventions were performed by various clinicians with varying surgical skillsets in differing clinical environments using different biomaterials so caution must be used when interpreting these findings.

Evaluation of the Effectiveness of Bone Grafting in Alveolar Ridge Augmentation Using the Two-Stage Splitting Technique.

Stimulation of neoosteogenesis is the main mechanism of osseointegration during installation of dental implants, bone tissue recession, and alveolar process augmentation in adentia. In experiments on miniature pigs, we used the technology of two-stage splitting of the ridge of the alveolar process of the mandible in combination with a xenograft that was placed between the fragments of the split bone plate. The morphology of the reparative process and the distribution of osteogenic differentiation markers in the compact and trabecular bone of the alveolar crest were studied. Signs of reparative osteogenesis were observed in the bone regenerate that had a lamellar structure, formed osteons, and foci of woven tissue. It was found that the xenograft was replaced by newly formed trabecular bone tissue. These sites were characterized by increased expression of osteocalcin and CD44. Augmentation technology through two-stage splitting provides trophic relationship of osteoprogenitor cells and is an effective method of osteogenesis stimulation in the alveolar process.

Clinical outcomes following a combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement using either autogenous tooth roots or autogenous bone blocks.

To assess and compare the short-term clinical outcomes following a combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement using either autogenous tooth roots (TR) or autogenous bone blocks (AB). A total of n = 27 patients (TR/AB: 13/14) exhibiting n = 31 implants (TR/AB: 14/17) were available for the analysis. Each subject had been allocated to a combined vertical and horizontal alveolar ridge augmentation using either (1) healthy TR (e.g., retained wisdom teeth), or (2) monocortical AB harvested from the retromolar area (i.e. external oblique line). Clinical parameters (e.g., bleeding on probing, BOP; probing pocket depth, PD; mucosal recession, MR) were recorded after a follow-up period of 16.03 ± 4.3 months following implant placement. The survival rates amounted to 100% in both groups. TR and AB grafted sites were associated with similar changes in mean BOP (8.97 ± 27.73%; 11.90 ± 18.97%), PD (0.53 ± 0.49; 0.47 ± 0.67 mm), and MR (0.03 ± 0.13; 0.0 ± 0.02 mm) values. The incidence of peri-implant mucositis and peri-implantitis at the patient level amounted to 15.38% and 0.0% in the TR-, and 28.57% and 7.14% in the AB group. Both surgical procedures were associated with peri-implant tissue health and stability on the short-term.

Sequential Human Histology Results of the Subperiosteal Minimally Invasive Aesthetic Ridge Augmentation Technique (SMART): A Chronologic Wound Healing Proof-of-Principle Study.

Traditional GBR procedures have been associated with frequent complications and compromised peri-implant esthetics. Tunneling techniques have been proposed as a promising alternative in this regard. More recently, a subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART) was reported to have been clinically successful in a prospective case series. This technique includes the use of a bone graft/recombinant human platelet-derived growth factor-BB combination delivered to the site by a tunneling method. However, published histologic information regarding the nature of the regenerated tissue has been limited. The current study evaluated the histologic and histomorphometric findings of four human specimens harvested at 2, 5, 9, and 14 months after ridge augmentation using the SMART method. Evaluations of the wound healing and bone regeneration sequence over time found that the ridge augmentation was the result of extensive new bone formation that progressed through the woven bone to lamellar bone stages, with remodeling of the xenogeneic graft material and replacement by patient bone. This is the first study utilizing sequential human specimens to histologically examine the chronology of wound healing following alveolar ridge augmentation.

Multidisciplinary approach in periodontics: Planning and treatment of complex cases – Case series

The aim of this case series is to show the management of complex cases by combining different surgical procedures from different dental specialties. Addressing complex cases with an interdisciplinary approach provides the best treatment outcome. This approach helps in reducing the cost, time, and postoperative sequelae. The presented three clinical cases showed a combination of surgical procedures such as aesthetic crown lengthening, lateral ridge augmentation, apical surgery, and implant placement. They also showed that using bone grafting during the apical surgery improved the healing.

Management of the Lingual Flap During Vertical Augmentation of the Atrophic Anterior Mandible: Anatomical Overview and Description of the Technique.

Vertical ridge augmentation in the anterior mandible is a technically delicate procedure that requires knowledge of some anatomical structures to reduce intra- and postoperative complications. Proper soft tissue management is one of the primary aspects to the success of these techniques, enabling tension-free primary wound closure and preventing membrane exposure. This cadaveric and clinical study provides an anatomical overview of the lingual portion of the anterior mandible. Moreover, there is a description of a novel surgical approach for release of the lingual flap that will help clinicians achieve primary closure without incurring intrasurgical complications.

New perspectives in the treatment of the severe atrophic posterior maxilla: interpositional sandwich osteotomy combined with sinus floor grafting - a novel technique

Purpose: Dental implant installation in the posterior maxilla depends fundamentally on the presence of an adequate bone quantity. Tooth loss in the posterior maxilla is followed by extensive loss of the alveolar ridge and increased maxillary sinus pneumatization that often makes implant installation difficult to achieve. Maxillary sinus floor augmentation is traditionally the common surgical technique to overcome this situation. When the deficiency in the vertical dimension relates more to severe ridge resorption, crestal ridge augmentation should also be considered. Posterior maxillary sandwich osteotomy combined with sinus augmentation, using inter–positional bone graft might be a viable option to address this problem. This study describes a successful implementation of this technique to solve a severe vertical osseous ridge defect under the sinus floor. Material and Methods: A two–stage lateral wall sinus floor augmentation combined with inter–positional sandwich osteotomy followed by the insertion of dental implants with adequate length and diameter was performed. Deproteinized natural bovine bone mineral (DBBM) covered by a resorbable collagen membrane were used. Rehabilitation of this area was completed by a standard prosthetic protocol. Results: As a result of completing the above procedure favourable bone mass and form was created to enable implant placement in positions that are optimal from a prosthetic and esthetic point of view in terms of reshaping the alveolar crest and normali- zing the interocclusal distance improving the crown–implant ratio. Conclusion: This case demonstrates a step–by–step illustration of an innovative technique for overcoming a vertical ridge defect combined with increased maxillary sinus pneumatization. It can be concluded that this novel technique is recommended to meet the dimensional requirements of bone augmentation both crestal and intrasinusal in severe atrophic posterior maxilla to achieve an improved alveolar plane, equalized crown–to–implant ratios, and a more favourable gingival shape.

Evaluation of short and ultra-short dental implants in challenging clinical situations of resorbed ridges: A narrative review

ABSTRACT Background: Dental implant treatment has gained widespread acceptance as a reliable method for replacing lost teeth. Nevertheless, the favorable outcome of implant therapy hinges on having adequate bone quality and quantity. Individuals with restricted bone height or density pose a unique challenge for implant placement. Short and ultra-short dental implants offer an alternative solution for such patients, as they necessitate less vertical bone height and can mitigate the necessity for supplementary bone augmentation procedures. Aim: This narrative review was conducted to understand the different types of short and ultra-short implants, their indications and contraindications, and their prosthetic considerations, summarizing the current literature on the clinical outcomes, success rates, and potential complications. Methods: Research publications were searched on search engines such as EBSCO, EMBASE, PubMed, Web of Science, and Cochrane library databases, and the articles published from January 1988 to December 2022 with terms such as “short implants, ultra-short implants, atrophic ridge, and alveolar ridge augmentation” were collected. Results: A total of 10 articles were collected, and they were further used to formulate this review. Despite their constraints, short and ultra-short implants have demonstrated comparable clinical results to conventional implants in specific scenarios and provide several advantages, such as reduced surgical time, lower costs, and decreased risk of anatomical complications. Discussion: Short and ultra-short dental implants are used when regular ones are not feasible. They increase stability by enhancing bone contact. They work well for various dental prostheses, especially for those who cannot use removable options. While not recommended for everyone, they can be successful in many cases. Factors such as implant shape, surgical technique, and prosthetic considerations play a key role in their success. Studies show high survival rates for short implants, making them a reliable choice for specific situations. They offer a less invasive and cost-effective alternative in challenging cases. Conclusion: As technology and designs continue to advance, the adoption of short and ultra-short implants is expected to see a rise in implant dentistry. It is imperative to exercise careful patient selection, comprehensive treatment planning, and precise execution of both surgical and prosthetic techniques for the successful implementation of implant therapy with short and ultra-short implants.

Volumetric Analysis After Modified Pedicle Roll Flap in Soft Tissue Ridge Augmentation in the Maxillary Esthetic Zone

Volumetric Analysis After Modified Pedicle Roll Flap in Soft Tissue Ridge Augmentation in the Maxillary Esthetic Zone

Volumetric and Linear Assessment of Maxillary Tuberosity Bone as A Donor Site for Alveolar Ridge Augmentation using CBCT A Cross Sectional Analytical Study

Volumetric and Linear Assessment of Maxillary Tuberosity Bone as A Donor Site for Alveolar Ridge Augmentation using CBCT A Cross Sectional Analytical Study

Bone Scrapers for Intraoral Bone Harvesting: A Comparative Review

Abstract Background: Dental implants are a standard treatment, but bone defects can complicate their placement. Alveolar ridge augmentation using autogenous bone (AB) grafts, harvested with tools such as bone scrapers, is a well-established solution. This review compares three famous bone scrapers: Ebner, Safe and 1/2 Buser Double-ended. Objective: This review aimed to compare the effectiveness, versatility and clinical outcomes of three commonly used bone scrapers for intraoral bone harvesting: Ebner scraper, Safescraper and 1/2 Buser Double-ended scraper. Methods: A systematic search identified ten relevant articles evaluating the use of these scrapers in intraoral bone harvesting procedures. The review compared the physical characteristics of the scrapers and summarised the clinical outcomes reported in the literature. Results: All three scrapers were effective for intraoral bone harvesting, offering advantages such as precision, cost-effectiveness and minimal risk of damage to surrounding tissues. However, they differed in their blade design, preferred harvesting site and amount of bone obtained. The Ebner scraper was most suitable for convex surfaces, the Safescraper for flat surfaces and the 1/2 Buser Double-ended scraper for irregular surfaces. Studies also showed that bone scrapers can effectively collect AB particles for optimal integration and healing. Conclusion: Bone scrapers are the valuable tools for intraoral bone harvesting procedures. The choice of scraper should be based on the specific clinical scenario and the desired amount of bone to be harvested. This review provides clinicians with information to select the most appropriate tool for their needs.

Methods of alveolar ridge augmentation with autograft in pre-implant preparation

Pre-implant ridge preparation using various bone augmentation methods is used to allow the insertion of endosseous dental implants in alveolar ridge atrophy. Purpose: Comparative analysis of methods to increase the alveolar bone ridges in pronounced atrophy in pre-implant preparation with autogenous bone grafts, improving and evaluation of the optimal method. Material and methods: 63 patients (20 males and 43 females) with partial edentulousness aged between 17 and 65 years, mean age 38.9 years, between 2011—2023, whose edentulous alveolar ridge corresponds to Misch’s type C-h atrophy, were studied. Three techniques were used to increase bone volume with the use of autogenous grafts: with the use of bone blocks; bone laminates according to F. Khoury; the method proposed by the authors. Results and discussion: the surgical techniques of using each method were described, the comparative analysis of the results demonstrated the effectiveness of the method proposed by the authors.

Regeneration of total tissue using alveolar ridge augmentation with soft tissue substitute on periodontally compromised extraction sites: case report

Regeneration of total tissue using alveolar ridge augmentation with soft tissue substitute on periodontally compromised extraction sites: case report

Horizontal ridge augmentation with porcine bone-derived grafting material: a long-term retrospective clinical study with more than 5 years of follow-up.

The purpose of this study was to evaluate the outcomes of implants placed in horizontally augmented alveolar ridges using porcine bone grafts and to investigate the long-term stability of the porcine bone grafts. A retrospective analysis was conducted on 49 sites that underwent horizontal ridge augmentation using porcine bone grafts and implant placement with a follow-up period longer than 5 years. Furthermore, additional analysis was conducted on 24 sites where porcine bone grafts were used exclusively for horizontal ridge augmentation and implant placement. The mean follow-up period after prosthesis loading was 67.5 months, with a mean marginal bone loss of 0.23 mm at 1 year and a cumulative mean marginal bone loss of 0.40 mm over the entire follow-up period. Of the 49 implants, 2 were lost and 3 did not meet the success criteria, resulting in a survival rate of 95.9% and a success rate of 89.8%. In 24 sites, the mean marginal bone loss was 0.23 mm at 1 year and 0.41 mm at 65.8 months, with 100% survival and success rates. Porcine bone grafts can be successfully used in horizontal ridge augmentation for implant placement in cases of ridges with insufficient horizontal width.

Horizontal Ridge Augmentation in Class III Alveolus Defect According to the Elian and Tarnow Classification

Guided bone regeneration (ROG) is the process of reconstructing bone defects. The size of the alveolar ridge can be affected by loss of alveolar bone due to trauma or periodontal disease. In this case report, horizontal ridge augmentation with a xenograft and resorbable collagen membrane was used to restore anterior bone loss in a 69-year-old patient with stage IV generalized periodontitis, stage B periodontitis and stage III alveolar defects according to Elian and Tarnow. Treatment consisted of the extraction of the affected teeth. The results obtained over six months showed an increase in the horizontal ridge of 4.8 mm, demonstrating the efficacy of ROG in alveolar defects. Finally, the results of this case highlight the potential of ROG for horizontal flanges.

The influence of vertical ridge augmentation techniques on peri-implant bone loss: A systematic review and meta-analysis.

The primary aim of this systematic review was to investigate and compare the outcomes of different vertical ridge augmentation (VRA) techniques in relation to peri-implant bone loss (PBL), after at least 12 months of functional loading. The search was conducted to find all the studies about VRA and measurements of PBL with at least 12 months follow-up. Three pairwise meta-analysis (MA) was performed to completely evaluate the outcomes. A total of 42 studies were included, of which 11 were randomized clinical trials (RCTs). RCTs were available only for guided bone regeneration (GBR), onlay, and inlay techniques. The weighted mean estimate (WME) of PBL value was found to be 1.38 mm (95% confidence interval [95% CI]: 1.10-1.66) after a mean follow-up of 41.0 ± 27.8 months. GBR, Inlay, Onlay, osteodistraction, and SBB represented in weight 32.9%, 30.6%, 25.0%, 7.6%, and 3.9%, respectively; and their WME (95% CI) were 1.06 (0.87-1.26) mm, 1.72 (1.00-2.43) mm, 1.31 (0.87-1.75) mm, 1.81 (0.87-1.75) mm, and 0.66 (0.55-0.77) mm, respectively. Among the secondary outcomes, the analysis was conducted for vertical bone gain, healing complication rate, surgical complication rate, implant survival, and success rate. The primary findings of the meta-analysis, based on the changes between final and baseline values, showed that the peri-implant bone loss could be influenced by the type of intervention but there is a need to evaluate in RCTs the behavior of the peri-implant bone levels after long-term follow-up for all techniques.

Reconstructive Surgery with Autogenous Chin Block Graft for Esthetic Rehabilitation of Deficient Anterior Maxillary Region.

Endosseous implants have revolutionized the field of Implants and Prosthodontics. Implant placement is a viable option in the treatment of partial and full edentulism. However, placement of implants in alveolar deficiencies may lead to adverse angulations, mechanical overload and esthetic dissatisfaction. When minimum dimensions for implant placement are not present in alveolar process, it is necessary to augment the size of the ridge. This can be achieved by various methods and materials. Here in this article presented a successful case of a 27year old male patient with horizontal ridge augmentation in anterior left central incisor region using autogenous chin graft followed by the placement of implants after a period of six months of grafting and finally the prosthesis given after a period of six months of healing of implants.

Case Report: Autogenous bone block grafting in esthetic zone for implant supported prosthetic rehabilitation

Background: Dental implants provide a novel method of successful treatment and have been a highly predictable surgical procedure for replacing single or multiple teeth. Maxillary anterior single-tooth replacement is often the most difficult procedure in all of implant dentistry. The highly esthetic zone of the premaxilla often requires both hard (bone and teeth) and soft tissue restoration. Therefore, augmentation of alveolar ridge defect becomes more important in terms of providing sufficient bone volume for the placement of implants and for aesthetic considerations. The aim of this case report was to bring forward the novel technique of combining ridge augmentation using autogenous bone block graft for anterior implant placement using piezoelectric apparatus. Case description: In this case report, a 27-year-old male patient presented to the department of periodontics with a chief complaint of poor aesthetics owing to missing tooth in the upper-front region (11) due to trauma that occurred 3 years back. The patient was diagnosed with an alveolar bone wall defect with 11 region. The authors brought forward the novel technique of combining ridge augmentation using autogenous bone block graft for anterior implant placement using piezoelectric apparatus in order to treat the patient. The follow-up was done at 6- and 9-months post-op respectively. Conclusion: In spite of all the technical difficulties that the surgical and restoring clinician may face, the anterior single-tooth implant is the ideal modality of choice to replace a missing anterior maxillary tooth. Clinical significance: Unique surgical and prosthetic concepts were implemented in this case for successful results.