Severe Bone Atrophy Research Articles

Previous reconstruction of severely atrophic maxilla with calvarial bone graft and implant supported fixed partial prosthesis - Case report

Purposes: Autogenous bone graft is still considered the “gold standard” for bone augmentation of the jaws prior to dental implants placement. In cases of major bone defects, we can relinquish reconstructive techniques using grafts from extra buccal donor areas, such as the calvarial bone graft. Although this technique is well established in the literature, many professionals feel insecure in indicating this type of treatment to their patients, due to the high degree of complexity for the execution of the procedure and not acceptance by the patient. Case report: A female patient, 42-year-old, had undergone reconstructive surgery by means of a calvarial bone graft for pre-maxilla reconstruction prior to dental implants placement in regions of 14 to 24. The graft collection procedure was performed in a hospital setting and under general anesthesia. The grafts were transplanted from the calvarial bone to reconstruct the anterior maxilla. After 7 months, 4 dental implants were placed, allowing a future prosthetic rehabilitation. After the period of osseointegration, screw-retained partial fixed prosthesis was made, returning function and aesthetics to the patient. Conclusions: In view of the clinical case and literature presented, it is concluded that patients with severe maxillary bone atrophy can undergo a successful reconstruction process with calvarial bone grafts and dental implants.

The management of vertical bone defects in the posterior area – The challenge

Background The rehabilitation in the posterior area in the absence of adequate quantity and quality of bone represents one of the most complicated challenges in the implantology. The management of the atrophy can be performed with different methods and materials. The autogenous bone is still considered the best material for the regeneration of the bone defects particularly when we have to recovery atrophy in the 3 D dimension. Aim/Hypothesis The present study evaluated the reliability and predictability of the treatment of severe bone loss in the posterior maxilla and mandible. The inclusion criteria were the advanced bone defects due to previously lost teeth and complications of cases already treated with other materials and technique Material and Methods Of 32 consecutive patients were treated in the posterior area (premolar and molar) after failures of previous treatment or in the cases of severe 3D bone atrophy and followed from 4 years to 8 years post-operative. In all the cases was performed only a 2 stage approach due to the severe bone loss. All the augmentation were carried out according to Khoury's biological concept. The harvested bone block from the mandibular retromolar area with the Microsaw, was splitted in 2 thin blocks and they were screwed to reconstruct at least two bone walls with the micro screws allowing a 3D reconstruction of the alveolar crest. The space between the two blocks were filled with particulate bone chips collected with a bone scraper. 22 reconstructions were carried out in the maxilla and 18 in the posterior mandible. No membranes were used. Implants were placed 4 months after the augmentation. The soft tissue management and augmentations were performed during the implant exposure 3 months post-operative Results A primary good healing occurred in all the 32 patients. No exposure of the grafts was registered after the augmentation or at the moment of implant insertion. The grafted bone after 4 months showed a good revascularization and stable bone volume showing the same consistence and bleeding like the native bone. Therefore, we proceeded to insert 93 implants with regular diameter (3.4–4.5 mm) and length (9.5–13 mm) in the augmented posterior area in the mandible and in the maxillary as we planned. In only two patients a secondary bone augmentation with local harvested bone was necessary due to incomplete bone regeneration (both cases were complication of previous reconstruction techniques). All the patients presented after a follow-up between 4 and 8 years a good function and aesthetical result with the correct hight of the crowns. The radiographic control, repeated every year, documented the stability of the grafted and regenerated bone. Conclusion and Clinical Implications The management of bone defects in 3D dimension represents a big challenge particularly when the demand of the patient is really important. With the biological concept we were able to ensure a long-term stability with very good outcomes for aesthetics and function. The use of autogenous bone offered more safety and reduced considerably the time of the treatment in comparison to other augmentation materials remaining nowadays more reliable and predictable.

Extra-Long Nasal Wall-Directed Dental Implants for Maxillary Complete Arch Immediate Function: A Pilot Study.

Immediate loading of maxillary denture prostheses in the context of severe bone atrophy is complicated by posterior implant placement, sometimes requiring a complex surgical approach as zygomatic or pterygoid implants. To overcome this complexity, the authors developed an extra-long (20-24mm) 24-degree angulated platform. It was tested on 33 patients, with 24 patients immediately loaded (72.7%) for a total of 115 implants (46% nasal). All delayed loading implants osseointegrated. Eight bilateral and six unilateral sinus grafts were performed. There were no complications during the follow-up period.

Rehabilitation of atrophic jaw using iliac onlay bone graft combined with dental implants

BackgroundRehabilitating severely atrophic alveolar crests remains challenging for implantologists and maxillofacial surgeons. Recently, a combination of augmentation and dental implantation has been used to treat cases with severe bone atrophy in the maxilla and mandible. Among autogenous bone grafts, iliac bone grafting (IBG) is considered safe for collecting large amounts of bone and obtaining high-density multipotent cells. However, vertical bone resorption may occur during the initial healing stage after IBG. The purpose of the present study is to evaluate bone graft success and implant survival rate, along with bone height in the augmented site and marginal bone level around dental implants placed in iliac onlay bone grafts. We also introduce technique and treatment considerations for successful IBG procedures, as well as optimal implant installation strategy and soft tissue manipulation.MethodsWe examined seven patients who were treated with IBG combined with implant systems over a period of 10 years. The long-term success rate of bone grafts and implant survival rate were recorded. Bone height change and marginal bone loss (MBL) were analyzed by assessing the radiograms acquired after augmentation, at implant installation, prosthetic loading, and after installation 1 year, 2 years, 3 years, and 5 years.ResultsIn a mean observation period of 50 months (range 12–62 months), the success rate of IBG was 100%. A total of 29 implants were installed and the implant success rate was 100%. The mean bone height reductions compared to post-augmentation bone heights were 1.33 ± 0.81 mm after 3 months, 2.00 ± 1.88 mm at implant installation, 2.55 ± 1.68 mm at prosthetic loading, and 3.05 ± 1.63 mm after implant installation 1 year. The cumulative bone height change after implant installation 5 years was 4.05 ± 1.83 mm which corresponds to a mean resorption rate of 42.5%. The mean MBL after installation 3 months, at prosthetic loading, and after installation 1 year, 2 years, 3 years, and 5 years follow-ups were significantly higher than at implant installation. However, MBL at 2 years, 3 years, and 5 years post-installation did not differ significantly (p < 0.05).ConclusionIn patients with atrophic jaws, a combination of the iliac onlay bone graft and dental implants can result in satisfactory reconstruction and reliable long-term prognosis. Despite early stage vertical bone resorption, we observed high success rates and comparable MBL over long-term follow-up. To reduce bone resorption, case evaluation and surgical planning must be meticulous. Further large-scale studies with longer-term follow-up are needed.

Horizontal ridge augmentation with guided bone regeneration using particulate xenogenic bone substitutes with or without autogenous block grafts: A randomized controlled trial.

To evaluate dimensional bone alterations following horizontal ridge augmentation using guided bone regeneration (GBR) with or without autogenous block graft (ABG) for the rehabilitation of atrophic jaws with dental implants. Forty-two patients, with 42 severe horizontal bone atrophy sites in the maxilla or mandible were randomly assigned to two groups: ABG or GBR. The ABG group received a combination of ABG with particulate xenograft, covered by a collagen membrane, while the GBR group received particulate xenograft alone, covered by a collagen membrane. After 6-9 months of healing, implants were inserted. All implants were definitively restored 6 months after implant placement. Radiographic examination (cone-beam computed tomograms) was performed immediately after bone grafting procedure (T0), at 6 months (T6), and at 18 months (T18), to evaluate the amount of horizontal bone width (HBW) gain. Patient demographic information, amount of ridge width augmentation, implant survival, complications, and contributing factors were gathered and analyzed. Thirty-nine patients completed the study. Both groups developed enough bone ridge width for implant placement. A total of 65 implants were placed. Implant survival rate was 100% in both groups at T18. Mean increases in HBW amounted to 5.6 ± 1.35 mm in GBR sites and 4.8 ± 0.79 mm in ABG sites at T18. There was no statistically significant difference in HBW gain obtained in the GBR group when compared to the ABG group at 6 months (P = 0.26) or 18 months (P = 0.26). However, the ABG group had a statistically significant higher prevalence of sensory disturbances (P = 0.02) and hematomas (P = 0.002) compared to the GBR group. These findings indicated that either GBR with or without ABG is an effective approach in augmenting resorbed horizontal deficient ridges prior to implant placement. However, more complications may be seen with the use of ABG related to the donor sites.

Dental implants placed buccally to the mandibular canal in molar regions with severe vertical bone loss: case reports

Introduction: Alveolar bone loss in posterior regions of the mandible is a serious limiting factor for the installation of osseointegrated dental implants. New surgical procedures are needed to circumvent the lack of vertical bone. Objective: The objective of this study was to present an alternative technique for dental implants in the lateral posterior region of the mandible in patients with severe vertical ridge atrophy Case Reports: Four patients with the specific anatomical characteristics that met the requirements of the technique were selected. Six implants were inserted buccally to the mandibular canal and were restored after at least two months of healing time. The mean follow up period of the implants was 3 years. No implant was lost during this time. All of them remained in excellent clinical condition and met the aesthetic criteria and functional demands of occlusion. Conclusion: The technique presented here proved to be minimally invasive, safe, conservative and effective as an alternative treatment option for dental rehabilitation in mandibular posterior regions with severe bone atrophy. However, it requires experience, preparation and skill of the professional in order not to damage the inferior alveolar nerve and at the same time install the implant in the correct position, thus allowing its functional and aesthetic rehabilitation.

Transalveolar Osteotomy of the Mandibular Canal Wall for the Treatment of Severely Atrophied Posterior Mandible

Treatment of severe bone atrophy of the posterior mandible requires an advanced surgical bone augmentation technique. This report describes a minimally invasive approach for a residual alveolar height less than 5mm. A retrospective case series was conducted in a single private dental clinic. Outcome variables were dental implant survival rate, intraoperative complications, occurrence of neurosensory disturbances, and marginal bone loss. Descriptive analysis was performed for patients' demographic data, postoperative healing, and implant details. Kaplan-Meier method was used to assess the implant survival rate. The mean age of the 19 patients was 60±13years. Twenty-eight implants (5.5mm long) were placed in a residual alveolar bone height of 4.5±0.6mm. The implant survival rate was 96% at 5-year follow-up. Extra-short implants and transalveolar preparation of the inferior alveolar cortical bone could be a safe and effective treatment of severe mandibular atrophy.

Additively manufactured sub-periosteal jaw implants

Severe bone atrophy jeopardizes the success of endosseous implants. This technical note aims to present the innovative concept of additively manufactured sub-periosteal jaw implants (AMSJIs). Digital datasets of the patient’s jaws and wax trial in occlusion are used to segment the bone and dental arches, for the design of a sub-periosteal frame and abutments in the optimal location related to the dental arch and for the design of the suprastructure. The implants and suprastructure are three-dimensionally (3D) printed in titanium alloy. The provisional denture is 3D-printed in polymer. AMSJIs offer an alternative approach for patients with extreme jaw bone atrophy. This report refers to the use of this technique for full maxillary rehabilitation, but partial defects in either jaw and extended post-resection defects may also be approached using the same technique. This customized, prosthesis-driven reverse-engineering approach avoids bone grafting and provides immediate functional restoration with one surgical session.

A Novel Method of Mild to Moderate Parry-Romberg Syndrome Reconstruction: Computer-Assisted Surgery With Mandibular Outer Cortex and Fat Grafting.

In patients with mild to moderate Parry-Romberg syndrome (PRS), plastic surgeons have mainly focused on the restoration of soft tissue deficiencies. While, bone deficits are easily overlooked. This study developed a new method combines the autologous mandibular outer cortex (MOC) grafting with fat grafting in mild to moderate patients with PRS, and apply computer-assisted techniques to improve the surgical outcomes and accuracy. Seven patients with mild to moderate PRS were prospectively enrolled in the study. Preoperative and 7 days and 6 months postoperative computed tomography (CT) and photographs were performed. Computer-aided design was done based on preoperative CT data. Surgical templates for MOC harvesting and grafting were designed and printed out. The topographic map of fat grafting was generated. The accuracy of MOC bone grafting was evaluated by the MOC thickness relative error, the MOC thickness accuracy at the preop most severe bone atrophy point (preop MSBAP), and the MOC volume accuracy. The percentage volume maintenance of the fat grafting surgery was assessed. All 7 patients had ideal clinical outcomes with significant improvement in facial symmetry and no major complications happened. The average MOC thickness relative error is 2.85 ± 0.50%. The average MOC thickness accuracy at the preop MSBAP is 3.36 ± 1.13%. The average MOC volume accuracy is 3.41 ± 1.37%. The average percentage volume maintenance of fat grafting is 62.79 ± 5.73%. The combination of MOC grafting with fat grafting can be an excellent choice in reconstruction of mild to moderate patients with PRS. Applying computer-assisted techniques offers a reliable and accurate outcome.

Applications of biomaterials for bone augmentation of jaws: clinical outcomes and in vitro studies.

Partially or totally edentulous jaws frequently undergoes from moderate to severe bone atrophy with problems of prosthetic rehabilitation. The inability to make a prosthetic rehabilitation on implants may led to the use of a partial or total removable denture with difficulties in eating and speech, ulcerations of the oral mucosa and loss of facial vertical dimension. These problems may be solved performing bone augmentation procedures. Bone grafts and distraction osteogenesis brought implant dentistry from an experimental practice to become a consolidate dental procedure. Bone grafts, in particular, are currently a valuable treatment modality for the prosthetic rehabilitation. Numerous biomaterials have been developed for the rehabilitation of partially or totally edentulous jaws with fixed or removable dentures. The aim of this paper is to describe biomaterials for bone augmentation. Biomaterials are gradually resorbed by the osteoclasts and replaced by new bone formed through osteoblastic activity. Many biomaterials have been studied, but the most common are as follows: Allogro®, Algipore®, Osteobiol®, Peptide-15, Engipore®, Medpore®, Osteoplant®, Calcium sulfate, Perioglass®, Bio-Oss®, Calcium phosphate.

Lateral Ridge Augmentation Using Autogenous Block Grafts and Guided Bone Regeneration: A 10-Year Prospective Case Series Study.

The use of autogenous block grafts harvested from intraoral donor sites has proven to be effective for the reconstruction of horizontal bone defects. The objective of this study was to analyze implant success and the rate of block graft resorption 10 years after ridge augmentation to elucidate contributing factors influencing graft maintenance. A staged horizontal block graft augmentation was performed in 52 implant sites exhibiting severe horizontal bone atrophy using autogenous block grafts protected by DBBM and collagen membranes. The crest width was assessed intraoperatively at surgery and at re-entry after 6 months. At the 10 year reexamination clinical and radiographic parameters were assessed using cone beam computed tomography. The 10-year implant success rate amounted to 98.1%, with minimal peri-implant bone loss (-0.17 mm for the maxilla, -0.09 mm for the mandible). The surface resorption rate after 10 years was 7.7% (0.38 mm). Grafts originating from the chin demonstrated significantly better graft maintenance at 10 years compared to retromolar grafts. Recipient site and age had no significant impact on graft resorption, whereas females showed more bone loss at the 10-year examination. Lateral ridge augmentation using autogenous block grafts and guided bone regeneration demonstrated a favorable success rate of 98.1% with minimal block graft resorption of 7.7% after 10 years. Modulating factors were origin of the graft and gender.

Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.

Treatment of the severely atrophic maxilla with dental implants is challenging due to the insufficient horizontal and vertical bone volume and centripetal resorption pattern of the maxilla. Bone-augmentation procedures are often necessary prior to implant placement. The objective of this study was to assess the suitability of using calvarial bone grafts to enable implant placement in severely atrophic maxillae. Seventeen patients with severe atrophic edentulous maxillae were reconstructed with autogenous calvarial bone grafts. After a 4-month healing period, the patients received a total of 134 dental implants, which were left to heal in submerged positions for 3months before prosthetic rehabilitation was performed. Patients were followed clinically and radiographically for an average observation period of 53.94months. At the intraoral recipient sites, two infections developed, causing partial loss of the respective bone grafts. Implant placement, however, was possible at all sites. No donor-site complications occurred. Two of 134 implants were lost in two patients prior to prosthetic loading. The implant survival rate was 98.51%. The implant success rate was 87.6%, and a mean marginal bone loss of 0.62mm (SD 0.77mm) was documented. Patients with severe bone atrophy of the edentulous maxilla can be successfully reconstructed with calvarial bone grafts and dental implants and show a stable clinical and radiographic situation after a mean observation period of 53months.

Surgical complications in zygomatic implants: A systematic review.

BackgroundThe use of zygomatic implants in the prosthetic rehabilitation of the patient with severe maxillary bone atrophy is another therapeutic alternative, not exempt from complications. The main objective of this review is to analyze and describe the most frequent surgical complications associated with the use of zygomatic implants.Material and MethodsAn electronic database search on PubMed, along with a manual search, without taking into account date nor language, was undertaken by two observers, selecting studies that comprised a study period from 6 to 12 months, any type of clinical trial, and series that included a follow-up and/or review period during the aforementioned margin, that mentioned at least two types of complications.ResultsOut of the initial search that yielded 455 studies, 67 were considered potentially relevant for the present study, out of which 14 were finally selected. Out of the most frequent surgical complications, sinusitis (3,9%) and failure in osseointegration (2,44%) are highlighted.ConclusionsThe analysis of the results shows that the most frequent complications are sinusitis and failure in osseointegration of the zygomatic implant. However, a standardised data collection system for the data on complications is needed. Key words:Implant, zygomatic implant, surgery, complications.

Retracted: Histological and histomorphometric analyses of narrow implants, crestal and subcrestally placed in severe alveolar atrophy: a study in foxhound dogs

Narrow-diameter implants provide an alternative to the horizontal augmentation techniques situations severe bone atrophy. Lack of bone width and interdental space has been regarded as an encumbrance in the case selection for prosthetic rehabilitation using dental implants. The aim of the study was to evaluate bone-to-implant contact and marginal bone loss of two different narrow implants in resorbed ridges at different crestal positions. 48 Bredent Narrow(®) implants (24 MiniSky(®) and NarowSky(®) ) were placed at crestal and subcrestal levels in healing bone of atrophic alveolar ridge of 6 American foxhounds. Histological and histomorphometric analyses of osseointegration were carried out at 4 and 8 weeks. Modeling in the marginal defect region was accompanied by marked decreases in the dimensions of both the buccal and the more lingual bone walls. Relative to BIC, significant differences were found in favor of subcrestal group, for both Narrow Sky and MiniSky. Linear measurements showed to be slightly high in the crestal group. With significant differences for PM-IS (peri-implant mucosa to implant shoulder) and IS-BC (implant shoulder to buccal bone crest). Within the limitations of animal study, it can be stated that the NarrowSky(test group) crestal and subcrestal implants showed less crestal bone resorption, higher ISQ values and most BIC at 4 and 8 weeks of evaluation compared with MiniSky implants (control group). The design of the implants plays an important role in peri-implant mucosa and crestal bone maintenance at 8-week follow-up period.

Incremental, Transcrestal Sinus Floor Elevation With a Minimally Invasive Technique in the Rehabilitation of Severe Maxillary Atrophy. Clinical and Histological Findings From a Proof-of-Concept Case Series

In the posterior maxillary sextants, the residual dimensions of the edentulous ridge can considerably limit the insertion of implants with the desired length and diameter. A minimally invasive procedure for transcrestal sinus floor elevation (tSFE), namely the Smart Lift technique, which is based on a standardized sequence of specifically designed drills and osteotomes, was introduced in 2008 and subsequently validated in a series of recent studies. The present technical note describes the use of the technique by a staged approach, called incremental tSFE (i-tSFE), in the augmentation of severely resorbed edentulous ridges. The i-tSFE consists of 2 staged tSFE procedures performed with a transcrestal access, the second of which is performed concomitantly with implant placement. In the present case series, 3 patients with severe bone atrophy (residual bone height, 2 to 3 mm) in the edentulous posterior maxilla were treated with i-tSFE. At the second surgical stage of i-tSFE, implants at least 8 mm long were placed at all sites, and the success of the implant-supported restoration was monitored to 6 months (1 patient) or 3 years (2 patients). Histologic findings from an augmented site showed the presence of newly formed bone, bone marrow spaces with numerous vascular canals, and residual graft particles occupying approximately 50%, 15%, and 35% of the total area, respectively. The results of the study showed that i-tSFE can be performed successfully with the Smart Lift technique to rehabilitate atrophic maxillary posterior sextants.

Regenerative Surgery for the Rehabilitation of a Patient after Surgery and Radiation Therapy for Head and Neck Cancer: A Case Report

Oral cancer is usually treated combining surgery, radiation therapy and chemotherapy, following effective therapeutic protocols. Severe maxillary and mandibular bone atrophy resulting after therapies are usually treated with autologous bone grafting procedures even though these techniques often present a significant risk of postoperative complications and disadvantages. We describe the case of a 59-year-old woman presenting severe bone defect after being treated with surgery and radiotherapy for recurrent oral verrucous squamous cell carcinoma. We performed bone regeneration using Platelet-Derived Growth Factors (PDGF) in combination with autologous bone chips. Our procedure of bone regeneration allowed the placement of dental implants and the achievement of a good aesthetic and functional result. Regenerative surgery may enable the regeneration of substantial bone defects. Moreover, PDGF application decreases the risk of implant failure in irradiated patients.

Implant-Guided Vertical Bone Augmentation Around Extra-Short Implants for the Management of Severe Bone Atrophy

The purpose of this study is to describe the conservative treatment of severe vertical bone atrophy by combining the insertion of extra-short implants and implant-guided bone augmentation. For that, a low-speed drilling protocol was selected to facilitate the collection of bone particles and to maintain graft osteogenic properties. Extra-short implants were incompletely inserted because of the severe atrophy, and the denuded implant surface was covered by autologous bone particles held together by the adhesive properties of plasma rich in growth factors. The surgical site was then covered with resorbable fibrin membrane, and the flap was repositioned and sutured. Eight patients with a mean residual bone height of 4.19 ± 0.97 mm were treated according to the described treatment protocol. The distance between the implant shoulder and the bony crest was 1.77 ± 0.18, 2.16 ± 0.23, and 1.97 ± 0.26 mm at the mesial, central, and distal aspects, respectively. Vertical bone augmentation resulted in the coverage of 85% of exposed surface by stimulating 1.6 ± 0.5 mm of supra-alveolar bone growth. All 10 extra-short implants placed were successfully osseointegrated. After a mean of 5 ± 1.6 months, provisional screw-retained prostheses were placed. Within the limitations of this study, we conclude that the minimally invasive approach described may successfully rehabilitate extreme vertical bone atrophy in the posterior mandible.

Case of Severe Bone Atrophy of the Posterior Maxilla Rehabilitated With Blocks of Equine Origin Bone

To report the histological outcomes of a case of bilateral severely resorbed posterior maxilla augmented with the use of blocks of enzymatically deantigenated equine bone. In conjunction with bilateral sinus lifts, blocks of enzymatically deantigenated equine bone were used bilaterally to augment the severely atrophic maxilla of a patient seeking a fixed implant-supported prosthesis. After 8 months, bone core samples were obtained from the augmentation sites and implants were placed. Six months after implant placement, the peri-implant bone levels were maintained. A prosthesis delivered 3 months after implant placement provided excellent rehabilitation. Histological analysis of the bone cores revealed that the graft material was still undergoing remodeling, with newly formed vital bone in all fields and osteoclasts included in the mineralized component. The deantigenated equine bone was biocompatible and resorbed only minimally. This material seems to offer excellent potential for being incorporated in a procedure that increases the width of edentulous alveolar crests.

A New Approach to Maintenance of Regenerated Autogenous Bone Volume: Delayed Relining with Xenograft and Resorbable Membrane

The aim of this case series is to propose an approach to help maintain autogenous bone grafts. This is done by applying a collagen membrane (CM) and anorganic bovine bone (ABBM) at the time of implant surgery, rather than at the time of ridge augmentation, to avoid volume loss after implants are inserted. Ten patients with severe horizontal bone atrophy were consecutively enrolled in this study. A staged approach was chosen for implant placement following horizontal ridge augmentation. A block graft was harvested from the retromolar area and secured to the recipient site with fixation screws; contour overbuilding was avoided. The width of the ridge was measured before and after horizontal augmentation. After 4 months of healing, implants were inserted, the augmented site was relined with ABBM, and CM was applied to prevent bone volume loss. Another 4 months later, at the time of abutment placement, cone beam computed tomography was performed to quantify the end result. The mean horizontal ridge width prior to treatment was 2.1 ± 0.5 mm. Mean postsurgical crest width was 6.9 ± 0.5 mm. After the 4-month healing period, the mean alveolar crest width was 6.6 ± 0.6 mm. At the time of abutment connection, the mean width of the regenerated ridge, as measured on three-dimensional cone beam images, was 7.7 ± 0.8 mm. Minimal bone loss occurred in unprotected autogenous bone grafts with respect to alveolar bone contour (0.25 ± 0.29 mm). After the implants were inserted, no further remodeling/resorption occurred with sites treated by ABBM and CM relining; moreover, an additional increase in alveolar crest width was evident. The nonresorbable ABBM osseointegrated clinically and radiologically, preventing bone loss prior to implant loading. This layer appeared to maintain the regenerated crest volume.

Minimally invasive approach with tissue engineering for severe alveolar bone atrophy case

The gold standard of bone augmentation for dental implants in severe alveolar bone atrophy is autogenous bone graft, but it has disadvantages such as limited amounts of grafted bone, poor morphological and aesthetic outcomes, and donor-site morbidity and invasiveness, especially in cases with diseases. In this reported case, the authors applied a novel tissue engineering method as minimally invasive surgery for a 58-year-old patient who had severe bone atrophy. The method, tissue-engineered bone (TEB), composed of mesenchymal stem cells as stem cells, platelet-rich plasma as growth factor and guided bone regeneration membrane. After bone regeneration by TEB, three 13mm long dental implants were inserted. Adequate bone regeneration was shown by radiological analysis and histological observation. The augmented bone height was 4.2mm after the operation and the radiopaque areas were increased. The clinical progress over 2 years showed a good course without bone resorption. These results indicated that TEB, as bone regeneration treatment with minimal invasiveness, could be useful as one of the novel options in dental implant treatment with severe bone atrophy.