Vertical Bone Volume Research Articles

Comparative analysis of alveolar bone volume reconstruction outcomes using the guided bone regeneration technique

Relevance. The success of dental implant treatment in cases of reduced alveolar bone volume hinges on restoring bone to the required dimensions in each case. The guided bone regeneration (GBR) technique, which encompasses various techniques, holds a central role in oral reconstructive surgery and dental implantology due to its capacity for continuous improvement. The authors' experience with a modified GBR technique incorporating a situational Vicryl framework (SVF) has demonstrated enhanced effectiveness, with the potential to restore vertical bone volume by 5 mm or more. This study aimed to evaluate the advantages of the modified GBR technique using SVF compared to the conventional GBR technique.Materials and methods. This study is based on a comprehensive comparative analysis of two datasets: a retrospective evaluation of dental implant treatment outcomes in 210 patients who required alveolar bone volume restoration using the classical GBR technique, and clinical data from 40 patients treated with both the classical GBR technique and the proposed modified SVF technique The oral status of 40 patients included in the clinical analysis was characterized by partial edentulism, accompanied by mild to moderate alveolar bone deformities resulting from either inflammatory resorption or natural atrophy. The retrospective group 1 (comparisons) consisted of archival data of 210 patients. Retrospective data from 210 patients and clinical data from 40 patients were subjected to statistical analysis using parametric and non-parametric methods with IBM SPSS Statistics software.Results. A comprehensive comparative analysis of retrospective and clinical data revealed the following results. The value of the integrated "restored bone volume" parameter after vertical reconstruction in group 1 was 2-3 mm. The mean value of the integrated "restored bone volume" parameter after vertical reconstruction in group 2 was 3.20±0.96 mm, while in group 3, it was 4.60±1.63 mm for patients of both sexes. Comparison of the integrated "baseline deformation" parameter by technique showed a median deformation of 2.95 mm in group 2, treated with the classical GBR technique, and 4.95 mm in group 3, treated with the modified SVF technique. Similarly, the integrated "restored bone volume" parameter showed a median value of 2.95 mm in group 2 and 4.85 mm in group 3. The average value of the integrated "restored bone volume" parameter in group 2 was comparable to retrospective data from 210 patients in group 1.Conclusion. The comprehensive analysis of alveolar bone volume reconstruction using two GBR techniques, based on "baseline deformation" and "restored bone volume" parameters, demonstrated a significant advantage of the modified GBR technique compared to the classical technique.

Research trends and mapping knowledge for maxillary sinus augmentation in oral and maxillofacial surgery

BackgroundThe method most frequently employed to alleviate the deficiency of vertical bone volume in the maxillary posterior region is maxillary sinus augmentation. Given its importance in the field of dental implants and its possible impact on implant survival, it is crucial to assess the caliber and bibliometric characteristics of research related to maxillary sinus augmentation. This study aimed to understand the development and trends of studies and guide future studies by performing a bibliometric analysis of research related to maxillary sinus augmentation. MethodsThe Web of Science database was searched on 29.05.2024 with the developed search strategy. Articles were listed in descending order according to the number of citations and analyzed using the Bibliometrix program prepared in R base. The articles were analyzed in four sections: performance analysis, word analysis, collaboration analysis, and thematic analysis. ResultsWang HL is the most frequently listed author on this topic with 24 h-indexes and 1686 total citations. The highest number of articles were published in 2017, with 102 articles with an average of 2.7 citations. The most popular keyword was "dental implants." with 426 usages. Italy and the USA are the countries that have published the most collaborative papers. Clinical Oral Implants Research comes at the top when evaluating the journals that publish on maxillary sinus augmentation based on the h-index. Basic research and technical-oriented studies between 1999 and 2005 have given way to more clinical and patient-oriented research. ConclusionThis bibliometric study will serve as a guide for future research by illustrating the existing state of knowledge and limitations regarding the development of sinus lifting methods, given the constantly growing demand for implant therapy.

Does alveolar ridge preservation reduce the need for sinus floor elevation: A comparative study to spontaneous healing.

In cases of atrophy in the maxillary posterior region, characterized by reduced vertical bone volume, implant placement becomes challenging. Augmentation procedures like sinus lifts are often needed to address insufficient bone volume. This study aims to explore if alveolar ridge preservation, using a bovine bone substitute and a porcine collagen membrane, significantly decreases the need for sinus lifts compared to natural wound healing after tooth extraction. In this comparative clinical study, 40 patients requiring a total of 53 extractions were assigned to one of the following groups: a test group with bovine bone substitute material (Straumann® XenoFlex) and a porcine collagen membrane (Jason® membrane), or a control group with spontaneous socket healing. After 6 months, digital volume tomography was performed for implant planning. For seven patients from the control group (n = 22 extracted sites) sinus lift augmentations were performed while only four sinus lift procedures were performed in the test group (n = 31 extracted sites), indicating a higher need for sinus augmentation procedures in the control group, however not statistically different on a p value of 0.05 (p = 0.168). In the control group, the mean value of the radiographically measured bone height (mesial and distal) was 11.13 ± 2.12 mm preoperatively before tooth extraction, while it was 11.3 ± 2.17 mm postoperatively after implant placement. In contrast, the mean value in the test group was 11.78 ± 3.09 mm preoperatively and 11.92 ± 2.79 mm postoperatively. Statistical analysis revealed no significant difference between the two groups (odds ratio 0.32; 95% CI: 0.08, 1.26; p = 0.951). The implant survival rate in the control group was 100%, compared to 96.77% in the test group. Within the limits of this study, the use of bovine bone substitute and a porcine resorbable membrane after tooth extraction in the posterior maxilla seems to reduce the need for sinus augmentation in comparison to spontaneous healing although the difference was not statistically significant. Additionally, the Alveolar Ridge Preservation in the test group made external sinus floor elevation unnecessary compared to the control group. The change in radiographically measured bone height pre- and postoperatively showed no significant difference between the two groups.

Development, Characterisation and Biocompatibility Analysis of a Collagen-Gelatin-Hydroxyapatite Scaffold for Guided Bone Regeneration

Guided Bone Regeneration (GBR) is the choice of treatment for improving the horizontal and vertical bone volume through bone grafting. GBR membranes work on the principle of preventing epithelial migration into the defect space while maintaining the space for cell migration and differentiation at the defect site. Hydroxyapatite has been commonly used as a bone graft for infrabony defects. The study was conducted at the Department of Biomaterials at Saveetha Dental College. GBR membrane was prepared and its material characterization was done using Scanning Electron Microscope (SEM), Energy Dispersive X-ray (EDX) analysis, Fourier Transform Infrared Radiation (FTIR), and Confocal Analysis. The developed GBR membrane revealed SEM properties conducive to cell attachment. EDX and FTIR analysis showed the successful development of the collagen-gelatin-hydroxyapatite membrane. Cell culture and confocal analysis revealed excellent biocompatibility with a homogenous layer of viable cells. The developed composite GBR membrane is a biogenic membrane with relevant biomineralization potential that should be applied for GBR applications.

Prosthetically CAD-CAM-Guided Bone Augmentation of Atrophic Jaws Using Customized Titanium Mesh: Preliminary Results of an Open Prospective Study.

This study evaluated the outcomes of computer-aided design-computer-aided machining (CAD-CAM)-customized titanium mesh used for prosthetically guided bone augmentation related to the occlusion-driven implant position, to the vertical bone volume gain of the mandible and maxilla, and to complications, such as mesh exposure. Nine patients scheduled for bone augmentation of atrophic sites were treated with custom titanium mesh and particulate bone grafts with autologous bone and anorganic bovine bone in a 1:1 ratio prior to implant surgery. The bone volume needed to augment was virtually projected based on implant position, width, and length, and the mesh design was programmed for the necessary retaining screws. After 6 to 8 months, bone augmentations of 1.72 to 4.1 mm (mean: 3.83 mm) for the mandibular arch and 2.14 to 6.88 mm (mean: 3.95 mm) for the maxilla were registered on cone-beam computerized tomography. Mesh premature (within 4 to 6 weeks) exposure was observed in 3 cases and delayed (after 4 to 6 weeks) in 3 other cases. One titanium mesh was removed before the programmed time but in all augmented sites was possible implant insertion. No complication occurred during prosthetic follow-up. Using CAD-CAM technology for prosthetically guided bone augmentation showed important postoperative morbidity of mesh exposure (66%). Because of this high prevalence of mesh exposure and the potential infection that could affect the expected bone augmentation, this study suggests a cautious approach to this procedure when designing the titanium mesh, to avoid flap tension that may cause mucosal rupture.

Influence of Chromium-Cobalt-Molybdenum Alloy (ASTM F75) on Bone Ingrowth in an Experimental Animal Model.

Cr-Co-Mo (ASTM F75) alloy has been used in the medical environment, but its use as a rigid barrier membrane for supporting bone augmentation therapies has not been extensively investigated. In the present study, Cr-Co-Mo membranes of different heights were placed in New Zealand white, male rabbit tibiae to assess the quality and volume of new bone formation, without the use of additional factors. Animals were euthanized at 20, 30, 40, and 60 days. Bone formation was observed in all of the cases, although the tibiae implanted with the standard membranes reached an augmentation of bone volume that agreed with the density values over the timecourse. In all cases, plasmatic exudate was found under the membrane and in contact with the new bone. Histological analysis indicated the presence of a large number of chondroblasts adjacent to the inner membrane surface in the first stages, and osteoblasts and osteocytes were observed under them. The bone formation was appositional. The Cr-Co-Mo alloy provides a scaffold with an adequate microenvironment for vertical bone volume augmentation, and the physical dimensions and disposition of the membrane itself influence the new bone formation.

Reactive Soft Tissue Preservation in Maxillary Large Bone Defects.

Granulation tissue containing reactive soft tissue with potential multipotent stem cells can help socket healing following extraction. The aim of this study was to assess bone healing of maxillary large bone defects while maintaining reactive soft tissue. A total of 32 patients presenting large bone defects were selected for this prospective study. Eight patients (Group A) presented with large bone defects but an intact buccal cortical plate, while 24 patients (Group B) presented with large bone defects lacking a buccal cortical plate. Teeth were extracted, and reactive soft tissue was left in the defects. Bone volume was assessed through cone beam computed tomography (CBCT) both before tooth extraction and at 4 months. A histomorphometric evaluation was performed. CBCT and cylinder bone cores were obtained for histology and histomorphometry analysis. At 4 months after tooth extraction, CBCT showed bone volume preservation and bone formation and no statistically significant difference in bone volume before and after tooth extraction in group A. However, in group B, over the same time period, a statistically significant increase (P < .01) of vertical bone volume was reported. Biopsy specimens showed the presence of vital bone in the defects 4 months later. Reactive soft tissue left in large bone defects after tooth extraction may support a significant bone volume gain and vital bone formation.

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.

Reactive Soft Tissue Preservation in Large Bone Defects After Tooth Extractions: A Cone Beam Study.

Reduction of alveolar height and width after tooth extraction may present problems for implant placement, since bone volume is important for biologic and esthetic reasons. The aim of this study was to assess bone healing of large bone defects grafted with collagen sheets and maintenance of reactive soft tissue, evaluating cone beam computed tomography (CBCT) scans and histomorphometric results. Patients presented large bone defects after tooth extractions. Reactive soft tissue was left in the defects filled by collagen sheets. Vertical bone volume was assessed by CBCT examinations before tooth extractions and 3 months later. At 3 months, cylinder bone samples were obtained for histology and histomorphometry analysis. Twenty-six patients were included in the clinical study. Examined defects reported mean bone gain of 12.13 ± 3.91 mm, and mean vertical bone levels showed a statistically significant increase (P < .05) at 3 months after extraction. Histologic examinations revealed bone formation; mean vital bone measurements were 41.59% ± 5.80%, and connective tissue percentages averaged 50.37% ± 7.73%. Reactive soft tissue left in large bone defects after tooth extraction and grafted collagen may support a significant vertical bone gain and vital bone formation.

Sinus Lift Augmentation by Using Calcium Sulphate. A Retrospective 12 Months Radiographic Evaluation Over 25 Treated Italian Patients

Purpose:The aim of this investigation was to assess bone healing of sinus lift procedure in which the augmentation has been performed by using calcium sulphate like bone substitutes. The methods of this investigation how the use of Cone Beam Computed Tomography (CBCT) may be a valid instrument to support reconstructive surgery of the jaws.Patients and Methodology:25 Patients presented large bone defects after tooth extractions located in the upper jaw posterior area. Vertical bone volume was assessed by CBCT examinations before and about six months after sinus lift surgery. Results:Examined defects treated with sinus lift surgery and evaluated by CBCT showed a strong increasing on the bone volume at 6 months follow up control.Conclusion:Calcium sulphate application in sinus lift surgery represent a safe and predictable option in the place of autologous bone. Therefore the application of CBCT investigation may give the clinicians the opportunity of evaluating with high precision value, the consistence of the bone defects before the surgery.

Vertical Trabeculae are Thinned More Than Horizontal Trabeculae in Skeletal-Unloaded Rats.

Skeletal unloading results in a rapid thinning of the trabecular bone network, but it is unknown whether vertical and horizontal trabeculae are equally affected. Therefore, the purpose of the present study was to investigate whether horizontal and vertical trabeculae were thinned similarly during skeletal unloading in rats. Fifty-seven 16-week-old female Wistar rats were randomized into six groups: baseline; control 4 weeks; botulinum toxin A (BTX) 4 weeks; control 8 weeks; BTX 8 weeks; and two BTX injections 8 weeks (BTX + BTX8). The BTX animals were injected in the right hind limb with 4 IU BTX at the start of the study, while the BTX + BTX8 were also injected with 2 IU BTX after 4 weeks. The animals were killed after 0, 4, or 8 weeks. The distal femoral metaphyses were μCT scanned, and the strengths of the femoral necks, mid-diaphyses, and distal femoral metaphyses were ascertained. Disuse resulted in a significant loss of BV/TV, thinning of the trabeculae, and decrease in the degree of anisotropy, and in a significant reduced bone strength after both 4 and 8 weeks. The ratio of horizontal to vertical trabecular thickness (Tb.Th.horz/Tb.Th.vert) and the ratio of horizontal to vertical bone volume (BV.horz/BV.vert) were significantly higher in BTX animals than in control animals. In addition, the horizontal and vertical trabecular thickness probability density functions were more similar in BTX animals than in control animals. In conclusion, skeletal unloading decreased BV/TV, Tb.Th, the degree of anisotropy, and mechanical strength, while BV.horz/BV.vert and Tb.Th.horz/Tb.Th.vert were increased. This indicates that the more loaded vertical trabeculae are pronouncedly more thinned than the less loaded supporting horizontal trabeculae during unloading.

Calvarial Bone Grafting for Three-Dimensional Reconstruction of Severe Maxillary Defects: A Case Series.

To evaluate the efficacy, associated morbidity, and results of a three-dimensional reconstruction technique for repairing severe defects of the maxilla using a calvarial autogenous bone graft and a soft tissue double-layered surgical approach in preparation for placing dental implants. Bone defects of the maxilla consecutively reconstructed with calvarial autologous graft in the authors' institution were retrospectively evaluated. Patients with combined maxilla alveolar ridge defects with a width less than 4 mm and a height less than 7 mm (to the level of the maxillary sinus or the nostril), with at least three teeth involved, were included in the study. Calvarial bone blocks were sagittally sectioned in fine layers and fixed three-dimensionally in a boxlike structure with particulate bone inside. The purpose was to obtain an adequate amount of vertical and horizontal alveolar bone to enable restoration with dental implants at least 3.4 mm in diameter and 11 mm in length. Eleven reconstructive procedures were performed in 10 patients. Bone graft integration was successful in all of them. No major complications were observed in the donor cranial site. A mean bone gain of 5.04 mm (range, 3.4 to 7.8 mm) in height was obtained (standard deviation [SD], 1.69). The implant surgery was performed between the 15th and 19th weeks. A total of 28 implants were placed, and the mean follow-up time was 45 months (range, 23 to 65 months; SD, 12). The mean graft vertical resorption was 0.78 mm (range, 0.50-1.50 mm; SD, 0.00) 41 months after implant fixation. Three-dimensional reconstruction technique using calvarial bone grafts to restore severe segmental or crestal bone defects in the maxilla is an effective and predictable procedure that can increase the horizontal and vertical bone volume in preparation for the successful placement of dental implants.

Adjunctive Orthodontic Applications in Dental Implantology

Implant placement is often necessitated for replacement of teeth with pathologically damaged alveolar bone due to periodontitis or traumatic injury. Surgical augmentation of resorbed bone has many limitations, including lower efficacy of vertical augmentation than horizontal augmentation, as well as morbidity associated with grafting procedure. Orthodontic therapy has been proposed as a useful method for augmenting the resorbed alveolar bone and reforming aesthetically appealing gingival margin, prior to implant placement. This narrative review summarizes the available evidence for the application of orthodontic strategies that can be used as adjunct in selected cases to augment bone volume for the future implant site and maintain space for the prosthetic parts of the implant. These are (1) orthodontic extrusion of compromised teeth to generate vertical bone volume and enhance gingival architecture, (2) tooth preservation and postponing orthodontic space opening to maintain bone volume in future implant site, (3) orthodontic implant site switching to eliminate the deficient bone volume or risky implant sites, and (4) the provision of a rigid fixed-bonded retainer to maintain the implant site. Although there are no randomized controlled clinical trials to evaluate the efficacy of orthodontic therapy for implant site development, clinical case reports and experience document the efficacy of orthodontic therapy for this application.

Autotransplantation of an ectopic impacted premolar with sinus lift and allogenic bone graft

This article presents a case report of autogenous tooth transplantation to a site which had insufficient bone volume using a sinus lift and allogenic bone graft. An ectopic, fully impacted premolar tooth was autotransplanted from its ectopic impaction site into its original site, where there was insufficient recipient vertical bone volume because of sinus expansion. The deciduous tooth was extracted from the recipient site, and the sinus membrane detached and elevated via the alveolar socket. Allogenic bone grafting was performed, and the impacted premolar was transplanted into the prepared site. To improve adaptation, the recipient site was prepared using a rapid prototype tooth model, a replica tooth which allowed complete socket preparation in advanced of the actual removal of the donor tooth. The donor tooth was fixed with sutures and maintained for 17 days to allow physiologic movement. Root canal treatment was initiated 24 days after autotransplantation, and an intra-canal medicament was used for 4 months. Canal filling was completed 5 months after autotransplantation. There was no root resorption of the transplanted tooth, and the grafted bone was well preserved and had no signs of infection. When the recipient bone volume is insufficient, autotransplantation can be preceded by bony augmentation. The preparation of the recipient tooth socket using a tooth replica from CBCT reduces the extra-oral time of the actual tooth and promotes better periodontal ligament healing. Careful evaluation of the pulp status of the donor tooth is important in advance of timely endodontic treatment.

Analysis of the Anatomy of the Maxillary Sinus Septum Using 3-Dimensional Computed Tomography

Maxillary posterior teeth exhibit a high incidence of periodontal bone and tooth loss. After tooth loss, the edentulous alveolar process of the posterior maxilla is often affected by resorption, which results in loss of vertical bone volume. Moreover, progressive sinus pneumatization leads to a decrease in the alveolar process from the cranial side. The sinus elevation and augmentation surgical technique opened a new way of anchoring endosseous implants despite discernible bone reduction. However, the surgical interventions require in-depth knowledge of maxillary sinus anatomy such as sinus septum and potential variations. The purpose of this study was to investigate the prevalence, location, height, morphology, and orientation of maxillary sinus septa by use of computed tomography (CT) and 3-dimensional imaging. Two hundred patients undergoing implant treatment at the Yonsei University College of Dentistry, Seoul, South Korea, were randomly selected for analysis of maxillary sinus septa. CT and DentaScan (GE Medical Systems, Milwaukee, WI)-reformatted data from 400 sinuses were analyzed with the Preview program (Infinitt, Seoul, South Korea). Three-dimensional images were rendered for measurement by use of the Accurex program (CyberMed, Seoul, South Korea). We found 111 septa in 400 maxillary sinuses (27.7%). This corresponded to 37% of the patients. Among total septa, 25 sinus septa (22.5%) were located in the anterior, 51 (45.9%) in the middle, and 35 (31.5%) in the posterior regions. The directional orientation analyses showed that 106 septa were buccopalatal, 4 were sagittal, and 1 was transverse type. The mean septal heights were 7.78 ± 2.99 and 7.89 ± 3.09 mm in the right and left sinuses, respectively. Three-dimensional CT image analyses may provide useful information that can avoid unnecessary complications during sinus augmentation procedures by facilitating adequate, timely identification of the anatomic structures inherent to the maxillary sinus.

Vertical bone volume in the paramedian palate of adolescents: A computed tomography study

The paramedian palate (PP) has been used as a host site for orthodontic implant anchorage. Available bone and interference of adjacent tooth roots must be considered in identifying the most appropriate locations for implantations in the PP. Cone-beam computed tomography (CBCT) scans (NewTom QR-DVT 9000; QR s.r.l., Verona, Italy) were acquired in 183 orthodontic patients (ages, 10-19 years). Views of the PP region were reconstructed at increments posterior from the incisive foramen, and measurements of bone height were made in each reconstruction laterally from the midline to describe the PP. At 4 mm posterior to the incisive foramen and 3 mm lateral to the midline, 93% of the male and 91% of the female subjects met the criterion for implantation. At 8 mm posterior to the incisive foramen and 3 mm lateral to the midline, 86% of the male and 58% of the female subjects met the criterion for implantation. The PP contains several valid implant host sites in adolescent patients. At 4 mm distal and 3 mm lateral to the incisive foreman, 93.2% of the boys and 91.9% of the girls had sufficient vertical bone depth to host a 3-mm implant with little practical tooth interference. CBCT allows accurate assessment of the entire volume of a proposed implant site.