The use of ramus autogenous block grafts for vertical alveolar ridge augmentation and implant placement: a pilot study

PURPOSE: This study presents a clinical, radiographic, laboratory, and histologic/histomorphometric analysis of the use of mandibular ramus block autografts for vertical alveolar ridge augmentation and implant placement. MATERIALS AND METHODS: Autogenous block autografts were fixed at the recipient site with fixation screws while a mixture of autogenous bone marrow and inorganic bovine material (Bio-Oss) was used at the periphery. All grafts appeared well incorporated at the recipient site during reentry surgery. RESULTS: Radiographic measurements revealed an average of 6.12 mm vertical ridge augmentation 1 month after surgery and 5.12 mm 4 to 6 months after surgery. Laboratory volumetric measurements revealed an average of 0.91 mL alveolar ridge augmentation 1 month after surgery and 0.75 mL 6 months postoperatively. Linear laboratory measurements revealed 6.12 mm of vertical ridge augmentation 1 month postoperatively and 4.37 mm 4 to 6 months after surgery. Histologic evaluation indicated signs of active remodeling in all the specimens. Histomorphometric analysis of the peripheral particulate bone indicated bone present at 34.33% of the grafted area, while 42.17% of the area was occupied by fibrous tissue and 23.50% by residual Bio-Oss particles. DISCUSSION: The results demonstrated the potential of mandibular block autografts harvested from the ascending ramus to maintain their vitality. Volumetric resorption rate of 17.58% and radiographic resorption rate of 16.34% were in accordance with previously published literature. Early exposure appeared to compromise the results, while late exposures did not affect the vitality of the block autografts. CONCLUSION: Mandibular block autografts can maintain their vitality when used for vertical alveolar ridge augmentation. Inorganic bovine mineral (Bio-Oss) can be used at the periphery of the block graft when mixed with autogenous bone marrow.     

Alveolar ridge augmentation using a resorbable copolymer membrane and autogenous bone grafts. An experimental study in the rat

The aim of the present study was to compare the result of maxillary alveolar ridge augmentation by the combined use of mandibular bone grafts and resorbable membranes (Resolut), with that achieved by the use of the same type of bone graft combined with the placement of e-PTFE membranes (Gore-Tex). The experiment was carried out in 30 rats. In one side of the maxillary jaw, the edentulous alveolar ridge between the incisor and the first molar was augmented by means of an autogenous mandibular bone graft that was fixed with a titanium microimplant and covered with a resorbable membrane. The contralateral side, serving as control, was treated in the same way, with the difference that an e-PTFE membrane was placed over the bone graft. Histological analysis at 15, 30, 60, 120 and 180 days after surgery demonstrated that, in both test and control sites where the membrane was properly adapted and not exposed, the bone grafts presented no resorption and were integrated into the maxillary bone at the recipient site. In cases where the membrane was exposed, however, the bone grafts presented extensive resorption and lack of continuity between the graft and the recipient bed. At 60-180 days after surgery, the exposure of both types of membrane had frequently led to complete resorption of the grafts, encapsulation of the titanium microimplant by fibrous connective tissue, or exfoliation of the microimplant. It is concluded that alveolar ridge augmentation can be predictably accomplished by combining mandibular bone grafting with the placement of resorbable or non-resorbable membranes according to the GTR principle, provided that the membrane is properly adapted over the graft and complete closure of the treated area is maintained during healing.     

Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients

OBJECTIVE: To analyze the clinical outcome of horizontal ridge augmentation using autogenous block grafts covered with an organic bovine bone mineral (ABBM) and a bioabsorbable collagen membrane. MATERIAL AND METHODS: In 42 patients with severe horizontal bone atrophy, a staged approach was chosen for implant placement following horizontal ridge augmentation. A block graft was harvested from the symphysis or retromolar area, and secured to the recipient site with fixation screws. The width of the ridge was measured before and after horizontal ridge augmentation. The block graft was subsequently covered with ABBM and a collagen membrane. Following a tension-free primary wound closure and a mean healing period of 5.8 months, the sites were re-entered, and the crest width was re-assessed prior to implant placement. RESULTS: Fifty-eight sites were augmented, including 41 sites located in the anterior maxilla. The mean initial crest width measured 3.06 mm. At re-entry, the mean width of the ridge was 7.66 mm, with a calculated mean gain of horizontal bone thickness of 4.6 mm (range 2-7 mm). Only minor surface resorption of 0.36 mm was observed from augmentation to re-entry. CONCLUSIONS: The presented technique of ridge augmentation using autogenous block grafts with ABBM filler and collagen membrane coverage demonstrated successful horizontal ridge augmentation with high predictability. The surgical method has been further simplified by using a resorbable membrane. The hydrophilic membrane was easy to apply, and did not cause wound infection in the rare instance of membrane exposure.     

Clinical and histologic evaluation of the use of mandibular tori as donor site for mandibular block autografts: report of three cases

The present paper reports on three patients who underwent localized alveolar ridge augmentation using block autografts harvested from the mandibular tori. Autogenous particulate bone graft was placed at the periphery of the block. Resorbable collagen membrane was placed above the graft material. Implant placement surgery followed at 6 to 16 months after bone grafting. During implant surgery, a biopsy was taken from the block autograft. Clinical evaluation revealed incorporation of the graft material at the recipient site. No donor site complication was noted. Histologic evaluation suggested that the block autograft was vital and in an active remodeling phase at the time of implant placement. Impressions were made intraorally before and 6 months after bone grafting. Laboratory measurements revealed 13% resorption at 6 months after bone grafting while 0.53 mL of ridge augmentation was achieved 6 months after bone grafting. Linear tomographs indicated 4.33 mm of lateral alveolar ridge augmentation. This report suggests that block autografts harvested from the mandibular tori may have the potential to maintain their vitality after bone grafting, while they may demonstrate resorption rates similar to those of autografts harvested from other intraoral donor sites.     

Use of titanium mesh for staged localized alveolar ridge augmentation: clinical and histologic-histomorphometric evaluation

The use of titanium mesh for localized alveolar ridge augmentation was evaluated by clinical, radiographic, laboratory, and histologic-histomorphometric evaluation. Seventeen patients participated in this study. All patients required localized alveolar ridge augmentation before placement of dental implants. An equal mixture of autogenous bone graft and inorganic bovine mineral (Bio-Oss) was used as a bone graft material. Autogenous bone graft was harvested intraorally. Titanium mesh was submerged for 8.47 months (SD 2.83). Impressions were taken intraorally before bone grafting, 6 months after bone grafting, and 6 months after implant placement. Impressions were used to measure the volume of alveolar ridge augmentation and provide linear laboratory measurements regarding the results of bone augmentation. Bone quality (type II-IV) was recorded during implant surgery. Standardized linear tomographs were taken before bone grafting and before implant placement. A biopsy was harvested with a trephine bur from the grafted area during implant surgery for histologic-histomorphometric evaluation. In all cases the grafted area had adequate bone volume and consistency for placement of dental implants. Early mesh exposure (2 weeks) was observed in 2 patients, and late exposure (>3 months) was observed in 4 patients. Volumetric laboratory measurements indicated 0.86 cc (SD 0.69) alveolar augmentation 1 month after bone grafting, 0.73 cc (SD 0.60) 6 months after bone grafting, and 0.71 cc (SD 0.57) 6 months after implant placement. This indicated 15.11% resorption 6 months after bone grafting, and no further resorption occurred after implant placement. Linear laboratory measurements indicated vertical augmentation of 2.94 mm (SD 0.86) 1 month after bone grafting, 2.59 mm (SD 0.91) 6 months after bone grafting, and 2.65 mm (SD 1.14) 6 months after implant placement. The corresponding measurements for labial-buccal augmentation were 4.47 mm (SD 1.55), 3.88 mm (SD 1.43), and 3.82 mm (SD 1.47). Radiographic evaluation indicated 2.56 mm (SD 1.32) vertical augmentation and 3.75 mm (SD 1.33) labial-buccal augmentation. Histomorphometric evaluation indicated 36.47% (SD 10.05) new bone formation, 49.18% (SD 6.92) connective tissue, and 14.35% (SD 5.85) residual Bio-Oss particles; 44.65% (SD 22.58) of the Bio-Oss surface was in tight contact with newly formed bone. The use of titanium mesh for localized alveolar ridge augmentation with a mixture of autogenous intraorally harvested bone graft and Bio-Oss offered adequate bone volume for placement of dental implants. Intraorally harvested autogenous bone graft mixed with Bio-Oss under a titanium mesh offered 36.47% new bone formation, and 15.11% resorption occurred 6 months after bone grafting.     

GBR技术应用于上前牙种植骨缺损的临床研究

目的：评估引导骨再生技术（GBR）在上前牙不同类型骨缺损种植修复中的效果。方法：对35例上前牙牙槽骨缺损种植的患者采用GBR技术进行骨增量,其中29例种植体周围骨缺损患者仅采用GBR技术,在植体植入骨床后,同期植入Bio～oss人工骨粉,表面盖Bio～gide可吸收性胶原膜;6例牙槽骨缺损患者采用移植自体块状骨联合Bio～oss人工骨粉,盖Bio～gide可吸收性胶原膜,5～6个月后行Ⅱ期种植体植入术。结果：所有患者在植体植入术后6～12个月临床观察种植体与骨结合良好,软组织形态与周围组织一致,行冠或桥修复,修复后12个月随诊复查无种植体失败。结论：引导骨再生技术皆能有效地对上前牙不同类型骨缺损进行骨增量,符合美学种植要求。     

The use of titanium mesh in conjunction with autogenous bone graft and inorganic bovine bone mineral (bio-oss) for localized alveolar ridge augmentation: a human study

This study evaluated the effects of using a titanium mesh for localized alveolar ridge augmentation. Seven consecutively treated human subjects participated in the study. Clinical, radiographic, laboratory, and histologic/histomorphometric analysis revealed the efficacy of using the titanium mesh in conjunction with intraorally harvested autogenous bone graft and inorganic bovine bone mineral (Bio-Oss). Radiographic measurements detected that a 2.86-mm vertical and 3.71-mm buccolabial ridge augmentation was achieved, while histomorphometry demonstrated that 36.4% of the grafted area consisted of bone. Laboratory measurements revealed 15.08% resorption of the graft for the first 6 months, which appeared to consolidate after placement of the implants. Exposure of the mesh did not appear to compromise the result.     

The use of intraorally harvested autogenous block grafts for vertical alveolar ridge augmentation: a human study

This study presents a clinical, radiographic, laboratory, and histologic/histomorphometric analysis of the use of mandibular block autografts for vertical alveolar ridge augmentation. Twelve patients were included in the study. The autogenous block autografts were fixated at the recipient sites with screws, and a mixture of autogenous bone marrow and inorganic bovine mineral (Bio-Oss) was used at the periphery. At re-entry surgery, all the grafts appeared well incorporated at the recipient sites. Radiographic measurements revealed an average of 5.75 +/- 1.29 mm vertical ridge augmentation at 1 month after surgery and 4.75 +/- 1.29 mm at 4 to 6 months after surgery. This indicated 17.4% resorption. Laboratory volumetric measurements revealed an average of 0.84 +/- 0.34 mL of alveolar ridge augmentation 1 month after surgery and 0.71 +/- 0.28 mL at 6 months postoperatively. The resorption rate according to the laboratory volumetric measurements was 15.5%. Linear laboratory measurements revealed 5.92 +/- 1.38 mm of vertical ridge augmentation 1 month postoperatively and 4.08 +/- 1.01 mm at 4 to 6 months after surgery. Histologic evaluation of the block autografts indicated signs of active remodeling activity in 10 of the 12 specimens. In one case the block graft became exposed and infected, and in another case the block autograft became dislodged during implant placement surgery. Histomorphometric analysis of the peripheral particulate bone indicated bone present at 33.99% +/- 8.82% of the graft surface, while 42.43% +/- 11.06% of the area was occupied by fibrous tissue and 23.89% +/- 9.12% was made up of residual Bio-Oss particles. Residual Bio-Oss particles were in tight contact with newly formed bone along 58.57% +/- 15.22% of their perimeter.     

Alveolar ridge augmentation with Bio-Oss: a histologic study in humans

The aim of the present study was to investigate the healing of alveolar ridge defects augmented with cancellous bovine bone mineral. In six partially edentulous patients, bone augmentation was necessary prior to implant placement because of severe alveolar ridge resorption. The defect sites, all located in the maxilla, were filled with Bio-Oss and covered with the resorbable collagen membrane Bio-Gide. Biopsies were obtained from the defect sites 6 to 7 months following grafting and were processed for ground sectioning. The histologic analysis revealed that the Bio-Oss particles occupied 31% of the total biopsy area. An intimate contact between woven bone and Bio-Oss was detected along 37% of the particle surfaces. A mixed type of bone was found; it contained woven bone and parallel-fibered bone, which demonstrates features of remodeling activity. Signs of resorption of the grafting material were observed in the histologic sections, which indicates that the material takes part in the remodeling process. It is suggested that Bio-Oss may be a very suitable material for staged localized ridge augmentation in humans.     

Staged horizontal bone augmentation for dental implants in aesthetic zones: A prospective randomized controlled clinical trial comparing a half-columnar bone block harvested from the ramus versus a rectangular bone block from the symphysis

In this study, the clinical outcomes of horizontal ridge augmentation using half-columnar bone grafts from the ramus (group I: 27 patients, 32 implants) versus rectangular bone grafts from the symphysis (group II: 19 patients, 27 implants) were compared; grafts were combined with organic bovine bone and collagen membrane. Cone beam computed tomography images were obtained preoperatively, immediately after restoration (baseline), and 1 year after loading. Four months after grafting, horizontal bone resorption at the alveolar crest did not differ significantly between the two groups (P = 0.291). At 4 mm apical to the alveolar crest, horizontal bone resorption in group I was significantly less than that in group II (P = 0.041). One year after loading, horizontal bone resorption in group I was lower than that in group II, with no significant difference. The residual thickness of the labial bone at the implant site in group I was significantly higher than that in group II. Horizontal ridge augmentation with either a half-columnar autogenous graft from the ramus or a rectangular autogenous graft from the symphysis can provide acceptable results in aesthetic regions. The half-columnar group demonstrated better graft stability both at 4 months after augmentation and 1 year after loading.     

Alveolar ridge augmentation by combining autogenous mandibular bone grafts and non-resorbable membranes

The aim of the present study was to evaluate the effect of using mandibular cortical bone grafts covered with e-PTFE membranes for maxillary alveolar ridge augmentation, in comparison with the use of mandibular cortical grafts alone. The experiment was carried out in 20 rats. At one side of the maxillary jaw, the edentulous alveolar ridge between the incisor and the first molar was augmented by means of an autogenous mandibular bone graft, which was fixed with a titanium microimplant and covered with a Teflon membrane. The contralateral side, serving as control, was treated the same way, except for the placement of a membrane. Histological analysis at 15, 30, 60 and 90 days after surgery demonstrated that, in situations where the membrane was not exposed to the oral cavity during healing, the mandibular bone grafts presented no resorption and were in continuity with the maxillary bone at the recipient site. In situations where the membrane had become exposed, however, the bone grafts presented extensive resorption and lack of continuity with the bone at the recipient site. These latter findings were similar to those made at the non-membrane-treated side. The results indicate that the volume of autogenous bone graft used for alveolar ridge augmentation can be retained by covering the graft with a membrane, provided that the membrane is properly adapted and is kept covered with mucosa during healing.     

Periodontally accelerated osteogenic orthodontics combined with autogenous bone grafting

This case report documents the first use of particulate autogenous bone graft with the corticotomy-assisted rapid orthodontic procedure known as periodontally accelerated osteogenic orthodontics (PAOO). A 41-year-old man, with class II, division 2 crowded occlusion, was treated with the PAOO procedure. Buccal mucoperiosteal flaps were reflected, and selected vertical and horizontal corticotomy was performed around the roots in both the maxillary and mandibular arches. Particulate bone graft was harvested from the rami and exostosis for alveolar ridge augmentation. Orthodontic movement was initiated immediately after the surgical intervention and adjusted every 2 weeks. Eight months after corticotomy surgery, total active orthodontic treatment was completed. No detrimental periodontal effects or root resorption were observed. The alveolar ridges of both the maxilla and mandible maintained the original thickness and configuration despite facial tipping of the incisors. It was concluded that PAOO is an effective treatment approach in adults to decrease treatment time and reduce the risk of root resorption. Selected corticotomy limited to the buccal and labial aspects also significantly reduces treatment time. More clinical studies with additional patients and long-term follow-up are needed to determine the optimal amount of autogenous bone graft.     

Harvesting bone in the recipient sites for ridge augmentation

A modified ridge augmentation technique is introduced for augmenting deficient alveolar ridges in preparation for endosseous implant placement. The technique is based on the principles for guided bone regeneration, in which a created space is kept isolated from the surrounding soft tissues by a resorbable membrane with an excellent extended resorption profile, thus permitting the accrual of bone-formative elements into the graft site. The absorbable membrane is propped up by an autogenous mixture of native corticocancellous bone cores taken in the graft site and reduced to smaller particle sizes and osseous coagulum collected in bone traps and with a special bone scraper. The major advantage of this technique is that all the autogenous bone graft material is obtained from the actual graft site, avoiding second remote intra- or extraoral surgical sites and attendant morbidities. Ridges augmented with this technique permit optimal endosseous implant placement.     

Clinical evaluation of particulate allogeneic with and without autogenous bone grafts and resorbable collagen membranes for bone augmentation of atrophic alveolar ridges

Objectives: The evaluate the clinical outcome of bone augmentation with the use of particulate mineralized freeze‐dried bone allograft (FDBA) with or without the addition of autogeneous bone chips, applied in a bi‐layered (BL) technique, covered by a resorbable cross‐linked collagen membrane. Material and methods: Fifty patients presenting with a vertical and/or lateral ridge deficiency of at least 3 mm were included: Group FDBA, N=27 patients, particulate FDBA was the only graft; and Group BL, N=23 patients, a BL bone grafting procedure where autogenous bone chips were the inner layer and FDBA the outer. Bone graft was covered with a ribose cross‐linked collagen barrier membrane. Ridge dimensions were clinically or radiographically (computerized tomography scan) measured at the time of the bone augmentation procedure and at implant placement or uncovering and the maximum linear vertical or horizontal calcified tissue gain was calculated. Statistical analysis consisted of linear regression analysis, with maximum bone gain being the dependent variable. Results: In the FDBA group, mean vertical bone gain was 3.47 mm (SD 1.25) and the horizontal, 5 mm (SD 1.28), while in the BL values were 3.5 mm (SD 1.2) and 3.6 mm (SD 1.72), respectively. Addition of autogenous bone does not appear to statistically significantly enhance the results. Spontaneous membrane exposure occurred in 24% of the cases and was the only variant that significantly influenced results (P<0.001). Conclusions: Large vertical and/or horizontal ridge deficiencies may be treated with FDBA and ribose cross‐linked collagen barrier membranes with good clinical outcome. No added effect of the application of a layer of autogenous bone in these bone augmentation procedures could be demonstrated. Spontaneous membrane exposure was the only parameter to affect the degree of new calcified tissue formation. To cite this article:
Beitlitum I, Artzi Z, Nemcovsky CE.
Clinical evaluation of particulate allogeneic with and without autogenous bone grafts and resorbable collagen membranes for bone augmentation of atrophic alveolar ridges.
Clin. Oral Impl. Res. 21 , 2010; 1242–1250.
doi: 10.1111/j.1600‐0501.2010.01936.x     

Clinical evaluation of freeze-dried block allografts for alveolar ridge augmentation: a case series

Various grafting materials have been used in guided bone regeneration procedures to augment alveolar ridges deficient in horizontal or vertical dimensions or both. Autogenous block grafts from intraoral and extraoral sites have been used for ridge augmentation with encouraging results. However, the risk of vascular and neurologic injury at the donor site as well as postoperative patient morbidity have been reported following these surgical procedures. The use of a cancellous block allograft could be one alternative to avoid potential donor site complications. Five deficient alveolar ridges in three patients were each grafted with a freeze-dried cancellous block allograft and a resorbable barrier membrane. Ridge measurements taken at baseline, graft placement, and a 6-month reentry surgery demonstrated an increase in alveolar ridge width from 2 to 4 mm. These gains in ridge width compare favorably with other guided bone regeneration studies, suggesting that a freeze-dried cancellous block allograft in conjunction with a resorbable membrane may be an acceptable alternative to the autogenous block graft in the treatment of compromised alveolar ridge deficiencies.     

Alveolar ridge augmentation with a prototype trilayer membrane and various bone grafts: a histomorphometric study in baboons

Barrier membranes have become a standard treatment option in alveolar ridge augmentation prior to implant placement. However, non-resorbable membranes require secondary surgery and resorbable membranes show an unfavorable degradation profile. The purpose of this study was to evaluate the potential of a slowly biodegradable/bioresorbable prototype trilayer membrane (PTLM) for supporting bone regeneration in alveolar ridge augmentation. Clinically relevant cavities were made 3 months after the extraction of the first and second molars in each jaw of six baboons. Each animal was treated with four different regimens: (1) autogenous bone block (ABB) alone, (2) ABB+PTLM, (3) deproteinized bovine bone mineral (DBBM)+PTLM and (4) no treatment. After 9 months, the baboons were sacrificed and block sections of the augmented area were subjected to histologic and histomorphometric analyses. Newly formed bone areas were determined at a distance of 1, 3, 7 and 10 mm from crestal. The data showed a well-preserved ridge profile at the membrane-protected sites, whereas non-protected bone blocks and control sites underwent severe resorption resulting in knife-edge ridge profiles. Significant differences were found between ABB+PTLM and ABB (P=0.0137-0.0232). DBBM+PTLM also produced a larger bone area compared with ABB alone (P=0.0396-0.0439). No significant difference in bone area was detectable between ABB+PTLM and DBBM+PTLM (P>0.05). The present study supports the use of the slowly biodegradable/bioresorbable PTLM with autografts and DBBM for lateral ridge augmentation in this type of bone defects.     

Lateral ridge augmentation using different bone fillers and barrier membrane application. A histologic and histomorphometric pilot study in the canine mandible

Lateral ridge augmentation has become a standard treatment option to enhance the bone volume of deficient recipient sites prior to implant placement. In order to avoid harvesting an autograft and thereby eliminating additional surgical procedures and risks, bone grafting materials and substitutes are alternative filler materials to be used for ridge augmentation. Before clinical recommendations can be made, such materials must be extensively studied in experimental models simulating relevant clinical situations. The present pilot study was conducted in three dogs. Different grafting procedures were evaluated for augmentation of lateral, extended (8 x 10 x 14 mm) and chronic bone defects in the mandibular alveolar ridge. Experimental sites received tricalcium phosphate (TCP) granules or demineralized freeze-dried bone allograft (DFDBA) particles. Barrier membranes (ePTFE) were placed for graft protection. These approaches were compared to ridge augmentation using autogenous cortico-cancellous block grafts, either with or without ePTFE-membrane application. After a healing period of six months, the sites were analyzed histologically and histomorphometrically. Autografted sites with membrane protection showed excellent healing results with a well-preserved ridge profile, whereas non-protected block grafts underwent bucco-crestal resorption, clearly limiting the treatment outcome. The tested alloplastic (TCP) and allogenic (DFDBA) filler materials presented inconsistent findings with sometimes encapsulation of particles in connective tissue, thereby reducing the crestal bone width. The present pilot study supports the use of autografts with barrier membranes for lateral ridge augmentation of extended alveolar bone defects.     

两种生物膜材料在牙周辅助加速成骨正畸治疗技术中的骨增量研究

目的探讨正畸治疗前骨增量手术中使用可吸收膜和不可吸收膜在牙槽骨再生方面的区别。方法在佛山市口腔医院正畸科2018年8月至2019年8月就诊的成人患者中通过锥形束CT(CBCT)检查选取下前牙区骨开窗骨开裂的错牙合畸形患者40例作为研究对象,使用随机数字表方法将患者随机分为两组,每组20例,其中一组在治疗过程中覆盖的生物膜材料选择可吸收膜(可吸收膜组),另外一组治疗过程中覆盖的生物膜材料选择不可吸收膜(不可吸收膜组),在充分告知知情同意下进行手术。通过CBCT测量术前及术后半年每颗下前牙唇舌侧牙槽嵴顶距釉牙骨质界的距离及唇舌侧根尖区牙槽骨厚度,并由此计算术前及术后半年唇舌侧牙槽骨高度及厚度增量变化的情况,使用t检验对比可吸收膜组与不可吸收膜组唇舌侧牙槽骨高度及厚度增量。结果可吸收膜组接受牙周辅助加速成骨正畸治疗后,唇侧牙槽骨高度增量平均为(1.8±0.5)mm,舌侧牙槽骨高度增量平均为(0.6±0.5)mm,唇侧牙槽骨厚度增量平均为(2.3±0.5)mm,舌侧牙槽骨厚度增量平均为(0.5±0.6)mm;不可吸收膜组接受牙周辅助加速成骨正畸治疗后,唇侧牙槽骨高度增量平均为(2.1±0.5)mm,舌侧牙槽骨高度增量平均为(0.7±0.6)mm,唇侧牙槽骨厚度增量平均为(2.4±0.6)mm,舌侧牙槽骨厚度增量平均为(0.4±0.5)mm。可吸收膜组唇侧牙槽骨高度增量与不可吸收膜组唇侧牙槽骨高度增量差异有统计学意义(t=-2.250,P=0.03),舌侧牙槽骨高度增量差异无统计学意义(t=-0.547,P=0.587),唇侧牙槽骨厚度增量差异无统计学意义(t=-0.534,P=0.596),舌侧牙槽骨厚度增量差异无统计学意义(t=-0.826,P=0.414)。结论术中使用不可吸收膜可以显著增加唇侧牙槽骨高度,但二次手术对患者接受度的影响仍有待研究。     

Histologic and histomorphometric evaluation of alveolar ridge augmentation using bone grafts and titanium micromesh in humans

BACKGROUND: Recently, the use of titanium micromesh for alveolar bone augmentation has drawn interest; however, only limited histologic data are available on the quality of the bone regenerated. Therefore, this study compared the use of 100% intraoral autogenous bone to a combination of intraoral autogenous bone (70%) and bovine porous bone mineral (BPBM) (30%) for alveolar ridge augmentation with titanium micromesh histologically and histomorphometrically. METHODS: Twelve partially edentulous patients required alveolar bone augmentation before implant insertion because of ridge resorption. The defect sites, six in the maxilla and six in the mandible, were reconstructed with particulate autologous bone (control group, N = 6) or a mixture of autologous bone and BPBM (test group, N = 6) in combination with titanium micromesh. Core biopsies were taken from the defect sites 8 to 9 months after grafting at the time of implant insertion. RESULTS: Newly formed compact bone with a well-organized lamellar pattern was identified in all specimens. In the samples taken from the test group, the BPBM particles were surrounded completely by newly formed bone with no signs of resorption. The mean total bone volume was 62.38% +/- 13.02% in the control group and 52.88% +/- 11.47% in the test group. The soft tissue volume was 37.61% +/- 13.02% and 29.96% +/- 12.58%, respectively, and the residual BPBM volume was 17.15% +/- 2.72% in the test group. No statistical difference was observed in the histologic parameters evaluated, irrespective of graft type and site (P >0.05). CONCLUSION: Within the limits of this study, BPBM (30%) in combination with autogenous bone (70%) did not yield a lower percentage of new bone formed compared to autogenous bone alone in ridge augmentation with titanium micromesh.     

Sandwich bone augmentation using recombinant human platelet-derived growth factor and beta-tricalcium phosphate alloplast: case report

This report presents a case of reconstructing and augmenting a buccal fenestration defect associated with simultaneous implant placement using recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with the synthetic alloplast beta-tricalcium phosphate (beta-TCP) and collagen membrane. Fenestration and fracture of the labial plate occurred at the time of implant placement at the maxillary left lateral incisor position. The sandwich bone augmentation technique was applied using autogenous bone as the inner grafting material and rhPDGF-BB + beta-TCP as the outer grafting material. A collagen barrier membrane was then tented over these materials. After approximately 5 months of healing, second-stage surgery was performed, showing complete healing at the defect site. This case suggests that the combination of rhPDGF-BB and beta-TCP can be a suitable material for predictable bone augmentation, especially during sandwich bone augmentation.