Bio-Oss骨粉在上颌窦提升牙种植术中的临床应用

目的：评价上颌窦提升，植Bio-Oss骨粉在上颌后牙种植的方法和效果。方法：对11例牙槽骨高度不足的上颌后牙种植进行上颌窦提升，植Bio-Oss骨粉，同期种植7例，延期种植4例。结果：6个月后，X线片显示Bio-Oss骨粉改建形成了新骨，增加了牙槽骨高度，满足了种植要求，7例同期种植可见种植体与Bio-Oss诱导的新骨形成紧密的骨性结合，种植体植入9个月后进行二期修复。结论：Bio-Oss骨粉植入提升上颌窦增加了上颌后牙区的牙槽骨高度，拓展了种植的适应证，免疫除了自体取骨手术，方法简单，值得临床推广。     

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.     

Vertical ridge augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs. bovine anorganic bone. Clinical and histological results up to one year after loading from a randomized-controlled clinical trial

Objectives: To compare two different techniques for vertical bone augmentation of the posterior mandible: bone blocs from the iliac crest vs. anorganic bovine bone blocs used as inlays.
Materials and methods: Ten partially edentulous patients having 5–7 mm of residual crestal height above the mandibular canal had their posterior mandibles randomly allocated to both interventions. After 4 months implants were inserted, and after 4 months, provisional prostheses were placed. Definitive prostheses were delivered after 4 months. Histomorphometry of samples trephined at implant placement, prosthesis and implant failures, any complication after loading and peri-implant marginal bone-level changes were assessed by masked assessors. All patients were followed up to 1 year after loading.
Results: Four months after bone augmentation, there was statistically significant more residual graft (between 10% and 13%) in the Bio-Oss group. There were no statistically significant differences in failures and complications. Two implants could not be placed in one patient augmented with autogenous bone because the graft failed whereas one implant and its prosthesis of the Bio-Oss group failed after loading. After implant loading only one complication (peri-implantitis) occurred at one implant of the autogenous bone group. In 16 months (from implant placement to 1 year after loading), both groups lost statistically significant amounts of peri-implant marginal bone: 0.82 mm in the autogenous bone group and 0.59 mm in the Bio-Oss group; however, there were no statistically significant differences between the groups.
Conclusions: Both procedures achieved good results, but the use of bovine blocs was less invasive and may be preferable than harvesting bone from the iliac crest.     

Bone quality after sinus floor augmentation

The problem of insufficient alveolar bone in the edentulous maxilla caused by resorption and pneumatization can be overcome by augmentation of the sinus floor to increase bone volume for the placement of dental implants. The quality of bone which is achieved after sinus floor augmentation is hardly known. This study describes the histologic results obtained three till six months after sinus floor augmentation with autogenous bone from the iliac crest in patients with severe maxillary bone resorption. The bone biopsies taken from the implant sites showed a substantial bone volume with a mature trabecular pattern and active bone growth. It was concluded that with the obtained bone quality, the sinus floor augmentation procedure can be a good treatment modality for the rehabilitation with implants in patients with severe maxillary bone atrophy.     

Full mouth implant rehabilitation of a patient with ectodermal dysplasia after orthognathic surgery, sinus and ridge augmentation: a clinical report

An 18-year-old male presented severe hypodontia due to hypohidrotic ectodermal dysplasia was treated with Le Fort I maxillary osteotomy with simultaneous sinus floor augmentation using the mixture of cortical autogenous bone graft harvested from iliac crest and organic Bio-Oss to position the maxilla in a right occlusal plane with respect to the mandible, and to construct adequate bone volume at posterior maxilla allowing proper implant placement. Due to the poor bone quality at other sites, ridge augmentation with onlay graft was done to construct adequate bone volume allowing proper implant placement, using tissue harvested from the iliac bone. Seven implants were placed in the maxilla and 7 implants were inserted in the mandible and screw-retained metal ceramic FPDs were fabricated. The two year follow up data showed that dental implants should be considered as a good treatment modality for patients with ectodermal dysplasia.     

Influence of residual alveolar bone height on implant stability in the maxilla: an experimental animal study

Aims/Background: Empirically, for implant placement associated with sinus floor augmentation, a minimum of five mm of residual crestal bone height has been recommended in order to achieve sufficient initial implant stability. It has been the aim of the study to test this assumption in an experimental animal trial. Material and methods: In eight mini pigs, three premolars and two molars were removed on one side of the maxilla. Three months later the animals were assigned to four groups of two animals each. A cavity was created at the base of the alveolar process so that the residual bone height was reduced to 2, 4, 6 and 8 mm, respectively. The coronal part of the alveolar crest remained unchanged. An inlay augmentation procedure was carried out using a particulated autogenous bone graft from the iliac crest, and six implants (Xive, diameter 3.8 mm, length 13 mm) were placed. Implant stability was assessed by resonance frequency analysis at the time of implant placement (T0), after 6 months of unloaded healing (T1) and after 6 months of functional loading (T2). Results: During follow‐up, two implants were lost in sites with a residual alveolar bone height of 2 mm. At the time of implant placement, resonance frequencies were 6754.4±268, 6500.3±281.5, 6890.3±255.4 and 7877.9±233.7 Hz for residual bone heights of 2, 4, 6 and 8 mm, respectively. At stage‐two surgery and after 6 months of functional loading, resonance frequencies were 6431.7±290.8, 6351.8±437.6, 6213.4±376.2 and 6826.8±458.9 Hz vs. 6171±437.4, 6047±572.4, 6156.7±272.6 and 6412.8±283.5 Hz. Statistical analysis revealed an association of residual alveolar height and implant stability at T0 and T1 only (P<0.01), while bone height was not found to influence implant survival. Conclusion: The results of the present trial demonstrate an association of alveolar bone height and implant stability at the time of implant placement and stage‐two surgery. Yet the assumption that 5 mm of residual crestal bone height is a relevant threshold for simultaneous implant placement and sinus floor augmentation is not supported from an experimental point of view.     

牙种植术钻孔骨碎作植骨的临床研究

目的:评价在牙种植术中,钻备种植窝时收集到的自体骨颗粒单独或与Bio-Oss人工骨混合作为骨移植材料应用的临床效果。方法:34例52枚牙种植术的病例分成四组。第一组(对照组)22枚植体,单纯植入种植体,种植区无植入自体骨或人工骨。第二组6枚植体,植入螺纹种植体后,在部分暴露的植体处植入Bio-Oss人工骨。第三组8枚植体,收集种植术中准备植体窝时,在各种钻针上的自体骨颗粒,植入种植体周骨量不足区域。第四组16枚植体,自各种钻针上收集到的自体骨颗粒与Bio-Oss人工骨混合,植入种植体周骨缺损区。记录I、II期手术种植体周围骨组织高度。结果:植入术后3-12个月,II期手术时,实验组有新生骨形成,第四组(即Bio-Oss人工骨与自体骨颗粒混合物植入组),新生骨形成的量较其余组别多。结论:研究表明牙种植术中钻备种植窝时收集到的自体骨颗粒可作为有效的植骨材料,这种简单的方法避免从他处手术获得自体骨,对扩大牙种植适应症有重要意义。RRRR     

Sinus augmentation utilizing anorganic bovine bone (Bio-Oss) with absorbable and nonabsorbable membranes placed over the lateral window: histomorphometric and clinical analyses

The purpose of the present study, which used anorganic bovine bone (Bio-Oss) with and without autogenous bone as the augmentation material, was to compare the results of sinus elevation performed without a membrane (control) with the results of sinus elevation performed with either a short-term bioabsorbable membrane (Bio-Gide) or a nonabsorbable membrane (Gore-Tex) with regard to both vital bone formation and implant survival. Sinus lifts were performed on 51 patients (38 unilateral, 13 bilateral) with the delayed placement of 135 implants. Histomorphometric data were obtained at the time of implant placement, 6 to 10 months following the grafting procedure. Vital bone formation was 17.6%, 16.9%, and 12.1%, respectively, for the Bio-Gide, Gore-Tex, and no membrane groups. Of the 135 implants placed there were 3 failures (2 Bio-Gide, 1 Gore-Tex). There was no significant difference between the membrane groups as to vital bone formation and implant survival.     

上颌前牙区牙槽嵴骨劈开增量同期种植术的临床研究

目的 :评价骨劈开增宽上颌前牙槽嵴 ,同期植入种植体的临床效果。方法 :15例患者 ,缺失上前牙1～4颗 ,有充足的牙槽嵴高度 (>13mm) ,但牙槽嵴骨厚度仅2～3mm ,采用骨劈开术 ,形成唇侧骨瓣。在唇侧骨瓣与腭侧骨板间植入3.4～4.5mm直径的Frialit-2种植体共25枚,骨板间隙充填Bio -Oss骨粉 ,覆盖Bio -Gide胶原膜或纯钛膜 ,无张力下缝合黏骨膜瓣。术后第10天和6个月时拍X线根尖周片观察种植体骨结合状况 ,并于术后6个月时行Ⅱ期手术 ,翻开软组织瓣 ,检查骨增量效果和种植体稳固性 ,测量牙槽嵴骨的宽度和拆除钛膜。结果 :1枚种植体术后1个月脱落 ,其余种植体稳固 ,且完全被骨质包埋 ,X线根尖周片证实种植体骨结合良好 ,牙槽嵴宽度增加达3～5mm ,平均增宽4.4mm。Ⅱ期手术时种植体成活率96 %。24枚种植体完成金属烤瓷修复 ,经2年的追踪观察,无一种植体松动或脱落。结论 :当前牙区牙槽嵴骨厚度2～3mm时 ,采用骨劈开术增宽牙槽嵴 ,使植种植体获得同期植入是一种行之有效的方法。     

The use of autogenous block graft for augmentation of the atrophic alveolar ridge

The use of osseointegrated implants has become a standard treatment option in modern dental rehabilitation. Adequate bone quantity and quality is a prerequisite for good esthetic and biomechanical result. Alveolar ridge defects can be the result of trauma, periodontal diseases or other pathologic conditions. In these cases, alveolar ridge augmentation is needed if endosseous implants are to be used. While xenografts, alloplastic bone grafts and allografts have been proposed for alveolar ridge augmentation, the use of autogenous bone grafts represents the "gold standard" for bone augmentation procedures. Either intraoral or extraoral sites may be considered for donor sites. Although the iliac crest is the most common donor site in maxillofacial reconstruction, the mandibular symphysis or ramus offer important advantages like avoidance of general anesthesia, convenience due to the proximity between the donor site and the augmentation site and avoidance of cutaneous scar. Bone harvested from intraoral donor site is less associated with resorption when compared with iliac bone because membranous grafts revascularize more quickly than endocondral bone grafts. The main disadvantage of the intraoral donor sites is the limited amount of available bone. Alveolar ridge augmentation using autologous bone block, can be done during implant placement or staged with implant placement, after bone graft healing. In the staged technique, a better implant positioning and the use of wide diameter implants are possible. The overall implant success is higher in the staged technique. Alveolar ridge augmentation using autogenous block graft is a predictable way of treatment, for the atrophic alveolar ridge before implant placement.     

Intrasinusal locking technique: a novel use of the ring block technique at sinus perforations for simultaneous implant placement

Ten patients who underwent sinus lift surgery with simultaneous implant placement using the intrasinusal locking technique were evaluated retrospectively. All patients were scheduled for sinus floor elevation procedures with simultaneous implant placement. Schneiderian membrane perforation occurred during the lifting procedure, and conventional methods failed to repair the perforation. Therefore, an autogenous bone ring was placed at the base of the maxillary sinus and was locked to the alveolar crest with a dental implant. Marginal resorption around the dental implants was measured on panoramic radiographs. Prosthetic rehabilitation was performed at 6 months postoperative. The overall survival rate of the implants over a mean follow-up of 24.3 months was 90%. One case failed due to resorption of the alveolar crest around the implant as a result of infection; the implant and the adjacent ring were removed at 1 month postoperative. At the time of writing, the nine implants placed using the documented technique continue to function well, without any signs of peri-implant disease. The proposed approach allows for simultaneous dental implant placement in the extremely atrophic maxilla, even if there is extensive perforation of the Schneiderian membrane.     

Evaluation of sinus floor elevation using a composite bone graft mixture

BACKGROUND: The performance of implant surgery in the posterior maxilla often poses a challenge due to insufficient available bone. Sinus floor elevation was developed to increase needed vertical height to overcome this problem. The present study described and reported a simple, safe and predictable bone graft mixture for the sinus lifting procedure. MATERIAL AND METHODS: Seventy patients were recruited for this study and underwent a sinus lift procedure. All sites were treated with a composite graft of cortical autogenous bone, bovine bone and platelet-rich plasma (PRP). A total of 263 implants (171 Astra Tech and 92 Microdent) were placed either simultaneously or delayed. All sites were clinically and radiographically evaluated 24 months after their prosthetic loading. Biopsy samples were taken from 16 delayed implant placement sites at the time of their implant placement. RESULTS: A 100% implant success rate was found after 24 months of functioning. Only two Microdent implants failed before loading, which translates to a 99% overall implant success rate. No statistically significant differences were found between simultaneous and delayed implant placement. Image processing revealed 34+/-6.34% vital bone, 49.6+/-6.04% connective tissue and 16.4+/-3.23% remaining Bio-Oss particles. However, the histomorphometric analysis showed that the bovine bone was incorporated into new bone formation. CONCLUSION: The results showed that a composite graft comprised of cortical autogenous bone, bovine bone and PRP mixture can be successfully used for sinus augmentation.     

前牙区即刻种植和延迟种植软硬组织的保存比较：临床研究

目的：即刻种植被广泛认为是可靠而成功率相当高的治疗方法。主要的优点是：1、缩短疗程;2、保存牙槽骨;3、易于确定种植体位置。拔牙后3-12个月牙槽骨吸收程度最明显。拔牙后即刻种植被认为是保留牙槽骨的最好方法,但是有学者认为拔牙植骨后延迟种植对于美学效果更加可靠。我们总结了上颌前牙区即刻种植和延迟种植的两组病例,对其牙槽骨的变化和软组织变化进行追踪和测量。材料方法：组一：即刻种植拔牙前拍摄,不翻瓣拔牙后行即刻种植,种植系统为NobelBiocare Replace或Ankylos。在种植体骨壁之间填塞Bio-Oss骨颗粒和Bio-Gide胶原膜。仔细关闭伤口,以确保初期愈合。术后6个月拍3D锥形束CT,并开始修复（临时或者永久修复）。组二：延迟种植拔牙同时植入Bio-col骨胶原,3个月后行种植体植入,之后6个月开始临时修复。种植体植入后6个月拍摄3D锥形束CT。结果：通过3DCT观察,两组患者的牙槽骨都得到了比较好的保存,牙龈的边缘水平和牙龈乳头的高度都比较理想。第二组患者在拔牙后和种植后牙龈乳头变圆钝,有不同程度的萎缩现象,但是在临时修复后3个月出现自动恢复的现象。结论：两组患者都显示出美学效果良好,说明这两种方法都可以比较可靠地达到良好的美学效果。即刻种植更显示出缩短疗程的优势;而延迟种植需要更长的治疗时间。我们建议在前牙即刻种植或延迟种植时使用引导骨再生技术,同时使用移植骨材料和隔离膜。在组织稳定性和美学效果的稳定性方面还需要长期的前瞻性临床观察。     

Maxillary sinus floor augmentation using bioactive glass granules and autogenous bone with simultaneous implant placement. Clinical and histological findings

This clinical study was undertaken to: 1) evaluate the use of bioactive glass Biogran combined with autogenous bone as grafting material for maxillary sinus augmentation with simultaneous implant placement using radiography and histology; and 2) document the short-term post-loading success of implants inserted in sinus cavities augmented with this material. Unilateral or bilateral sinus augmentation was performed in 12 patients with 3-5 mm of alveolar crestal bone height in the posterior maxilla prior to grafting. The sinuses were grafted with bioactive glass mixed in a 4:1 ratio with autogenous bone. Simultaneously, 2-3 threaded titanium implants were inserted into the augmented sinuses. Second stage surgery was carried out 9 to 12 months post implantation. At abutment connection, 10 core biopsy specimens were taken from different grafted sites and evaluated histologically. All 27 implants were clinically stable at second stage surgery. A mean increase in mineralized tissue height of 7.1 +/- 1.6 mm was evident when comparing the pre-surgical CT scans with those performed 9-12 months following the sinus augmentation procedure. Evaluation of the cores yielded a mean of 30.6 +/- 5.7% of bone tissue in the grafted sites. One implant failed during the prosthetic phase while the remaining 26 implants were stable 12 months post loading. This study suggests that Biogran/autogenous bone graft combination used in one-stage sinus augmentation yields sufficient quality and volume of mineralized tissue for predictable simultaneous implant placement in patients with 3-5 mm of bone height prior to grafting.     

上颌窦提升术同期或延期牙种植的早期临床评价

目的对上颌窦提升术同期或延期牙种植进行早期临床评价。方法37例患者38侧上颌窦进行上颌窦提升同期或延期牙种植,种植体上部结构修复完成后6～36个月定期复查。结果观察期内同期牙种植27侧上颌窦共59颗种植体,松动、脱落1颗,成功率为98.3%。延期牙种植上颌窦11侧共23颗种植体,全部成功。除1颗失败种植体外,其余同期或延期植入的种植体均无松动或脱落,经X线片检查显示植入骨材料改建良好,种植体周围未见明显骨吸收阴影。结论上颌窦提升术同期或延期牙种植的早期临床效果无明显差异。     

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.     

Histomorphometric analysis of natural bone mineral for maxillary sinus augmentation

PURPOSE: Lack of bone height in the posterior maxilla often necessitates augmentation prior to or simultaneously with dental implant placement. The purpose of this clinical study was to evaluate the use of the natural bone mineral Bio-Oss alone or in combination with autogenous bone in sinus floor elevations performed as 1- or 2-step procedures. MATERIALS AND METHODS: Thirty-eight patients required sinus augmentation. Natural bone mineral alone was used in sinus floor augmentation in 21 patients. In 13 patients, a mixture of the bone substitute and autogenous bone was used, and in 4 patients autogenous bone alone was used. In all of the patients, samples were taken for biopsy 3 to 8 months postoperatively, and bone regeneration was evaluated histologically and histomorphometrically. RESULTS: In all patients, the amount of new bone significantly increased over the observation time, while marrow areas decreased. There was no statistically significant difference in the amount of new bone formation between the Bio-Oss group (new bone 29.52% +/- 7.43%) and the Bio-Oss/autogenous bone group (new bone 32.23% +/- 6.86%). In the 4 patients treated with autogenous bone alone, a greater amount of newly formed bone was found; however, in these cases the area volume filled was smaller than in the other 2 groups. DISCUSSION: The data showed that new bone formation takes place up to 8 months after sinus floor elevation and that there is no difference in the amount of bone formation between procedures done with the bone substitute alone or with the mixture of the substitute and autogenous bone. CONCLUSION: These data suggest that predictable bone formation can be achieved with the use of Bio-Oss.     

Implant treatment in combination with lateral augmentation of the alveolar process: a 3-year prospective study

Background: In patients in whom the height of the alveolar process is adequate but the crest is too narrow to host an implant, lateral augmentation is required. Such augmentations have mostly been performed using autogenous bone blocks secured to the buccal surface. An alternative to autogenous bone may be bovine hydroxyapatite (Bio‐Oss, Geistlich Pharma AG, Wolhusen, Switzerland) or other bone substitutes. Purpose: The aim of this study was to evaluate the clinical and radiographic outcome of dental implants inserted after lateral augmentation of too narrow alveolar processes with a combination of bovine hydroxyapatite (Bio‐Oss) and autogenous bone. Methods: Thirty patients (14 males and 16 females) with a mean age of 41.6 years fulfilled the inclusion criteria. Twenty‐nine augmentation sites with a total of 74 implants could be followed for 3 years. Results: Three implants were lost; these were lost before loading (at the abutment operation). The survival rate was 95.9%. The mean marginal bone loss during the 3‐year observation period was 0.3 ± 0.2 mm. Conclusions: A 50/50 combination of Bio‐Oss and autogenous bone chips stabilized with Tisseel (Baxter AG/Duo Quick AG, Vienna, Austria) was useful for lateral augmentation of the alveolar crest. Lateral grafts with Bio‐Oss, autogenous bone, and Tisseel made it possible to achieve good implant stability and high implant survival results. The bone level changes adjacent to the implants were the same as in nongrafted cases.     

上颌窦提升植骨在上颌后牙区种植术的临床应用

目的评价上颌窦提升、植入上颌结节自体骨加Bio-Oss骨粉在上颌后牙种植的方法和效果。方法对5例上颌后牙区垂直骨量不足患者行6侧上颌窦提升,植入上颌结节自体骨加Bio-Oss骨粉,同期种植体植入。结果6个月后X线片显示植骨区改建成新骨,种植体无松动脱落,与周围组织形成良好的骨性结合。结论上颌结节自体骨加Bio-Oss骨粉植入,提升上颌窦拓展了种植的应用范围。     

Cortical tenting grafting technique in the severely atrophic alveolar ridge for implant site preparation

OBJECTIVES: Alveolar ridge augmentation using intraoral autogenous block grafts to augment localized alveolar ridge defects before implant placement is a predictable method. However, large severely atrophic edentulous segments may require extraoral donor sites. The purpose of this study was to evaluate the effectiveness of using intraoral cortical block grafts in combination with particulate human mineralized allograft, in a "tenting" fashion, to augment large atrophic alveolar ridge defects for implant placement. MATERIALS: This prospective case study evaluated augmentation in 10 consecutive patients with severely resorbed alveolar ridges missing a minimum of 4 adjacent teeth. Before augmentation, all grafted sites were deemed inadequate for placement of a standard 4-mm-diameter implant. Horizontal ridge augmentation was performed using autologous membranous cortical bone grafts from an oral donor site to tent out the soft tissue matrix and periosteum for the adjacent particulate allograft. The ridges were clinically evaluated 4 to 5 months after augmentation, and 42 implants were placed at that time. RESULTS: Implants were successfully placed at all grafted sites 4 to 5 months after the original graft date. Clinical evaluation of the grafted sites upon re-entry revealed uniform ridge anatomy. All edentulous segments had at least 2 implants placed of at least 4.0 mm diameter. In all, 42 implants were placed into grafted sites in the 10 patients. Implants were checked for osseointegration by using a counter torque of 35 N.cm. One implant failed to integrate. Mean follow-up was 22 months after implant placement. All augmented ridges had retained their functional and esthetic integrity at 1 year after original augmentation. CONCLUSION: Tenting of the periosteum and soft tissue matrix using a cortical bone block maintains space and minimizes resorption of the particulate allograft volume. In addition, bridging the cortical blocks with particulate bone avoids unaesthetic ridge defects between cortical block grafts in larger ridge defects. The result was a more uniform and esthetic alveolar ridge, capable of maintaining an implant-supported prosthesis. The technique offers predictable functional and esthetic reconstruction of large-volume defects without extensive amounts of autogenous bone. This offers a superior functional and esthetic result than with either cortical or particulate grafting alone.