Fig. 20. Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration
Fig. 20. Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration
Fig. 19. Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration
Fig. 19. Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration
Fig. 18. Finalized prosthetic restoration after 1Â year
Fig. 18. Finalized prosthetic restoration after 1Â year
Fig. 17. Histology of dentin augmentation. aactive process in the bone marrow lacunae with osteoblast rimming. No signs of necrosis or infection (H&E stain, Ă—100 magnification). b Larger magnification at Ă—200. c EvG (Elastica van Gieson) stain, Ă—200
Fig. 17. Histology of dentin augmentation. a Asterisk denotes incorporated dentin particle, surrounded by vital woven bone. Triangle shows rea...
Fig. 16. Single tooth X-ray, 1Â year post-implantation, showing the finalized crown
Fig. 16. Single tooth X-ray, 1Â year post-implantation, showing the finalized crown
Fig. 15. Single tooth X-ray, showing a constant bone level 7Â months after implant placement
Fig. 15. Single tooth X-ray, showing a constant bone level 7Â months after implant placement
Fig. 14. Single tooth X-ray immediately after the augmentation using autogenous dentin
Fig. 14. Single tooth X-ray immediately after the augmentation using autogenous dentin
Fig. 13.
Fig. 13. a, b Clinical situation prior to implant placement
Fig. 12. Axial view
Fig. 12. Axial view
Fig. 11. Sagittal view
Fig. 11. Sagittal view
Fig. 10. Soft tissue graft placed on the recipient site
Fig. 10. Soft tissue graft placed on the recipient site
Fig. 9. Soft tissue punch
Fig. 9. Soft tissue punch
Fig. 8. Autologous, particulated dentin in the alveolar socket
Fig. 8. Autologous, particulated dentin in the alveolar socket
Fig. 7. Autologous, particulated dentin mixed with blood from the operating site
Fig. 7. Autologous, particulated dentin mixed with blood from the operating site
Fig. 6. Autologous dentin with the desired particle size
Fig. 6. Autologous dentin with the desired particle size
Fig. 5. Autologous dentin in a bone mill
Fig. 5. Autologous dentin in a bone mill
Fig. 4. Removal of enamel and the cementum
Fig. 4. Removal of enamel and the cementum
Fig. 3. Removal of the pulp
Fig. 3. Removal of the pulp
Fig. 2. The remaining root of tooth 11
Fig. 2. The remaining root of tooth 11
Fig. 1. Extraction with the benex system
Fig. 1. Extraction with the benex system
Valdec, S., Pasic, P., Soltermann, A. et al. Alveolar ridge preservation with autologous particulated dentin—a case series. Int J Implant Dent 3, 12 (2017). https://doi.org/10.1186/s40729-017-0071-9
Download citation
Received: 07 December 2016
Accepted: 15 March 2017
Published: 30 March 2017
DOI: https://doi.org/10.1186/s40729-017-0071-9
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, University Hospital Zurich, Plattenstrasse 11, 8032, ZĂĽrich, Switzerland
Silvio Valdec, Pavla Pasic, Bernd Stadlinger & Martin Rücker
Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
Alex Soltermann
Clinic of Fixed and Removable Prosthodontics and Dental Mater...
We would like to express our thanks to Dr. Gabriel Bosch for the superimposition, calculation and illustration of the intraoral scans.
SV, BS and MR created the conception and study design. MR performed the surgical and DT the prosthodontic treatment. SV, PP and DT performed the data collection and AS the histological examination. SV, BS and AS analysed and interpreted the data. SV drafted the ma...
Sculean A, Berakdar M, Chiantella GC, Donos N, Arweiler NB, Brecx M. Healing of intrabony defects following treatment with a bovine-derived xenograft and collagen membrane. A controlled clinical study. J Clin Periodontol. 2003;30(1):73–80.
Sutton DN, Lewis BR, Patel M, Cawood JI. Changes in facial form relative to progressive atrophy of the edentulous jaws. Int J Oral Maxillofac Surg. 2004;33(7...
Liu X, Li Q, Wang F, Wang Z. Maxillary sinus floor augmentation and dental implant placement using dentin matrix protein-1 gene-modified bone marrow stromal cells mixed with deproteinized boving bone: a comparative study in beagles. Arch Oral Biol. 2016;64:102–8. doi:10.1016/j.archoralbio.2016.01.004.
Pang KM, Um IW, Kim YK, Woo JM, Kim SM, Lee JH. Autogenous demineralized dentin matrix from ex...
Furhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res. 2005;16(6):639–44. doi:10.1111/j.1600-0501.2005.01193.x.
Guirado JL, Troiano M, Lopez-Lopez PJ, Ramirez-Fernandez MP, de Val JE, Marin JM, Gehrke SA. Different configuration of socket shield technique in peri-implant bone...
Al-Asfour A, Andersson L, Kamal M, Joseph B. New bone formation around xenogenic dentin grafts to rabbit tibia marrow. Dent Traumatol. 2013;29(6):455–60. doi:10.1111/edt.12045.
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11–25.
Andersson L. Den...
Within the limits of this case series, it has been shown that particulated dentin of autologous teeth may serve as an alternative to autologous bone for alveolar ridge preservation prior to implant therapy. However, randomized studies on this treatment option are necessary.
In humans, particulated tooth material has been used for sinus augmentation in order to enhance implant therapy. Preliminary results from five patients histologically showed an osteoconductive osteogenesis with partial resorption of tooth components [25].
In the present case series, all patients underwent socket preservation with AutoPD. In all cases, one or two upper frontal central incisors wer...
The aim of this case series is to demonstrate the efficacy and safety of this novel augmentative procedure for ridge preservation prior to implant therapy. This shall serve as a basis for a prospective study.
In all four cases, patients showed a stable volume of soft and hard tissues after the augmentation with AutoPD and good osseointegration of titanium implants, having been placed in this augm...
Four months post-extraction and augmentation with autologous, particulated dentin, all four patients received an implant placement in the augmented area. In all cases, a CBCT was taken in between the dentin augmentation and the implant placement.
During implant placement, a biopsy of the bone from the augmented area was taken for histological examination (Fig. 17).
The final prosthetic solution...
The 1-year follow-up examination of the presented case showed an implant success, according to the appropriate clinical criteria [2] (Figs. 14, 15 and 16).
The pink esthetic score (PES) was used for the evaluation of reproducible soft tissue around the final implant crown as a parameter for the aesthetic outcome [12]. Seven variables were evaluated comparing the soft tissue around the implant wi...
An autologous soft tissue graft was harvested from the patient’s palate using a soft tissue punch (Biopsy Punch, kai Europe GmbH, Solingen, Germany) (Fig. 9). The graft had a comparable dimension as the recipient site. The gingival graft was placed on top of the augmentation material, adapted and carefully sutured to the marginal gingiva after the sulcus epithelium was removed with a rotating d...
Four patients between 36 and 65Â years of age are presented in this case series. There was no financial compensation. All four patients suffered from a trauma, causing damage to one or two teeth of the anterior maxilla. The frontal tooth/teeth has/had to be extracted. The pulp of the extracted teeth of three patients and the root canal filling of one patient had to be removed. All patients were in...
Subsequent to tooth extraction, a resorption of the host bone as defined by atrophy of the alveolar ridge can be observed. Sutton et al. classified the different degrees of alveolar ridge atrophy [32]. Bone resorption especially occurs in the frontal and premolar area of the jaw in the region of the thin buccal lamella. This may lead to a change in contour [11, 28]. Physiological reason for this a...
Ridge preservation can be performed with autologous bone, alloplastic bone substitute material or a combination of both. Dentin is similar to bone in its chemical composition. In its use as bone substitute material, it undergoes a remodelling process and transforms to bone. The presented case report introduces a technique in which the extraction socket is augmented with autologous, particulated de...
Fig. 5. Survival rate of dental implants after autologous bone augmentation
Fig. 5. Survival rate of dental implants after autologous bone augmentation
Fig. 4. Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Double asterisk, N refers to the total number of the surgical approaches in the maxilla (N = 225)
Fig. 4. Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Dou...
Fig. 3. Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 3. Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 2. Survival rate of autologous bone grafts
Fig. 2. Survival rate of autologous bone grafts
Fig. 1. Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Fig. 1. Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Postoperative complications
%/procedures (N)
At donor sitea
Â
â€Wound infection
2.6% (8/300)
At recipient site...
Donor site
Bone grafts (N)/patients (N)
Lateral zygomatic buttress
113/112
Mandibular ramus (retromolar)
...
Patient characteristics
N (%)
Gendera
Â
â€Male
250 (89.6%)
â€Female
29 (10.4%)
...
Sakkas, A., Wilde, F., Heufelder, M. et al. Autogenous bone grafts in oral implantology—is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures.
Int J Implant Dent 3, 23 (2017). https://doi.org/10.1186/s40729-017-0084-4
Download citation
Received: 27 February 2017
Accepted: 22 May 2017
Published: 01 June 2017
DOI: https://doi...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
Andreas Sakkas, Frank Wilde, Marcus Heufelder & Alexander Schramm
Institute of Anatomy, Medical Faculty of Leipzig University, Leipzig, Germany
Karsten Winter
Department of Oral and Plastic Maxillofacial Surgery, University Hospit...
The authors thank the patients for their kindness to participate as study cases and the whole medical team at the Bundeswehrkrankenhaus Ulm.
AS participated in its design and coordination, carried out the data selection, and drafted the manuscript, and is the corresponding author. FW participated in its design and coordination and helped in drafting the manuscript. MH participated in its design a...
Semper W, Kraft S, Mehrhof J, Nelson K. Impact of abutment rotation and angulation on marginal fit: theoretical considerations. Int J Oral Maxillofac Implants. 2010;25:752–8.
Wiltfang J, Jätschmann N, Hedderich J, Neukam FW, Schlegel KA, Gierloff M. Effect of deproteinized bovine bone matrix coverage on the resorption of iliac cortico-spongeous bone grafts—a prospective study of two cohorts....
Chiapasco M, Zaniboni M. Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review. Clin Oral Implants Res. 2009;20:113–23.
Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical...
Verdugo F, Castillo A, Moragues MD, Pontón J. Bone microbial contamination influences autogenous grafting in sinus augmentation. J Periodontol. 2009;80:1355–64.
Wiltfang J, Schultze-Mosgau S, Merten HA, Kessler P, Ludwig A, Engelke W. Endoscopic and ultrasonographic evaluation of the maxillary sinus after combined sinus floor augmentation and implant insertion. Oral Surg Oral Med Oral Pathol O...
von Arx T, Buser D. Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients. Clin Oral Implants Res. 2006;17:359–66.
Levin L, Nitzan D, Schwartz-Arad D. Success of dental implants placed in intraoral block bone grafts. J Periodontol. 2007;78:18–21.
Andersson L. Patient self-evaluation of...
Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Maxillofac Implants. 2007;22:49–70.
Margonar R, dos Santos PL, Queiroz TP, Marcantonio E. Rehabilitation of atrophic maxilla using the combination of autogenous and allogeneic bone grafts followed by protocol-type prosthesis. J Craniofac Surg. 2010;2...
Schwartz-Arad D, Dori S. Intraoral autogenous onlay block bone grafting for implant dentistry. Refuat Hapeh Vehashinayim. 2002;19:35–9. 77.
Misch CM. Ridge augmentation using mandibular ramus bone grafts for the placement of dental implants: presentation of a technique. Pract Periodontics Aesthet Dent. 1996;8:127–35.
Altiparmak N, Soydan SS, Uckan S. The effect of conventional surgery and pi...
Jensen AT, Jensen SS, Worsaae N. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study. Oral Maxillofac Surg. 2016;20(2):115–22 [Epub ahead of print].
Buser D, Dula K, Hirt HP, Schenk RK. Lateral ridge augmentation using autografts and barrier membranes: clinical study with 40 partially edentulous patients. J Oral Maxill...
The results of the clinical study proves the reliability and low comorbidity of autologous bone grafts in preprosthetic alveolar ridge reconstructions prior to implant insertion. The high graft success rate (95.6%) and the low early implant failure rate (0.38%) in a surveillance of all patients treated in three following years with this technique showing no exclusion and no dropout of any case for...
Data on risk factors based on the original examination and documentation are difficult to assess the adverse effects of variable factors on the surgical prognosis because of the multifactorial genesis of surgical complications [73]. Factors such as gender, age, or smoking habit could be associated with postoperative complications after two-stage dentoalveolar reconstruction with autologous bone gr...
The results of the present study have to take into account the absence of a control group with patients undergoing bone augmentation procedures with bone substitutes (allogen, alloplastic, exogen). Without a comparative group of grafting surgeries using alternative bone material, only limited statements can be made.
However, the excellent surgical outcome of autologous surgical methods providing ...
The use of autologous bone in this study has shown excellent graft survival and success rate (95.6%). This is equal to the results from the studies on implants inserted in reconstructed sites [6, 8, 24]. The early implant survival rate of 99.7% found in the present material is very high comparable to that in the previous systematic reviews after staged horizontal ridge augmentation [9, 10, 22, 62,...
Of the sinus floor elevations performed in this study, 84.8% were defined absolutely successful. Only two of our 72 patients having sinus lift operations could not finally be treated with dental implants. These results are comparable to other studies considering the sinus graft to be a safe treatment modality with few complications [6, 8, 51,52,53]. Raghoebar et al. reported incidences of sinus co...
Postoperative morbidity after mandibular bone harvesting procedures was reported to be mainly related to temporary or permanent neural disturbances involving the inferior alveolar nerve and its branches [19]. In this study, only the incidence of the temporary hypoesthesia of the mandibular and lingual nerve after harvesting from the retromolar area could be detected. It was 10.4 and 2.8%, respecti...
Systematic reviews have failed to find evidence that one particular grafting technique is superior to others [10]. Intraoral bone grafts from the mandibular symphysis, mandibular ramus, and maxillary tuberosity provide a good treatment modality for ridge augmentation, and the amount of bone available for harvesting is sufficient for defects up to the width of three teeth [42]. Harvesting of retrom...
Several grafting procedures have been described to create sufficient volume of bone for implant placement [8, 9]. Autologous bone grafts can be harvested by an intraoral approach (mandibular ramus, mandibular symphysis, zygomatic buttress) or from distant sites (iliac crest, calvaria, and etc.) [17, 36, 37]. However, bone harvesting potentially causes donor site morbidity which is a major issue fo...
The average healing period until implant placement after bone harvesting was 4.53Â months. Initially, 546 implants in 279 patients were planned. After the healing period, it was possible to place 525 implants in 436 successfully augmented areas in 259 patients. Three hundred implants were inserted in the maxilla and 225 in the mandible. The remaining 21 implants planned for 20 patients could not b...
Regarding intraoperative complications, all sinus membrane perforations were covered with a resorbable collagen membrane (Bio-Gide®, Geistlich Biomaterials, Baden-Baden, Germany) which applied as sealant to overlap the site of perforation prior to insertion of the graft material. These patients were advised to avoid physical stress, blowing their noses, or sneezing for a period of 3 weeks, and n...
No permanent damage to any trigeminal nerves was evident in any of our entire cohort. All cases of postoperative hypoesthesia of the mental, lingual, or infraorbital nerve were just a temporary nature. At the time of implant surgery, none of these patients reported any persisting neural disturbances (Fig. 4).
In eleven patients, hypoesthesia of the mental area was mentioned, and three of them al...
Thirty-eight patients underwent a total of 116 augmentation procedures harvesting from the iliac crest. In 20 patients, a bone graft augmentation of the maxilla and the mandible in combination with bilateral sinus floor augmentations was performed. Eighteen patients had augmentations only in the maxilla, involving bone grafting and sinus lift elevations. Totally, 76 sinus lifts with bone material ...
In six patients, a partial graft resorption was detected at the time of implantation and an additional simultaneous augmentation with bone chips harvested with the Safescraper device (C.G.M. S.p.A., Divisione Medicale META, Italy) was then necessary in order to ensure the osseointegration of the implants. Two out of these six cases had grafts from the crista zygomatico-alveolaris, two from the ram...
A total of 112 sinus floor elevations were performed. In all of the cases, implants were inserted in a two-stage procedure. The donor site for harvesting the bone for the sinus elevations was in 76 procedures in the iliac crest area, and in 36 procedures, the bone was harvested with a bone scraper device from the lateral sinus wall at the site of sinus lifting.
The distribution and number of tran...
Two hundred seventy-nine patients—250 men and 29 women—underwent 456 augmentation procedures involving autologous bone grafts prior to implant placement. The patients ranged in age from 18.5 to 71.5 years (average 43.1 years) at the moment of augmentation surgery.
Of those patients, 162 (58.1%) were younger than 40Â years of age and 117 (41.9%) were older than 40Â years of age. Caries or pe...
Early and late implant loss was documented in this study, defining the clinical success of osseointegration. Early implant failures were assessed before the acquisition of osseointegration, i.e., before the placement of prosthodontic restorations. Early implant failure could occur from the time of placement, during the healing phase and before abutment connection. The implant inserted after re-aug...
Medical history of patient
Age of patient at the time of bone harvesting and augmentation
History of periodontal disease
Smoking habits
Donor site
Jaw area and dental situation of the recipient site
Intraoperative complications
Postoperative complications after augmentation
Management of complications
Bone graft stability and clinical resorption prior to implant placement
Complications a...
In addition to the bone already gained with the bone scraper device from the sinus wall during the antrostomy, bone was harvested with the same device from the maxillary buccal buttress, if more volume was needed. By taking this approach, the collection of enough bone for the augmentation of at least two implantation sites was feasible with a mean surgical time of 5 to 10Â min for harvesting. In c...
Grafting from the iliac crest was always performed under general anesthesia in a two-team approach. The iliac crest was exposed and autogenous grafts from the anterosuperior inner edge of the iliac wing were harvested with an oscillating saw and/or a chisel, keeping a safe distance of around 2Â cm from the anterosuperior iliac spine. After harvesting the bone grafts, the corticocancellous bone blo...
A standardized two-stage surgical protocol was used, and all sites were treated in a similar fashion. In the first intervention, a bone block harvested from the donor site was fixed with osteosynthesis titanium screws to the recipient site as an onlay graft to achieve a horizontal and/or vertical enlargement of the alveolar ridge. Placement of the bone graft was always guided by an augmentation te...
For this retrospective cohort study, we reviewed the records of all patients without exclusion criteria who were referred to the department of oral and plastic maxillofacial surgery at the military hospital of Ulm, Germany, between January 2009 and December 2011 for alveolar ridge augmentations prior to implant insertions using autologous bone grafts harvested from different donor sites and unilat...
In our military outpatient center exclusively, autologous bone transplantations harvested from different donor sites were used intraorally (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, anterior sinus wall) and extraorally (iliac crest) to reconstruct severe horizontal and/or vertical alveolar ridge atrophy prior to implant placement. The aim of this study was to assess the cli...
Although the iliac crest is most often used in jaw reconstruction, a significant bone resorption has been mentioned [12]. This disadvantage, and the fact that dental implants do not always require a large amount of bone, has increased the use of autologous block bone grafts from intraoral sources [13]. Bone grafts from intraoral donor sites offer several benefits like surgical accessibility, proxi...
Oral implantation has a significant role in the rehabilitation of patients. Bone reconstruction techniques have been advanced in order to optimize the esthetic and functional outcome. However, the restoration of the oral function of atrophic alveolar crests still remains a challenge in oral implantology. Bone augmentation procedures are often indicated to allow implant placement in an optimal thre...
This review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standar...
This study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts.
A consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the ...
Valdec, S., Pasic, P., Soltermann, A. et al. Alveolar ridge preservation with autologous particulated dentin—a case series.
Int J Implant Dent 3, 12 (2017). https://doi.org/10.1186/s40729-017-0071-9
Download citation
Received: 07 December 2016
Accepted: 15 March 2017
Published: 30 March 2017
DOI: https://doi.org/10.1186/s40729-017-0071-9
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, University Hospital Zurich, Plattenstrasse 11, 8032, ZĂĽrich, Switzerland
Silvio Valdec, Pavla Pasic, Bernd Stadlinger & Martin Rücker
Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
Alex Soltermann
Clinic of Fixed and Removable Prosthodontics and Dental Mater...
We would like to express our thanks to Dr. Gabriel Bosch for the superimposition, calculation and illustration of the intraoral scans.
SV, BS and MR created the conception and study design. MR performed the surgical and DT the prosthodontic treatment. SV, PP and DT performed the data collection and AS the histological examination. SV, BS and AS analysed and interpreted the data. SV drafted the ma...
Sculean A, Berakdar M, Chiantella GC, Donos N, Arweiler NB, Brecx M. Healing of intrabony defects following treatment with a bovine-derived xenograft and collagen membrane. A controlled clinical study. J Clin Periodontol. 2003;30(1):73–80.
Sutton DN, Lewis BR, Patel M, Cawood JI. Changes in facial form relative to progressive atrophy of the edentulous jaws. Int J Oral Maxillofac Surg. 2004;33(7...
Liu X, Li Q, Wang F, Wang Z. Maxillary sinus floor augmentation and dental implant placement using dentin matrix protein-1 gene-modified bone marrow stromal cells mixed with deproteinized boving bone: a comparative study in beagles. Arch Oral Biol. 2016;64:102–8. doi:10.1016/j.archoralbio.2016.01.004.
Pang KM, Um IW, Kim YK, Woo JM, Kim SM, Lee JH. Autogenous demineralized dentin matrix from ex...
Furhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res. 2005;16(6):639–44. doi:10.1111/j.1600-0501.2005.01193.x.
Guirado JL, Troiano M, Lopez-Lopez PJ, Ramirez-Fernandez MP, de Val JE, Marin JM, Gehrke SA. Different configuration of socket shield technique in peri-implant bone...
Al-Asfour A, Andersson L, Kamal M, Joseph B. New bone formation around xenogenic dentin grafts to rabbit tibia marrow. Dent Traumatol. 2013;29(6):455–60. doi:10.1111/edt.12045.
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11–25.
Andersson L. Den...
Within the limits of this case series, it has been shown that particulated dentin of autologous teeth may serve as an alternative to autologous bone for alveolar ridge preservation prior to implant therapy. However, randomized studies on this treatment option are necessary.
In humans, particulated tooth material has been used for sinus augmentation in order to enhance implant therapy. Preliminary results from five patients histologically showed an osteoconductive osteogenesis with partial resorption of tooth components [25].
In the present case series, all patients underwent socket preservation with AutoPD. In all cases, one or two upper frontal central incisors wer...
The aim of this case series is to demonstrate the efficacy and safety of this novel augmentative procedure for ridge preservation prior to implant therapy. This shall serve as a basis for a prospective study.
In all four cases, patients showed a stable volume of soft and hard tissues after the augmentation with AutoPD and good osseointegration of titanium implants, having been placed in this augm...
Four months post-extraction and augmentation with autologous, particulated dentin, all four patients received an implant placement in the augmented area. In all cases, a CBCT was taken in between the dentin augmentation and the implant placement.
During implant placement, a biopsy of the bone from the augmented area was taken for histological examination (Fig. 17).
The final prosthetic solution...
The 1-year follow-up examination of the presented case showed an implant success, according to the appropriate clinical criteria [2] (Figs. 14, 15 and 16).
The pink esthetic score (PES) was used for the evaluation of reproducible soft tissue around the final implant crown as a parameter for the aesthetic outcome [12]. Seven variables were evaluated comparing the soft tissue around the implant wi...
An autologous soft tissue graft was harvested from the patient’s palate using a soft tissue punch (Biopsy Punch, kai Europe GmbH, Solingen, Germany) (Fig. 9). The graft had a comparable dimension as the recipient site. The gingival graft was placed on top of the augmentation material, adapted and carefully sutured to the marginal gingiva after the sulcus epithelium was removed with a rotating d...
Four patients between 36 and 65Â years of age are presented in this case series. There was no financial compensation. All four patients suffered from a trauma, causing damage to one or two teeth of the anterior maxilla. The frontal tooth/teeth has/had to be extracted. The pulp of the extracted teeth of three patients and the root canal filling of one patient had to be removed. All patients were in...
Subsequent to tooth extraction, a resorption of the host bone as defined by atrophy of the alveolar ridge can be observed. Sutton et al. classified the different degrees of alveolar ridge atrophy [32]. Bone resorption especially occurs in the frontal and premolar area of the jaw in the region of the thin buccal lamella. This may lead to a change in contour [11, 28]. Physiological reason for this a...
Ridge preservation can be performed with autologous bone, alloplastic bone substitute material or a combination of both. Dentin is similar to bone in its chemical composition. In its use as bone substitute material, it undergoes a remodelling process and transforms to bone. The presented case report introduces a technique in which the extraction socket is augmented with autologous, particulated de...
Fig. 5. Survival rate of dental implants after autologous bone augmentation
Fig. 5. Survival rate of dental implants after autologous bone augmentation
Fig. 4. Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Double asterisk, N refers to the total number of the surgical approaches in the maxilla (N = 225)
Fig. 4. Postoperative nerve alterations. Single asterisk, N refers to the total number of the surgical approaches in the mandible (N = 155). Dou...
Fig. 3. Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 3. Surgical outcome after autologous augmentation procedures from different donor sites
Fig. 2. Survival rate of autologous bone grafts
Fig. 2. Survival rate of autologous bone grafts
Fig. 1. Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Fig. 1. Postoperative complications at the donor and recipient site, N refers to the total number of the donor sites (N = 300), N refers to the total number of the recipient sites (N = 378)
Postoperative complications
%/procedures (N)
At donor sitea
Â
â€Wound infection
2.6% (8/300)
At recipient site...
Donor site
Bone grafts (N)/patients (N)
Lateral zygomatic buttress
113/112
Mandibular ramus (retromolar)
...
Patient characteristics
N (%)
Gendera
Â
â€Male
250 (89.6%)
â€Female
29 (10.4%)
...
Sakkas, A., Wilde, F., Heufelder, M. et al. Autogenous bone grafts in oral implantology—is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures.
Int J Implant Dent 3, 23 (2017). https://doi.org/10.1186/s40729-017-0084-4
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Received: 27 February 2017
Accepted: 22 May 2017
Published: 01 June 2017
DOI: https://doi...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
Andreas Sakkas, Frank Wilde, Marcus Heufelder & Alexander Schramm
Institute of Anatomy, Medical Faculty of Leipzig University, Leipzig, Germany
Karsten Winter
Department of Oral and Plastic Maxillofacial Surgery, University Hospit...
The authors thank the patients for their kindness to participate as study cases and the whole medical team at the Bundeswehrkrankenhaus Ulm.
AS participated in its design and coordination, carried out the data selection, and drafted the manuscript, and is the corresponding author. FW participated in its design and coordination and helped in drafting the manuscript. MH participated in its design a...
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The results of the clinical study proves the reliability and low comorbidity of autologous bone grafts in preprosthetic alveolar ridge reconstructions prior to implant insertion. The high graft success rate (95.6%) and the low early implant failure rate (0.38%) in a surveillance of all patients treated in three following years with this technique showing no exclusion and no dropout of any case for...
Data on risk factors based on the original examination and documentation are difficult to assess the adverse effects of variable factors on the surgical prognosis because of the multifactorial genesis of surgical complications [73]. Factors such as gender, age, or smoking habit could be associated with postoperative complications after two-stage dentoalveolar reconstruction with autologous bone gr...
The results of the present study have to take into account the absence of a control group with patients undergoing bone augmentation procedures with bone substitutes (allogen, alloplastic, exogen). Without a comparative group of grafting surgeries using alternative bone material, only limited statements can be made.
However, the excellent surgical outcome of autologous surgical methods providing ...
The use of autologous bone in this study has shown excellent graft survival and success rate (95.6%). This is equal to the results from the studies on implants inserted in reconstructed sites [6, 8, 24]. The early implant survival rate of 99.7% found in the present material is very high comparable to that in the previous systematic reviews after staged horizontal ridge augmentation [9, 10, 22, 62,...
Of the sinus floor elevations performed in this study, 84.8% were defined absolutely successful. Only two of our 72 patients having sinus lift operations could not finally be treated with dental implants. These results are comparable to other studies considering the sinus graft to be a safe treatment modality with few complications [6, 8, 51,52,53]. Raghoebar et al. reported incidences of sinus co...
Postoperative morbidity after mandibular bone harvesting procedures was reported to be mainly related to temporary or permanent neural disturbances involving the inferior alveolar nerve and its branches [19]. In this study, only the incidence of the temporary hypoesthesia of the mandibular and lingual nerve after harvesting from the retromolar area could be detected. It was 10.4 and 2.8%, respecti...
Systematic reviews have failed to find evidence that one particular grafting technique is superior to others [10]. Intraoral bone grafts from the mandibular symphysis, mandibular ramus, and maxillary tuberosity provide a good treatment modality for ridge augmentation, and the amount of bone available for harvesting is sufficient for defects up to the width of three teeth [42]. Harvesting of retrom...
Several grafting procedures have been described to create sufficient volume of bone for implant placement [8, 9]. Autologous bone grafts can be harvested by an intraoral approach (mandibular ramus, mandibular symphysis, zygomatic buttress) or from distant sites (iliac crest, calvaria, and etc.) [17, 36, 37]. However, bone harvesting potentially causes donor site morbidity which is a major issue fo...
The surgical outcome after augmentation and implantation procedures is presented in Fig. 5.
The average healing period until implant placement after bone harvesting was 4.53Â months. Initially, 546 implants in 279 patients were planned. After the healing period, it was possible to place 525 implants in 436 successfully augmented areas in 259 patients. Three hundred implants were inserted in the maxilla and 225 in the mandible. The remaining 21 implants planned for 20 patients could not b...
Regarding intraoperative complications, all sinus membrane perforations were covered with a resorbable collagen membrane (Bio-Gide®, Geistlich Biomaterials, Baden-Baden, Germany) which applied as sealant to overlap the site of perforation prior to insertion of the graft material. These patients were advised to avoid physical stress, blowing their noses, or sneezing for a period of 3 weeks, and n...
No permanent damage to any trigeminal nerves was evident in any of our entire cohort. All cases of postoperative hypoesthesia of the mental, lingual, or infraorbital nerve were just a temporary nature. At the time of implant surgery, none of these patients reported any persisting neural disturbances (Fig. 4).
In eleven patients, hypoesthesia of the mental area was mentioned, and three of them al...
Thirty-eight patients underwent a total of 116 augmentation procedures harvesting from the iliac crest. In 20 patients, a bone graft augmentation of the maxilla and the mandible in combination with bilateral sinus floor augmentations was performed. Eighteen patients had augmentations only in the maxilla, involving bone grafting and sinus lift elevations. Totally, 76 sinus lifts with bone material ...
A total of 104 retromolar bone graft procedures in 86 patients were conducted. Twenty-two harvesting procedures were performed for augmentation of the maxilla and 82 for the mandible. Seven retromolar bone grafts (93.2%) in seven single-tooth gap dental regions by seven patients had been lost. Therefore, seven implants could not be inserted in augmented alveolar sites after graft failure. Three of...
In six patients, a partial graft resorption was detected at the time of implantation and an additional simultaneous augmentation with bone chips harvested with the Safescraper device (C.G.M. S.p.A., Divisione Medicale META, Italy) was then necessary in order to ensure the osseointegration of the implants. Two out of these six cases had grafts from the crista zygomatico-alveolaris, two from the ram...
A total of 112 sinus floor elevations were performed. In all of the cases, implants were inserted in a two-stage procedure. The donor site for harvesting the bone for the sinus elevations was in 76 procedures in the iliac crest area, and in 36 procedures, the bone was harvested with a bone scraper device from the lateral sinus wall at the site of sinus lifting.
The distribution and number of tran...
Two hundred seventy-nine patients—250 men and 29 women—underwent 456 augmentation procedures involving autologous bone grafts prior to implant placement. The patients ranged in age from 18.5 to 71.5 years (average 43.1 years) at the moment of augmentation surgery.
Of those patients, 162 (58.1%) were younger than 40Â years of age and 117 (41.9%) were older than 40Â years of age. Caries or pe...
Early and late implant loss was documented in this study, defining the clinical success of osseointegration. Early implant failures were assessed before the acquisition of osseointegration, i.e., before the placement of prosthodontic restorations. Early implant failure could occur from the time of placement, during the healing phase and before abutment connection. The implant inserted after re-aug...
Medical history of patient
Age of patient at the time of bone harvesting and augmentation
History of periodontal disease
Smoking habits
Donor site
Jaw area and dental situation of the recipient site
Intraoperative complications
Postoperative complications after augmentation
Management of complications
Bone graft stability and clinical resorption prior to implant placement
Complications a...
In addition to the bone already gained with the bone scraper device from the sinus wall during the antrostomy, bone was harvested with the same device from the maxillary buccal buttress, if more volume was needed. By taking this approach, the collection of enough bone for the augmentation of at least two implantation sites was feasible with a mean surgical time of 5 to 10Â min for harvesting. In c...
Grafting from the iliac crest was always performed under general anesthesia in a two-team approach. The iliac crest was exposed and autogenous grafts from the anterosuperior inner edge of the iliac wing were harvested with an oscillating saw and/or a chisel, keeping a safe distance of around 2Â cm from the anterosuperior iliac spine. After harvesting the bone grafts, the corticocancellous bone blo...
A standardized two-stage surgical protocol was used, and all sites were treated in a similar fashion. In the first intervention, a bone block harvested from the donor site was fixed with osteosynthesis titanium screws to the recipient site as an onlay graft to achieve a horizontal and/or vertical enlargement of the alveolar ridge. Placement of the bone graft was always guided by an augmentation te...
For this retrospective cohort study, we reviewed the records of all patients without exclusion criteria who were referred to the department of oral and plastic maxillofacial surgery at the military hospital of Ulm, Germany, between January 2009 and December 2011 for alveolar ridge augmentations prior to implant insertions using autologous bone grafts harvested from different donor sites and unilat...
In our military outpatient center exclusively, autologous bone transplantations harvested from different donor sites were used intraorally (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, anterior sinus wall) and extraorally (iliac crest) to reconstruct severe horizontal and/or vertical alveolar ridge atrophy prior to implant placement. The aim of this study was to assess the cli...
Although the iliac crest is most often used in jaw reconstruction, a significant bone resorption has been mentioned [12]. This disadvantage, and the fact that dental implants do not always require a large amount of bone, has increased the use of autologous block bone grafts from intraoral sources [13]. Bone grafts from intraoral donor sites offer several benefits like surgical accessibility, proxi...
Oral implantation has a significant role in the rehabilitation of patients. Bone reconstruction techniques have been advanced in order to optimize the esthetic and functional outcome. However, the restoration of the oral function of atrophic alveolar crests still remains a challenge in oral implantology. Bone augmentation procedures are often indicated to allow implant placement in an optimal thre...
This review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standar...
This study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts.
A consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the ...