Figure 9. Q14. Do you have any requests for dentists who practice implant treatment?
Figure 9. Q14. Do you have any requests for dentists who practice implant treatment?
Figure 8. Q13. What are the frequently received repair requests for IODs?
Figure 8. Q13. What are the frequently received repair requests for IODs?
Figure 7. Q12. What kind of creative steps do you take in order to prevent veneer fracture and chipping in the molar region?
Figure 7. Q12. What kind of creative steps do you take in order to prevent veneer fracture and chipping in the molar region?
Figure 6. Q11. What are the frequently received repair requests involving implant fixed prostheses?
Figure 6. Q11. What are the frequently received repair requests involving implant fixed prostheses?
Figure 5. Q10. What are the main fabrication challenges faced?
Figure 5. Q10. What are the main fabrication challenges faced?
Figure 4. Q8. What are the proportions of attachment types used with IODs?
Figure 4. Q8. What are the proportions of attachment types used with IODs?
Figure 3. Q6. What types of implant fixed prostheses are used in the posterior region?
Figure 3. Q6. What types of implant fixed prostheses are used in the posterior region?
Figure 2. Q5. What types of materials (i.e. veneer, coping) are used to make implant prostheses in the anterior region?
Figure 2. Q5. What types of materials (i.e. veneer, coping) are used to make implant prostheses in the anterior region?
Figure 1. Q4. What are the proportions of abutments used with cement-retained prostheses?
Figure 1. Q4. What are the proportions of abutments used with cement-retained prostheses?
Question
Values
Q9. What are the main issues generally encountered?
Compatibility precision issues
29.6%
Aesthetic issues
33.2%
...
Question
Values
Q7. The design of the implant overdenture:
Decision made according to instructions of dentist
43.2%
Work is left to technicians
19.3%
...
Question
Values
Q3. The percentages of implant fixed prostheses:
Cement-retained
61.4%
Screw-retained
38.6%
...
Question
Values
Q1. The years of experience working as a dental technician, and the number of dentists from whom job orders are received.
Mean (SD)
17.0 (6.8) years
36.5(12.4)/Lab.
...
Hagiwara, Y., Narita, T., Shioda, Y. et al. Current status of implant prosthetics in Japan: a survey among certified dental lab technicians. Int J Implant Dent 1, 4 (2015). https://doi.org/10.1186/s40729-015-0005-3
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Received: 13 October 2014
Accepted: 22 January 2015
Published: 17 February 2015
DOI: https://doi.org/10.1186/s40729-015-0005-3
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and in...
The authors have declare that they have no competing interests.
TN, YS, KI, TI and SN were compiled and aggregate of the questionnaire. YH and TS conceived of the study and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
Implant Dentistry, Nihon University School of Dentistry, Dental Hospital, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan
Yoshiyuki Hagiwara, Tatsuya Narita, Yohei Shioda, Keisuke Iwasaki, Takayuki Ikeda & Shunsuke Namaki
Department of Dental Specialties, Mayo Clinic, Mayo Clinic, 200 First Street SW, Rochester, MINN, 55905, USA
Thomas J Salinas
You can also search for this aut...
This paper was partially supported by a Grant-in-Aid for Scientific Research (C) (No. 24592935) from the Japan Society for the Promotion of Science.
Larsson C. Vult von Steyern P. Five-year follow-up of implant-supported Y-TZP and ZTA fixed dental prostheses. A randomized, prospective clinical trial comparing two different material systems. Int J Prosthodont. 2010;23:555–61.
Gonda T, Maeda Y. Why are magnetic attachments popular in japan and other asian countries? Jpn Dental Sci Rev. 2011;47:124–30.
Carlsson GE, Kronström M, de Baat C, ...
Andreiotelli M, Att W, Strub JR. Prosthodontic complications with implant overdentures: a systematic literature review. Int J Prosthodont. 2010;3:195–203.
Cehreli MC, Karasoy D, Kokat AM, Akca K, Eckert SE. Systematic review of prosthetic maintenance requirements for implant-supported overdentures. Int J Oral Maxillofac Implants. 2010;25:163–80.
Hatzikyriakos A, Petridis HP, Tsiggos N, Sakel...
Gatten DL, Riedy CA, Hong SK, Johnson JD, Cohenca N. Quality of life of endodontically treated versus implant treated patients: a University-based qualitative research study. J Endocrinol. 2011;37:903–9.
Johannsen A, Wikesjö U, Tellefsen G, Johannsen G. Patient attitudes and expectations of dental implant treatment—a questionnaire study. Swed Dent J. 2012;36:7–14.
Pavel K, Seydlova M, Dos...
Att W, Stappert C. Implant therapy to improve quality of life. Quintessence Int. 2003;34:573–81.
Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GO. Success criteria in implant dentistry: a systematic review. J Dent Res. 2012;91:242–8.
Shumaker ND, Metcalf BT, Toscano NT, Holtzclaw DJ. Periodontal and periimplant maintenance: a critical factor in long-term treatment success. Compend C...
This survey served to clarify the current status of implant prosthodontics, issues, and considerations in their fabrication, and the status of prosthetic complications and preventive initiatives, all from a laboratory perspective.
Concerning implant treatment, it was concluded that dentists either play the leading role or work in collaboration with technicians, including in the formulation of tre...
Finally, technicians gave voice to the several requests for dentists, who are their customers, as a result of their daily experiences accomplishing implant laboratory procedures (Q14) (Figure 9). These included asking dentists to use suitable implant location and orientation (31.8%), to allow technicians to participate and consult with technicians from the treatment planning stage (28.3%), to imp...
The questionnaire revealed several creative steps, based on laboratory considerations, being taken to prevent veneer chipping and fractures, a frequent and problematic prosthetic complication (Q12) (Figure 7). Technicians were taking into account metal (including zirconia) coping designs (36.3%), covering only the distal-most part of the molar region with metal (24%), using veneering composite re...
Looking at repair requests (i.e., complications) involving the superstructures of fixed implant prostheses (Q11) (Figure 6), facing damage and chipping accounted for more than half of all requests (54.5%). Generally speaking, there are many reports that indicate a high incidence of complications related to fixed prostheses involving abutment screw loosening, detachment of cement-retained crowns, ...
Bar and clip attachments were most commonly used for IODs, followed by magnet, ball, and socket, and Locator attachments (Q8) (Figure 4). It is noteworthy among the questionnaire results that magnetic attachment use is highest in Asian countries, including Japan [43]. Additionally, it is thought that the low use of Locators (5.2%) is strongly influenced by Japan’s strict pharmaceutical regulati...
Concerning the types of prostheses used in the posterior region (Q6) (Figure 3), PFM design accounts for about 40% of the total, although the questionnaire also revealed a trend (in 9.1% of all cases) toward metal occlusal designs to avoid fracture and chipping of the veneer material. The same trend is evident in indirect composite facing crowns, where metal occlusal designs are used in about 35%...
Next, concerning the types of abutments used with cement-retained prostheses (Q4) (Figure 1), CAD/CAM abutments accounted for about one third of the total (titanium, 19.7%; zirconia, 12.1%), and custom UCLA-type abutments made from cast gold alloy accounted for about the same proportion. It is likely that this breakdown is because, in many cases, implant systems using fabricated crowns are not su...
Dentists play a leading role in 39.3% of the time in implant treatment planning and prosthetic design, and dental technicians are consulted concerning cases and part usage 34.7% of the time, suggesting the approach to implants is driven by prosthetic considerations (by dentists) to some degree. However, because dental technicians indicated that they take the initiative 15% of the time, it is impos...
Out of 120 surveys sent, 74 technicians responded, resulting in a response rate of 61.6%. A summary of the responses is provided in Tables 1, 2, 3, and 4 and Figures 1, 2, 3, 4, 5, 6, 7, 8, and 9.
Because implant treatment (implant prostheses) requires a significant amount of specialized, high-precision laboratory procedures, this area of dental care exhibits slightly different trends than pros...
This cross-sectional questionnaire survey was performed among the certified dental technicians of JSOI from September to December in 2011. Selected were 120 out of 285 certified dental technicians of JSOI using a random number table and mailing each questionnaire directly to the participant. To facilitate coverage of a broad range of topics, the survey classified content into the following four ca...
This survey consists of a questionnaire targeting the certified dental technicians of the Japanese Society of Oral Implantology (JSOI) [32] who are primarily involved in fabricating dental implant restorations. It was formulated to clarify the current status of implant prostheses from a prosthetic and technician-oriented standpoint through questions addressing current trends among dental implant t...
Currently, dental implant treatment is evaluated on the basis not only of restoring masticatory function, but also a variety of other factors, including the implant and superstructure survival rate and psychological impacts [1-3]. Numerous factors must be taken into account, to offer highly predictable implant treatment, and there is no doubt that prosthetic-related factors such as the type and co...
There are many implant cases in which dental technicians take initiative with regard to the design of implant prostheses, and to a certain extent, this area of care is one in which dentists do not necessarily play the leading role. Moreover, inadequate communication between dental technicians and dentists and insufficient instructions for technicians has been highlighted as issues in the past. The...
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
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
Male
250 (89.6%)
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 4.53 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 40 years of age and 117 (41.9%) were older than 40 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 10 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 2 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 ...
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
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
Male
250 (89.6%)
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 surgical outcome after augmentation and implantation procedures is presented in Fig. 5.
The average healing period until implant placement after bone harvesting was 4.53 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 40 years of age and 117 (41.9%) were older than 40 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 10 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 2 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 ...
Figure 9. Do you have any requests for dentists who practice implant treatment?
Figure 8. What are the frequently received repair requests for IODs?
Figure 7. Creative steps to prevent veneer fracture and chipping in the molar region
Figure 6. the frequently received repair requests involving implant fixed prostheses
Figure 5. The main fabrication challenges faced
Figure 4. The proportions of attachment types used with IODs
Figure 3. Types of implant fixed prostheses are used in the posterior region
Figure 2. Types of materials used to make implant prostheses in the anterior region
Figure 1. The proportions of abutments used with cement-retained prostheses
This survey served to clarify the current status of implant prosthodontics, issues, and considerations in their fabrication, and the status of prosthetic complications and preventive initiatives, all from a laboratory perspective.
Concerning implant treatment, it was concluded that dentists either play the leading role or work in collaboration with technicians, inc...
While the literature includes reports of frequent IOD-related prosthetic complications such as attachment-related compromised retention, detachment or fracturing of denture teeth, relining, and attachment damage, this survey showed a somewhat different trend. It can be inferred that these results differ from actual complication trends because they constitute responses to cases sent to ...
The questionnaire revealed several creative steps, based on laboratory considerations, being taken to prevent veneer chipping and fractures, a frequent and problematic prosthetic complication (Q12) (Figure 7). Technicians were taking into account metal (including zirconia) coping designs (36.3%), covering only the distal-most part of the molar region with metal (24%), using veneering composi...
Looking at repair requests (i.e., complications) involving the superstructures of fixed implant prostheses (Q11) (Figure 6), facing damage and chipping accounted for more than half of all requests (54.5%). Generally speaking, there are many reports that indicate a high incidence of complications related to fixed prostheses involving abutment screw loosening, detachment of cement-retained cro...
This number was lower than in any of the other nine countries, and future changes in IOD use in Japan are a topic that remains interesting.
4. Prosthetic complications (Table 4)
According to Papaspyridakos et al., indicators such as implant level (the relationship between the implant and bone) and the state of soft tissue around the implant are the most frequently used indices of implant s...
There is also a greater possibility of direct (in-mouth) repair of failed veneering materials and greater shock-absorbing potential relative to occlusal force in comparison with porcelain. The trend to adhere resin materials instead of porcelain, from Brånemark and colleagues’ recommendations for acrylic resin as an occlusal surface material in the early 1980s, also cannot be ignored. All...
There is a low risk of facing damage and chipping for prostheses in the anterior region. Nonetheless, the questionnaire revealed the unexpected result that indirect composite facing crowns accounted for 21.3% of the total. This may be because there are many indirect composite resins (Estenia, Ceramage, etc.) available in Japan, and crowns and bridges in the anterior region (natural abutment ...
Our questionnaire indicated a distribution of 61.4% cement-retained versus 38.6% screw-retained prostheses (Q3), suggesting that cement retention is used more frequently in Japan. Unfortunately, the fabrication-oriented focus of this survey prevented clarification of the types of cement used for cement retention and the breakdown between provisional and definitive cement.
Next, ...
Dentists play a leading role in 39.3% of the time in implant treatment planning and prosthetic design, and dental technicians are consulted concerning cases and part usage 34.7% of the time, suggesting the approach to implants is driven by prosthetic considerations (by dentists) to some degree. However, because dental technicians indicated that they take the initiative 15% of the time, it is...
Results and discussion
Out of 120 surveys sent, 74 technicians responded, resulting in a response rate of 61.6%. A summary of the responses is provided in Tables 1, 2, 3, dan 4 dan Gambar 1, 2, 3, 4, 5, 6, 7, 8, dan 9.
Because implant treatment (implant prostheses) requires a significant amount of specialized, high-precision laboratory procedures, this area of dental care exhibits slight...
Question
Values
Q9. What are the main issues generally encountered?
Compatibility precision issues
29.6%
Aesthetic issues
33.2%
Occlusal issues
37.2%
Q10. What are the main fabrication challenges faced?
Poor implant location and orientation
42.4%
Inadequate consideration of occlusion
17.0%
Defects and inaccuracies in impression and bite registrat...
Question
Values
Q7. The design of the implant overdenture:
Decision made according to instructions of dentist
43.2%
Work is left to technicians
19.3%
Decided upon through consultation with each other
37.5%
Q8. What are the proportions of attachment types used with IODs?
Bar and clip
35.6%
Magnet
30.2%
Ball and socket
19.0%
Locator
5.2%
...
Question
Values
Q3. The percentages of implant fixed prostheses:
Cement-retained
61.4%
Screw-retained
38.6%
Q4. What are the proportions of abutments used with cement-retained prostheses?
CAD/CAM (titanium)
19.7%
CAD/CAM (zirconia)
12.1%
Custom abutments (UCLA-type abutment + gold alloy)
33.2%
Two-piece-type titanium (prepable type)
28.3%
...
Question
Values
Q1. The years of experience working as a dental technician, and the number of dentists from whom job orders are received.
Mean (SD)
17.0 (6.8) years
36.5(12.4)/Lab.
Q2. Who takes the leading role in treatment planning and prosthetic design (initiative with regard to prostheses)?
Dentists mainly exercise initiative
39.3%
Technicians mai...
Methods
This cross-sectional questionnaire survey was performed among the certified dental technicians of JSOI from September to December in 2011. Selected were 120 out of 285 certified dental technicians of JSOI using a random number table and mailing each questionnaire directly to the participant. To facilitate coverage of a broad range of topics, the survey classified content into the follow...
However, because understanding the status of these complications is based on the results of surveys targeting dentists, information is needed on the situation as seen from the standpoint of implant technicians, to clarify the causes of these complications and the techniques for dealing with them. Issues including inadequate communication between dental technicians and dentists and insufficient ins...
Background
Currently, dental implant treatment is evaluated on the basis not only of restoring masticatory function, but also a variety of other factors, including the implant and superstructure survival rate and psychological impacts. Numerous factors must be taken into account, to offer highly predictable implant treatment, and there is no doubt that prosthetic-related factors such as the typ...
Abstract
Background
There are many implant cases in which dental technicians take initiative with regard to the design of implant prostheses, and to a certain extent, this area of care is one in which dentists do not necessarily play the leading role. Moreover, inadequate communication between dental technicians and dentists and insufficient instructions for technicians has been highlighte...