Fig. 7. Orthopantomograph 2 years after implant placement
Fig. 6. Clinical picture 2 years after implant placement
Fig. 6. Clinical picture 2 years after implant placement
Fig. 5. Occlusal view of implants after vertical repositioning of the dental alveolus segment showing proper mesiodistal space and buccolingual spacing
Fig. 5. Occlusal view of implants after vertical repositioning of the dental alveolus segment showing proper mesiodistal space and buccolingual spacing
Fig. 4. Vertical repositioning of dental alveolus segment with placement of dental implants
Fig. 4. Vertical repositioning of dental alveolus segment with placement of dental implants
Fig. 3. Direct sinus lift with implant osteotomy preparation
Fig. 3. Direct sinus lift with implant osteotomy preparation
Fig. 2. Marked incision site for surgical access
Fig. 2. Marked incision site for surgical access
Fig. 1. Edentulous site with supra-eruption of opposing dentition
Fig. 1. Edentulous site with supra-eruption of opposing dentition
Tsegga, T., Wright, T. Maxillary segmental osteoperiosteal flap with simultaneous placement of dental implants: case report of a novel technique. Int J Implant Dent 3, 2 (2017). https://doi.org/10.1186/s40729-017-0067-5
Download citation
Received: 06 December 2016
Accepted: 13 January 2017
Published: 19 January 2017
DOI: https://doi.org/10.1186/s40729-017-0067-5
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...
Department of Oral & Maxillofacial Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Ft. Sam Houston, 78234, TX, USA
Tibebu Tsegga & Thomas Wright
Department of Oral & Maxilofacial Surgery, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX, 78236, USA
Tibebu Tsegga & Thomas Wright
You can also search for this author in PubMed Google S...
Irinakis T. Efficacy of injectable demineralized bone matrix as graft material during sinus elevation surgery with simultaneous implant placement in the posterior maxilla: clinical evaluation of 49 sinuses. J Oral and Maxillofac Surg. 2011;69:134–41.
Chiapasoo M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24:237–69.
Jenson...
This case highlights the evolving variations in dentoalveolar augmentation with an emphasis on concomitant implant placement. In the most traditional sense, a vertical osteoperiosteal flap technique would be bound with a stable basal bone that can be used to anchor simultaneous dental implant placement. Further refinement should consider minimizing crestal reflection and overall labial bone resorp...
A critical appraisal of the gingival architecture in the final end point of this case demonstrates some radiolucency through the soft tissue outlining the platform of the Nobel Biocare TiUnite implant. This would lead us to believe that either the transmucosal bone level placement attempt was inaccurate or excessive reflection of the labial tissue has caused some degree of resorption. This is anot...
A suitable alternative surgical management of this particular case might have been to simply perform an alveoloplasty to produce the desired inter-occlusal clearance and proceed with placement of implant and simultaneous direct sinus lift. That would have left more of the apical portion of the implant within the grafted sinus and possibly modified the location of keratinized band of tissue. The lo...
A 35-year-old female with a 10-year history of partial acquired edentulism at site numbers 3 and 4 presented to our clinic for dental implant evaluation. Preoperative clinical examination revealed a reproducible intercuspation, well-delineated band of keratinized tissue, and decreased inter-occlusal clearance to allow for optimal dimension of prosthetic crowns (Fig. 1). Radiographs demonstrated e...
Obtaining proper occlusal clearance to allow for a single unit crown restoration is a fundamental prerequisite for dental implant restoration. Long-standing edentulous sites are often fraught with disuse atrophy and unopposed supra-eruption of the opposing dentition. In the posterior maxillae/mandible, there are vital structures that have to be mobilized in order to allow space for either bone tra...
Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obl...
Fig. 5. OPG postoperatively
Fig. 5. OPG postoperatively
Fig. 4. Wound healing after 2 months
Fig. 4. Wound healing after 2 months
Fig. 3. Mobilised segment moved to the desired three-dimensional position and fixed with plate and screws
Fig. 3. Mobilised segment moved to the desired three-dimensional position and fixed with plate and screws
Fig. 2. Mandibular osteotomy by piezosurgery
Fig. 2. Mandibular osteotomy by piezosurgery
Fig. 1. Tunnel technique
Fig. 1. Tunnel technique
Santagata, M., Sgaramella, N., Ferrieri, I. et al. Segmental sandwich osteotomy and tunnel technique for three-dimensional reconstruction of the jaw atrophy: a case report. Int J Implant Dent 3, 14 (2017). https://doi.org/10.1186/s40729-017-0077-3
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Received: 23 December 2016
Accepted: 22 April 2017
Published: 01 May 2017
DOI: https://doi.org/10.1186/s40729-017-0077-3
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...
Multidisciplinary Department of Medical and Dental Specialties, Oral and Maxillofacial Surgery Unit, AOU - University of Campania “Luigi Vanvitelli”, Naples, Italy
Mario Santagata, Nicola Sgaramella, Ivo Ferrieri, Giovanni Corvo, Gianpaolo Tartaro & Salvatore D’Amato
Piazza Fuori Sant′Anna 17, 81031, Aversa, Italy
Mario Santagata
You can also search for this author in PubMed Goo...
None.
None.
All authors were involved with the literature review and performance of the surgery. All authors read and approved the final manuscript.
Mario Santagata, Nicola Sgaramella, Ivo Ferrieri, Giovanni Corvo, Gianpaolo Tartaro and Salvatore D’Amato declare that they have no competing interests.
Written informed consent was obtained from the patient for the publication of this report an...
Moura LB, Carvalho PH, Xavier CB, Post LK, Torriani MA, Santagata M, Chagas Júnior OL. Autogenous non-vascularized bone graft in segmental mandibular reconstruction: a systematic review. Int J Oral Maxillofac Surg. 2016;45:1388–94.
D'Amato S, Tartaro G, Itro A, Nastri L, Santagata M. Block versus particulate/titanium mesh for ridge augmentation for mandibular lateral incisor defects: clinical ...
In conclusion, segmental mandibular sandwich osteotomy is an easy and safety technique that could be performed in atrophic posterior mandible.
Future studies involving long-term follow-up are needed to evaluate the permanence of these results.
The sandwich technique for bone augmentation of the atrophic mandible was first described by Schettler and Holtermann, with promising results. Since then, variations in this surgical procedure have been proposed by several investigators [4,5,6,7,8,9,10].
All these authors have proposed the same approach about the flap: paracrestal incision. In order to preserve the blood supply, it is of fundamen...
A 59-year-old woman with a severely atrophied right mandible was treated with the sandwich osteotomy technique filled with autologous bone graft harvested by a cortical bone collector from the ramus.
The requirements of the Helsinki Declaration were observed, and the patient gave informed consent for all surgical procedures. After local infiltration of anaesthesia (mepivacaina plus adrenaline 1:2...
In cases of atrophic mandible, the distance to the mandibular canal and the transverse decrease in bone is an anatomic limitation for prosthetic rehabilitation with dental implants. The gold standard for treatment of this mandibular atrophy continues to be autologous bone grafting [1, 2].
A relatively modern technique for vertical bone augmentation is sandwich osteotomy. Schettler and Holtermann ...
Segmental mandibular sandwich osteotomy is an easy and safety technique that could be performed in an atrophic posterior mandible. Future studies involving long-term follow-up are needed to evaluate the permanence of these results.
A three-dimensionally favourable mandibular bone crest is desirable to be able to successfully implant placement to meet the aesthetic and functional criteria in the implant-prosthetic rehabilitation. Several surgical procedures have been advocated for bone augmentation of the atrophic mandible, and the sandwich osteotomy is one of these techniques. The aim of the present case report was to assess...
Fig. 7 Second stage surgery of patient in Fig. 1. a Vestibular depth reduction after augmentation and implant placement. b Partial thickness and apical repositioned flap. c CMX healing and soft tissue dehiscence with CCXBB exposure. d Dehiscence healing after re-contouring and buccal emergency profile. e Buccal aspect of the final restoration. f Buccal ridge contour
Fig. 6 Immunohistochemical analysis of slices from the same sample with four different markers. a TRAP. b OPN. c ALP. d OSC
ple. a Ground section stained with Levai-Laczkó. b Tissue identification of the ROI. c Closer view a bone and CCXBB. d Closer view of b
Fig. 5. Histomorphometric analysis of the same sample. a Ground section stained with Levai-Laczkó. b Tissue identification of the ROI. c Closer view a arrow pointing a cement line between new mineralized bone and CCXBB. d Closer view of b
Fig. 4. Histological samples. a CCXBB control without implantation. b Histologic samples with acute inflammatory infiltration. c Histologic sample with limited remaining CCXBB and large bone ingrowth
Fig. 4. Histological samples. a CCXBB control without implantation. b Histologic samples with acute inflammatory infiltration. c Histologic sample with limited remaining CCXBB and large bone ingr...
Fig. 3. Re-entry procedure of patient in Fig. 1. a Buccal aspect of the augmented region. b Horizontal bone augmentation. c Screws and pins removal and bone trephine sampling. d Implants placement and buccal bone width from the implant shoulder. e Primary flap closure. f Implants submerged healing
Fig. 3. Re-entry procedure of patient in Fig. 1. a Buccal aspect of the augmented region. b Ho...
Fig. 2. Lateral bone augmentation of the alveolar crest (a) atrophic ridge. b Perforations and adaptation of the cortical layer. c Shaping, pre-wetting and fixation of CCXBB with titanium screws. d Horizontal contour and peripheral gap between CCXBB and bone layer. e Outlying DBBM filling. f CM stabilized with pins
Fig. 2. Lateral bone augmentation of the alveolar crest (a) atrophic ridge. b ...
Fig. 1. Study chart and follow-up visits
Fig. 1. Study chart and follow-up visits
Differentiated tissues
Implant lost (Yes/no)
Mean
SD
Percentage
SD (%)
...
Patient
TRAP (%)
OPN (%)
ALP (%)
OSC (%)
1
...
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Mean
Standard deviation
Median
CI 95%
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...
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Connect...
Ortiz-Vigón, A., Martinez-Villa, S., Suarez, I. et al. Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement.
Int J Implant Dent 3, 24 (2017). https://doi.org/10.1186/s40729-017-0087-1
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Received: 21 March 2017
Accepted: 12 June 2017
Published: 21 Ju...
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...
ETEP Research Group, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal, 28040, Madrid, Spain
Alberto Ortiz-Vigón, Sergio Martinez-Villa, Iñaki Suarez, Fabio Vignoletti & Mariano Sanz
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We wish to acknowledge the dedication and scientific advise of Prof. Dr. Tord Berglundh on the histological analysis as well as the diligent work in processing the histological samples to Estela Maldonado for the immunohistochemistry and Asal Shikhan and Fernando Muñoz for the histomorphometry. The work of Esperanza Gross on the statistical analysis is highly acknowledged.
This study was partial...
Patti A, Gennari L, Merlotti D, Dotta F, Nuti R. Endocrine actions of osteocalcin. Int J Endocrinol. 2013;2013:846480.
Schwarz F, Herten M, Sager M, Wieland M, Dard M, Becker J. Histological and immunohistochemical analysis of initial and early osseous integration at chemically modified and conventional SLA titanium implants: preliminary results of a pilot study in dogs. Clin Oral Implants Res. 2...
Araujo MG, Linder E, Lindhe J. Bio-Oss collagen in the buccal gap at immediate implants: a 6-month study in the dog. Clin Oral Implants Res. 2011;22:1–8.
Chiapasco M, Colletti G, Coggiola A, Di Martino G, Anello T, Romeo E. Clinical outcome of the use of fresh frozen allogeneic bone grafts for the reconstruction of severely resorbed alveolar ridges: preliminary results of a prospective study. I...
Jeno L, Geza L. A simple differential staining method for semi-thin sections of ossifying cartilage and bone tissues embedded in epoxy resin. Mikroskopie. 1975;31:1–4.
Dias RR, Sehn FP, de Santana Santos T, Silva ER, Chaushu G, Xavier SP. Corticocancellous fresh-frozen allograft bone blocks for augmenting atrophied posterior mandibles in humans. Clin Oral Implants Res. 2016;27:39–46.
Nissan ...
Cremonini CC, Dumas M, Pannuti C, Lima LA, Cavalcanti MG. Assessment of the availability of bone volume for grafting in the donor retromolar region using computed tomography: a pilot study. Int J Oral Maxillofac Implants. 2010;25:374–8.
Nkenke E, Weisbach V, Winckler E, Kessler P, Schultze-Mosgau S, Wiltfang J, et al. Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic...
Sanz M, Vignoletti F. Key aspects on the use of bone substitutes for bone regeneration of edentulous ridges. Dent Mater. 2015;31:640–7.
Benic GI, Hammerle CH. Horizontal bone augmentation by means of guided bone regeneration. Periodontology. 2014;66:13–40.
Beretta M, Cicciu M, Poli PP, Rancitelli D, Bassi G, Grossi GB, et al. A Retrospective Evaluation of 192 Implants Placed in Augmented Bon...
Alkaline phosphatase
Cone beam computed tomography
Collagen containing xenogeneic bone block
Native collagen membrane
Deproteinized bovine bone mineral
Etiology and Therapy of Periodontal Diseases
Osteopontin
Osteocalcine
Tartrate-resistant acid phosphatase
Within the limitations of this clinical study, we may conclude that the use of CCXBB in combination with DBBM particles and a native bilayer collagen membrane for staged lateral bone augmentation in severe atrophic alveolar crests achieved significant horizontal crestal width allowing for staged implant placement in most of the patients. Histological analysis and implant survival records indicate ...
The immune-histochemical results reported expression of osteopontin mainly at the border between mineralized vital bone (MVB) with CCXBB, what coincides with findings from previous reports [38,39,40]. Alkaline phosphatase (ALP) is considered as an early osteoblast differentiation marker [41]. ALP-positive cells were detectable, in all specimens on the periphery of MVB, associated to areas of new b...
When correlating the clinical results and the histological outcomes, there was a positive association between the presence of soft tissue dehiscence with CCXBB exposure and a diminished amount of new mineralized bone (p = 0.06). This lower amount of new bone within the xenogeneic graft suggests a lack of full graft integration and diminished vascular supply, what may have caused the soft tissu...
The purpose of this investigation was to evaluate histologically and immunohistochemically the behavior of CCXBB blocks when used for staged lateral bone augmentation in severe human horizontal residual bone defects. Six months after the regenerative intervention using the CCXBB blocks, the mean increase in bone width was 4.12 mm and hence, this outcome allowed for the placement of dental implant...
The results from the histomorphometric measurements are depicted in Table 2. Bone biopsies were composed by 21.37% (SD 7.36) of residual CCXBB, 26.90% (SD 12.21) of mineralized vital bone (MVB), 47.13% (SD 19.15) of non-mineralized tissue and 0.92% of DBBM (Fig. 5b). Biopsies from patients who lost their implants had a statistical significant lower amount of MVB (p = 0.01u) and a statistical...
Twenty-eight CCXBB blocks were placed in 15 patients that fulfilled the selection criteria (12 women and 3 men) with a mean age of 54.5 (SD 8.34).
The detailed clinical and radiographical outcomes have been reported previously [21]. In brief, one patient experienced pain and soft tissue dehiscence leading to removal of the graft material 3 days after the regenerative procedure. Another patient r...
For the immunohistochemical analysis, the semi-thin sections were incubated over night with primary antibodies at 4 °C (Santa Cruz Biotechnology Inc., Santa Cruz, Calif., USA). The antibody dilutions used were alkaline phosphatase (ALP) 1:100, osteopontin (OPN) 1:100, osteocalcin (OSC) 1:100, and tatrate resistant acid phosphatase (TRAP) 1:100.
The obtained semi-thin sections were evaluated wit...
Twenty-six weeks after the regenerative procedure the patient returned for the re-entry intervention for placement of dental implants. After raising full-thickness flaps, the augmented area was exposed and horizontal crestal width measurements were performed. Then, the surgeon evaluated the bone availability and if implant placement was considered possible, a core bone biopsy was harvested with th...
CCXBB (Bio-Graft® Geistlich Pharma) is a bone substitute material in a natural block form. The dimensions of the Bio-Graft block are 10 mm in height, 10 mm in length and 5 mm in width. It consists of a natural cancellous bone structure of hydroxyapatite and endogenous collagen type I and III, equine origin and is a class III medical device according to the Medical Device Directive 93/42 EECs...
The present manuscript reports the histological outcomes of a prospective single arm study evaluating the safety and clinical performance of CCXBB blocks when used as replacement bone grafts for lateral bone augmentation prior to staged implant placement. The results of the clinical and radiographic outcomes have been reported in a previous publication [21]. For correlation of the histological wit...
Different techniques and grafting materials have been used for the horizontal reconstruction of deficient alveolar processes before implant placement, resulting in different degrees of predictability and clinical outcomes [1]. Among the grafting materials, particulated xenogeneic materials have been extensively studied in both experimental and clinical studies and when combined with porcine-derive...
The osteoconductive properties of collagen containing xenogeneic bone blocks (CCXBB) remain unclear. The aim of this prospective single-arm clinical study was to assess the histological outcomes of CCXBB blocks used as bone replacement grafts for lateral bone augmentation procedures.
In 15 patients with severe horizontal alveolar ridge resorption, lateral augmentation procedures were performed us...
Fig. 1. Clinical photographs of the both treatment groups after the initial surgery, 1 week post-op and at the re-entry. a) In the test group, no primary wound closure was achieved (left) and the barrier was left exposed for secondary intention healing. After 1 week, the matrix remained exposed (middle) showing no signs of infection. For months later, the exposed area was covered by a keratini...
Groups
Grafted ridge width
Ridge width at the re-entry
Grafted ridge reduction (mm)
Exposed (test)
...
Groups
Initial ridge width (mm)
Ridge width at re-entry (mm)
Ridge width gain (mm)
Exposed (tests)
...
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Subject no.
Sex
Site
Age
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...
Eskan, M.A., Girouard, ME., Morton, D. et al. The effect of membrane exposure on lateral ridge augmentation: a case-controlled study.
Int J Implant Dent 3, 26 (2017). https://doi.org/10.1186/s40729-017-0089-z
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Received: 01 March 2017
Accepted: 16 June 2017
Published: 22 June 2017
DOI: https://doi.org/10.1186/s40729-017-0089-z
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...
Sisli, Istanbul, Turkey
Mehmet A. Eskan
Sherbrooke, Québec, Canada
Marie-Eve Girouard
Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN, 46202, USA
Dean Morton
Department of Oral Health and Rehabilitation, Division of Periodontics, University of Louisville School of Dentistry, Louisville, KY, 40292, USA
Henry Greenwell
Clinic Eska, Terrace Fulya, Tesvi...
We like to thank to Dr. Lorenz Uebersax for his help during the preparation of this article.
MAE and MEG have made substantial contributions in completing all the surgical parts and collecting all the parameters from the subjects. HG was involved in analyzing, interpreting, and supervising the study. DM revised it critically and helped in finalizing the manuscript and giving important intellectua...
Falk H, Laurell L, Ravald N, Teiwik A, Persson R. Guided tissue regeneration therapy of 203 consecutively treated intrabony defects using a bioabsorbable matrix barrier. Clinical and radiographic findings. J Periodontol. 1997;68:571–81.
Eickholz P, Kim TS, Steinbrenner H, Dorfer C, Holle R. Guided tissue regeneration with bioabsorbable barriers: intrabony defects and class II furcations. J Peri...
Rachana C, Sridhar N, Rangan AV, Rajani V. Horizontal ridge augmentation using a combination approach. J Indian Soc Periodontol. 2012;16:446–50.
Kleinheinz J, Buchter A, Kruse-Losler B, Weingart D, Joos U. Incision design in implant dentistry based on vascularization of the mucosa. Clin Oral Implants Res. 2005;16:518–23.
Beitlitum I, Artzi Z, Nemcovsky CE. Clinical evaluation of particulate ...
Agarwal G, Thomas R, Mehta D. Postextraction maintenance of the alveolar ridge: rationale and review. Compend Contin Educ Dent. 2012;33:320–324, 326. quiz 327, 336.
Horvath A, Mardas N, Mezzomo LA, Needleman IG, Donos N. Alveolar ridge preservation. A systematic review. Clin Oral Investig. 2013;17:341–63.
Buser D, Dula K, Belser U, Hirt HP, Berthold H. Localized ridge augmentation using guid...
Within the limits of this case-controlled study, it can be concluded that lateral ridge augmentation procedures in atrophic alveolar ridges using bioresorbable matrix barriers without achieving primary flap closure or in the case of early exposures can still lead to clinically satisfying ridge width gain that allows for the placement of dental implants. However, exposures seem to limit the ridge w...
The microbial contamination of the matrix barrier during exposure could be another important factor that might hamper bone formation within the underlying graft. This factor has not been investigated in the present study. However, it has been reported by other groups that the resorbable matrix barrier per se might be less prone to bacterial contamination and can be better cleaned using disinfectan...
Although numerous studies in the literature show successful outcomes of the GBR procedure [6, 31], the most common clinical complication in GBR procedures is early membrane exposure [9]. There is a general clinical impression that the ridge augmentation results are compromised in the case of early membrane exposures [32, 33]. In this case-controlled study, which was based on a patient subset from ...
To assess if the baseline situations of the patients in the two treatment groups were comparable and well balanced, the distribution of gender, age, and the initial ridge measurements were compared. There were three women and four men in each group. The median age for the test and control group was 50 and 62 years old, respectively (Table 1). The initial alveolar mean ridge widths before lateral...
Means ± SD was calculated for all parameters. The statistical significance difference of means between the groups was tested using an exact two-sample Fisher-Pitman permutation test; since the sample size seemed too small to test for normality, p
Fourteen subjects were retrospectively recruited for this case-controlled study. In test group (seven patients), primary closure was not achieved and membrane was left exposed at the initial surgery or it became exposed during the first week of healing. In the control group (seven patients), primary wound closure was achieved and no exposure of the membrane occurred until the placement of a dental...
Various resorbable membranes exist in the market composing of dura mater, poly-lactic acid, polyglycolic acid, polyurethane, or mostly collagen. Still, even resorbable membranes show frequent events of membrane exposures after GBR procedures. For example, between 22 and 32% of early membrane exposure have been reported for collagen membrane by several authors [15,16,17,18]. A major drawback of col...
It has been reported that unpreserved alveolar ridges can show substantial horizontal and/or vertical ridge deficiency [1, 2] that lack the sufficient alveolar ridge dimensions to allow the ideal positioning of the implant and enhance long-term prognosis of the clinical outcomes [3]. Guided bone regeneration (GBR) is a predictable technique for augmenting the alveolar ridge width that has been use...
The effect of membrane exposure on guided bone regeneration (GBR) for lateral ridge augmentation has been poorly addressed. This case-controlled study aimed to investigate potential effect of membrane exposure lateral ridge augmentation and subsequent implant placement.
A total of 14 patients that did receive lateral ridge augmentation procedure using allogeneic cancellous graft particulate in co...
Tsegga, T., Wright, T. Maxillary segmental osteoperiosteal flap with simultaneous placement of dental implants: case report of a novel technique.
Int J Implant Dent 3, 2 (2017). https://doi.org/10.1186/s40729-017-0067-5
Download citation
Received: 06 December 2016
Accepted: 13 January 2017
Published: 19 January 2017
DOI: https://doi.org/10.1186/s40729-017-0067-5
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 & Maxillofacial Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Ft. Sam Houston, 78234, TX, USA
Tibebu Tsegga & Thomas Wright
Department of Oral & Maxilofacial Surgery, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX, 78236, USA
Tibebu Tsegga & Thomas Wright
You can also search for this author in
...
Irinakis T. Efficacy of injectable demineralized bone matrix as graft material during sinus elevation surgery with simultaneous implant placement in the posterior maxilla: clinical evaluation of 49 sinuses. J Oral and Maxillofac Surg. 2011;69:134–41.
Chiapasoo M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24:237–69.
Jenson...
This case highlights the evolving variations in dentoalveolar augmentation with an emphasis on concomitant implant placement. In the most traditional sense, a vertical osteoperiosteal flap technique would be bound with a stable basal bone that can be used to anchor simultaneous dental implant placement. Further refinement should consider minimizing crestal reflection and overall labial bone resorp...
A critical appraisal of the gingival architecture in the final end point of this case demonstrates some radiolucency through the soft tissue outlining the platform of the Nobel Biocare TiUnite implant. This would lead us to believe that either the transmucosal bone level placement attempt was inaccurate or excessive reflection of the labial tissue has caused some degree of resorption. This is anot...
A suitable alternative surgical management of this particular case might have been to simply perform an alveoloplasty to produce the desired inter-occlusal clearance and proceed with placement of implant and simultaneous direct sinus lift. That would have left more of the apical portion of the implant within the grafted sinus and possibly modified the location of keratinized band of tissue. The lo...
A 35-year-old female with a 10-year history of partial acquired edentulism at site numbers 3 and 4 presented to our clinic for dental implant evaluation. Preoperative clinical examination revealed a reproducible intercuspation, well-delineated band of keratinized tissue, and decreased inter-occlusal clearance to allow for optimal dimension of prosthetic crowns (Fig. 1). Radiographs demonstrated e...
Obtaining proper occlusal clearance to allow for a single unit crown restoration is a fundamental prerequisite for dental implant restoration. Long-standing edentulous sites are often fraught with disuse atrophy and unopposed supra-eruption of the opposing dentition. In the posterior maxillae/mandible, there are vital structures that have to be mobilized in order to allow space for either bone tra...
Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obl...
Santagata, M., Sgaramella, N., Ferrieri, I. et al. Segmental sandwich osteotomy and tunnel technique for three-dimensional reconstruction of the jaw atrophy: a case report.
Int J Implant Dent 3, 14 (2017). https://doi.org/10.1186/s40729-017-0077-3
Download citation
Received: 23 December 2016
Accepted: 22 April 2017
Published: 01 May 2017
DOI: https://doi.org/10.1186/s4072...
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...
Multidisciplinary Department of Medical and Dental Specialties, Oral and Maxillofacial Surgery Unit, AOU - University of Campania “Luigi Vanvitelli”, Naples, Italy
Mario Santagata, Nicola Sgaramella, Ivo Ferrieri, Giovanni Corvo, Gianpaolo Tartaro & Salvatore D’Amato
Piazza Fuori Sant′Anna 17, 81031, Aversa, Italy
Mario Santagata
You can also search for this author in
...
None.
None.
All authors were involved with the literature review and performance of the surgery. All authors read and approved the final manuscript.
Mario Santagata, Nicola Sgaramella, Ivo Ferrieri, Giovanni Corvo, Gianpaolo Tartaro and Salvatore D’Amato declare that they have no competing interests.
Written informed consent was obtained from the patient for the publication of this report an...
Moura LB, Carvalho PH, Xavier CB, Post LK, Torriani MA, Santagata M, Chagas Júnior OL. Autogenous non-vascularized bone graft in segmental mandibular reconstruction: a systematic review. Int J Oral Maxillofac Surg. 2016;45:1388–94.
D'Amato S, Tartaro G, Itro A, Nastri L, Santagata M. Block versus particulate/titanium mesh for ridge augmentation for mandibular lateral incisor defects: clinical ...
In conclusion, segmental mandibular sandwich osteotomy is an easy and safety technique that could be performed in atrophic posterior mandible.
Future studies involving long-term follow-up are needed to evaluate the permanence of these results.
The sandwich technique for bone augmentation of the atrophic mandible was first described by Schettler and Holtermann, with promising results. Since then, variations in this surgical procedure have been proposed by several investigators [4,5,6,7,8,9,10].
All these authors have proposed the same approach about the flap: paracrestal incision. In order to preserve the blood supply, it is of fundamen...
A 59-year-old woman with a severely atrophied right mandible was treated with the sandwich osteotomy technique filled with autologous bone graft harvested by a cortical bone collector from the ramus.
The requirements of the Helsinki Declaration were observed, and the patient gave informed consent for all surgical procedures. After local infiltration of anaesthesia (mepivacaina plus adrenaline 1:2...
In cases of atrophic mandible, the distance to the mandibular canal and the transverse decrease in bone is an anatomic limitation for prosthetic rehabilitation with dental implants. The gold standard for treatment of this mandibular atrophy continues to be autologous bone grafting [1, 2].
A relatively modern technique for vertical bone augmentation is sandwich osteotomy. Schettler and Holtermann ...
Segmental mandibular sandwich osteotomy is an easy and safety technique that could be performed in an atrophic posterior mandible. Future studies involving long-term follow-up are needed to evaluate the permanence of these results.
A three-dimensionally favourable mandibular bone crest is desirable to be able to successfully implant placement to meet the aesthetic and functional criteria in the implant-prosthetic rehabilitation. Several surgical procedures have been advocated for bone augmentation of the atrophic mandible, and the sandwich osteotomy is one of these techniques. The aim of the present case report was to assess...
Fig. 8. Soft tissue dehiscence (a) CCXBB exposure 15 weeks after bone augmentation, the dehiscence healed 2 weeks later after reducing the graft exposure (b) after soft tissue augmentation and abutment connection leading to the loss of the mesial implant. After partial removal of the bone graft and place a connective tissue graft the area healed properly and a month later it was possible to re...
Fig. 7. Second stage surgery of patient in Fig. 1. a Vestibular depth reduction after augmentation and implant placement. b Partial thickness and apical repositioned flap. c CMX healing and soft tissue dehiscence with CCXBB exposure. d Dehiscence healing after re-contouring and buccal emergency profile. e Buccal aspect of the final restoration. f Buccal ridge contour
Fig. 7. Second stage sur...
Fig. 6. Immunohistochemical analysis of slices from the same sample with four different markers. a TRAP. b OPN. c ALP. d OSC
Fig. 6. Immunohistochemical analysis of slices from the same sample with four different markers. a TRAP. b OPN. c ALP. d OSC
section stained with Levai-Laczkó. b Tissue identification of the ROI. c Closer view aized bone and CCXBB. d Closer view of b
Fig. 5. Histomorphometric analysis of the same sample. a Ground section stained with Levai-Laczkó. b Tissue identification of the ROI. c Closer view a arrow pointing a cement line between new mineralized bone and CCXBB. d Closer view of b
Fig. 4. Histological samples. a CCXBB control without implantation. b Histologic samples with acute inflammatory infiltration. c Histologic sample with limited remaining CCXBB and large bone ingrowth
Fig. 4. Histological samples. a CCXBB control without implantation. b Histologic samples with acute inflammatory infiltration. c Histologic sample with limited remaining CCXBB and large bone ingr...
Fig. 3. Re-entry procedure of patient in Fig. 1. a Buccal aspect of the augmented region. b Horizontal bone augmentation. c Screws and pins removal and bone trephine sampling. d Implants placement and buccal bone width from the implant shoulder. e Primary flap closure. f Implants submerged healing
Fig. 3. Re-entry procedure of patient in Fig. 1. a Buccal aspect of the augmented region. b Ho...
Fig. 2. Lateral bone augmentation of the alveolar crest (a) atrophic ridge. b Perforations and adaptation of the cortical layer. c Shaping, pre-wetting and fixation of CCXBB with titanium screws. d Horizontal contour and peripheral gap between CCXBB and bone layer. e Outlying DBBM filling. f CM stabilized with pins
Fig. 2. Lateral bone augmentation of the alveolar crest (a) atrophic ridge. b ...
Fig. 1. Study chart and follow-up visits
Fig. 1. Study chart and follow-up visits
Differentiated tissues
Implant lost (Yes/no)
Mean
SD
Percentage
SD (%)
...
Patient
TRAP (%)
OPN (%)
ALP (%)
OSC (%)
1
...
Tissue type
Mean
Standard deviation
Median
CI 95%
Mineralized bone
...
Patient
Soft tissue dehiscence
Mineralized bone (%)
CCXBB (%)
Bone marrow (%)
Connect...
Ortiz-Vigón, A., Martinez-Villa, S., Suarez, I. et al. Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement.
Int J Implant Dent 3, 24 (2017). https://doi.org/10.1186/s40729-017-0087-1
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Received: 21 March 2017
Accepted: 12 June 2017
Published: 21 Ju...
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...
ETEP Research Group, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal, 28040, Madrid, Spain
Alberto Ortiz-Vigón, Sergio Martinez-Villa, Iñaki Suarez, Fabio Vignoletti & Mariano Sanz
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We wish to acknowledge the dedication and scientific advise of Prof. Dr. Tord Berglundh on the histological analysis as well as the diligent work in processing the histological samples to Estela Maldonado for the immunohistochemistry and Asal Shikhan and Fernando Muñoz for the histomorphometry. The work of Esperanza Gross on the statistical analysis is highly acknowledged.
This study was partial...
Patti A, Gennari L, Merlotti D, Dotta F, Nuti R. Endocrine actions of osteocalcin. Int J Endocrinol. 2013;2013:846480.
Schwarz F, Herten M, Sager M, Wieland M, Dard M, Becker J. Histological and immunohistochemical analysis of initial and early osseous integration at chemically modified and conventional SLA titanium implants: preliminary results of a pilot study in dogs. Clin Oral Implants Res. 2...
Araujo MG, Linder E, Lindhe J. Bio-Oss collagen in the buccal gap at immediate implants: a 6-month study in the dog. Clin Oral Implants Res. 2011;22:1–8.
Chiapasco M, Colletti G, Coggiola A, Di Martino G, Anello T, Romeo E. Clinical outcome of the use of fresh frozen allogeneic bone grafts for the reconstruction of severely resorbed alveolar ridges: preliminary results of a prospective study. I...
Jeno L, Geza L. A simple differential staining method for semi-thin sections of ossifying cartilage and bone tissues embedded in epoxy resin. Mikroskopie. 1975;31:1–4.
Dias RR, Sehn FP, de Santana Santos T, Silva ER, Chaushu G, Xavier SP. Corticocancellous fresh-frozen allograft bone blocks for augmenting atrophied posterior mandibles in humans. Clin Oral Implants Res. 2016;27:39–46.
Nissan ...
Cremonini CC, Dumas M, Pannuti C, Lima LA, Cavalcanti MG. Assessment of the availability of bone volume for grafting in the donor retromolar region using computed tomography: a pilot study. Int J Oral Maxillofac Implants. 2010;25:374–8.
Nkenke E, Weisbach V, Winckler E, Kessler P, Schultze-Mosgau S, Wiltfang J, et al. Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic...
Sanz M, Vignoletti F. Key aspects on the use of bone substitutes for bone regeneration of edentulous ridges. Dent Mater. 2015;31:640–7.
Benic GI, Hammerle CH. Horizontal bone augmentation by means of guided bone regeneration. Periodontology. 2014;66:13–40.
Beretta M, Cicciu M, Poli PP, Rancitelli D, Bassi G, Grossi GB, et al. A Retrospective Evaluation of 192 Implants Placed in Augmented Bon...
Alkaline phosphatase
Cone beam computed tomography
Collagen containing xenogeneic bone block
Native collagen membrane
Deproteinized bovine bone mineral
Etiology and Therapy of Periodontal Diseases
Osteopontin
Osteocalcine
Tartrate-resistant acid phosphatase
Within the limitations of this clinical study, we may conclude that the use of CCXBB in combination with DBBM particles and a native bilayer collagen membrane for staged lateral bone augmentation in severe atrophic alveolar crests achieved significant horizontal crestal width allowing for staged implant placement in most of the patients. Histological analysis and implant survival records indicate ...
The immune-histochemical results reported expression of osteopontin mainly at the border between mineralized vital bone (MVB) with CCXBB, what coincides with findings from previous reports [38,39,40]. Alkaline phosphatase (ALP) is considered as an early osteoblast differentiation marker [41]. ALP-positive cells were detectable, in all specimens on the periphery of MVB, associated to areas of new b...
When correlating the clinical results and the histological outcomes, there was a positive association between the presence of soft tissue dehiscence with CCXBB exposure and a diminished amount of new mineralized bone (p = 0.06). This lower amount of new bone within the xenogeneic graft suggests a lack of full graft integration and diminished vascular supply, what may have caused the soft tissu...
The purpose of this investigation was to evaluate histologically and immunohistochemically the behavior of CCXBB blocks when used for staged lateral bone augmentation in severe human horizontal residual bone defects. Six months after the regenerative intervention using the CCXBB blocks, the mean increase in bone width was 4.12 mm and hence, this outcome allowed for the placement of dental implant...
The results from the histomorphometric measurements are depicted in Table 2. Bone biopsies were composed by 21.37% (SD 7.36) of residual CCXBB, 26.90% (SD 12.21) of mineralized vital bone (MVB), 47.13% (SD 19.15) of non-mineralized tissue and 0.92% of DBBM (Fig. 5b). Biopsies from patients who lost their implants had a statistical significant lower amount of MVB (p = 0.01u) and a statistical...
Twenty-eight CCXBB blocks were placed in 15 patients that fulfilled the selection criteria (12 women and 3 men) with a mean age of 54.5 (SD 8.34).
The detailed clinical and radiographical outcomes have been reported previously [21]. In brief, one patient experienced pain and soft tissue dehiscence leading to removal of the graft material 3 days after the regenerative procedure. Another patient r...
For the immunohistochemical analysis, the semi-thin sections were incubated over night with primary antibodies at 4 °C (Santa Cruz Biotechnology Inc., Santa Cruz, Calif., USA). The antibody dilutions used were alkaline phosphatase (ALP) 1:100, osteopontin (OPN) 1:100, osteocalcin (OSC) 1:100, and tatrate resistant acid phosphatase (TRAP) 1:100.
The obtained semi-thin sections were evaluated wit...
Twenty-six weeks after the regenerative procedure the patient returned for the re-entry intervention for placement of dental implants. After raising full-thickness flaps, the augmented area was exposed and horizontal crestal width measurements were performed. Then, the surgeon evaluated the bone availability and if implant placement was considered possible, a core bone biopsy was harvested with th...
CCXBB (Bio-Graft® Geistlich Pharma) is a bone substitute material in a natural block form. The dimensions of the Bio-Graft block are 10 mm in height, 10 mm in length and 5 mm in width. It consists of a natural cancellous bone structure of hydroxyapatite and endogenous collagen type I and III, equine origin and is a class III medical device according to the Medical Device Directive 93/42 EECs...
The present manuscript reports the histological outcomes of a prospective single arm study evaluating the safety and clinical performance of CCXBB blocks when used as replacement bone grafts for lateral bone augmentation prior to staged implant placement. The results of the clinical and radiographic outcomes have been reported in a previous publication [21]. For correlation of the histological wit...
Different techniques and grafting materials have been used for the horizontal reconstruction of deficient alveolar processes before implant placement, resulting in different degrees of predictability and clinical outcomes [1]. Among the grafting materials, particulated xenogeneic materials have been extensively studied in both experimental and clinical studies and when combined with porcine-derive...
The osteoconductive properties of collagen containing xenogeneic bone blocks (CCXBB) remain unclear. The aim of this prospective single-arm clinical study was to assess the histological outcomes of CCXBB blocks used as bone replacement grafts for lateral bone augmentation procedures.
In 15 patients with severe horizontal alveolar ridge resorption, lateral augmentation procedures were performed us...
Fig. 1. Clinical photographs of the both treatment groups after the initial surgery, 1 week post-op and at the re-entry. a) In the test group, no primary wound closure was achieved (left) and the barrier was left exposed for secondary intention healing. After 1 week, the matrix remained exposed (middle) showing no signs of infection. For months later, the exposed area was covered by a keratini...
Groups
Grafted ridge width
Ridge width at the re-entry
Grafted ridge reduction (mm)
Exposed (test)
...
Groups
Initial ridge width (mm)
Ridge width at re-entry (mm)
Ridge width gain (mm)
Exposed (tests)
...
Groups
Subject no.
Sex
Site
Age
Exposed (test) group
...
Eskan, M.A., Girouard, ME., Morton, D. et al. The effect of membrane exposure on lateral ridge augmentation: a case-controlled study.
Int J Implant Dent 3, 26 (2017). https://doi.org/10.1186/s40729-017-0089-z
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Received: 01 March 2017
Accepted: 16 June 2017
Published: 22 June 2017
DOI: https://doi.org/10.1186/s40729-017-0089-z
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...
Sisli, Istanbul, Turkey
Mehmet A. Eskan
Sherbrooke, Québec, Canada
Marie-Eve Girouard
Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN, 46202, USA
Dean Morton
Department of Oral Health and Rehabilitation, Division of Periodontics, University of Louisville School of Dentistry, Louisville, KY, 40292, USA
Henry Greenwell
Clinic Eska, Terrace Fulya, Tesvi...
We like to thank to Dr. Lorenz Uebersax for his help during the preparation of this article.
MAE and MEG have made substantial contributions in completing all the surgical parts and collecting all the parameters from the subjects. HG was involved in analyzing, interpreting, and supervising the study. DM revised it critically and helped in finalizing the manuscript and giving important intellectua...
Falk H, Laurell L, Ravald N, Teiwik A, Persson R. Guided tissue regeneration therapy of 203 consecutively treated intrabony defects using a bioabsorbable matrix barrier. Clinical and radiographic findings. J Periodontol. 1997;68:571–81.
Eickholz P, Kim TS, Steinbrenner H, Dorfer C, Holle R. Guided tissue regeneration with bioabsorbable barriers: intrabony defects and class II furcations. J Peri...
Rachana C, Sridhar N, Rangan AV, Rajani V. Horizontal ridge augmentation using a combination approach. J Indian Soc Periodontol. 2012;16:446–50.
Kleinheinz J, Buchter A, Kruse-Losler B, Weingart D, Joos U. Incision design in implant dentistry based on vascularization of the mucosa. Clin Oral Implants Res. 2005;16:518–23.
Beitlitum I, Artzi Z, Nemcovsky CE. Clinical evaluation of particulate ...
Agarwal G, Thomas R, Mehta D. Postextraction maintenance of the alveolar ridge: rationale and review. Compend Contin Educ Dent. 2012;33:320–324, 326. quiz 327, 336.
Horvath A, Mardas N, Mezzomo LA, Needleman IG, Donos N. Alveolar ridge preservation. A systematic review. Clin Oral Investig. 2013;17:341–63.
Buser D, Dula K, Belser U, Hirt HP, Berthold H. Localized ridge augmentation using guid...
Within the limits of this case-controlled study, it can be concluded that lateral ridge augmentation procedures in atrophic alveolar ridges using bioresorbable matrix barriers without achieving primary flap closure or in the case of early exposures can still lead to clinically satisfying ridge width gain that allows for the placement of dental implants. However, exposures seem to limit the ridge w...
The microbial contamination of the matrix barrier during exposure could be another important factor that might hamper bone formation within the underlying graft. This factor has not been investigated in the present study. However, it has been reported by other groups that the resorbable matrix barrier per se might be less prone to bacterial contamination and can be better cleaned using disinfectan...
Although numerous studies in the literature show successful outcomes of the GBR procedure [6, 31], the most common clinical complication in GBR procedures is early membrane exposure [9]. There is a general clinical impression that the ridge augmentation results are compromised in the case of early membrane exposures [32, 33]. In this case-controlled study, which was based on a patient subset from ...
To assess if the baseline situations of the patients in the two treatment groups were comparable and well balanced, the distribution of gender, age, and the initial ridge measurements were compared. There were three women and four men in each group. The median age for the test and control group was 50 and 62 years old, respectively (Table 1). The initial alveolar mean ridge widths before lateral...
Means ± SD was calculated for all parameters. The statistical significance difference of means between the groups was tested using an exact two-sample Fisher-Pitman permutation test; since the sample size seemed too small to test for normality, p
Fourteen subjects were retrospectively recruited for this case-controlled study. In test group (seven patients), primary closure was not achieved and membrane was left exposed at the initial surgery or it became exposed during the first week of healing. In the control group (seven patients), primary wound closure was achieved and no exposure of the membrane occurred until the placement of a dental...
Various resorbable membranes exist in the market composing of dura mater, poly-lactic acid, polyglycolic acid, polyurethane, or mostly collagen. Still, even resorbable membranes show frequent events of membrane exposures after GBR procedures. For example, between 22 and 32% of early membrane exposure have been reported for collagen membrane by several authors [15,16,17,18]. A major drawback of col...
It has been reported that unpreserved alveolar ridges can show substantial horizontal and/or vertical ridge deficiency [1, 2] that lack the sufficient alveolar ridge dimensions to allow the ideal positioning of the implant and enhance long-term prognosis of the clinical outcomes [3]. Guided bone regeneration (GBR) is a predictable technique for augmenting the alveolar ridge width that has been use...
The effect of membrane exposure on guided bone regeneration (GBR) for lateral ridge augmentation has been poorly addressed. This case-controlled study aimed to investigate potential effect of membrane exposure lateral ridge augmentation and subsequent implant placement.
A total of 14 patients that did receive lateral ridge augmentation procedure using allogeneic cancellous graft particulate in co...
Fig. 4. Linear regression plots to depict the relationship between BI26 and CWb/SA26 values. a CWb (TR group). b CWb (AB group). c SA26 (TR group). d SA26 (AB group)
Fig. 4. Linear regression plots to depict the relationship between BI26 and CWb/SA26 values. a CWb (TR group). b CWb (AB group). c SA26 (TR group). d SA26 (AB group)
Fig. 3. Representative CBCT outcomes at 26 weeks. a, b TR graft. c, d AB graft
Fig. 3. Representative CBCT outcomes at 26 weeks. a, b TR graft. c, d AB graft
Fig. 2. Radiographic assessments. Images of the coronal planes representing the most central aspect of the respective defect sites were analyzed for the basal graft integration (i.e., contact between the graft and the host bone in %) (BI26) and the cross-sectional grafted area (mm2) (SA26)
Fig. 2. Radiographic assessments. Images of the coronal planes representing the most central aspect of t...
Fig. 1. Lateral ridge augmentation—a surgical procedure in the AB and TR groups. a The retromolar area served as a donor site for the harvesting of monocortical bone blocks in the AB group. b AB blocks were shaped to match the size and configuration of the defect site and fixed using one central osteosynthesis screw. c TR grafts were separated from either partially/fully retain...
CWb
GT
SA26
BI26
a) TR group (n = 15 patients)
Mean
...
Visit 1
Visit 2
Visit 3
Visit 4
Visit 5
Visit 6
...
Parvini, P., Sader, R., Sahin, D. et al. Radiographic outcomes following lateral alveolar ridge augmentation using autogenous tooth roots.
Int J Implant Dent 4, 31 (2018). https://doi.org/10.1186/s40729-018-0142-6
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Received: 11 July 2018
Accepted: 17 August 2018
Published: 28 September 2018
DOI: https://doi.org/10.1186/s40729-018-0142-6
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...
The study protocol was approved by the ethics committee (4837R) of the Heinrich Heine University, Düsseldorf, Germany, and registered via the Internet Portal of the German Clinical Trials Register (DRKS00009586). Each patient was given a detailed description of the study procedures and signed a consent to participate.
Consent for publication was obtained from all participants.
Puria Parvini, Ro...
Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
Puria Parvini & Frank Schwarz
Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
Robert Sader
Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
Didem Sahin, J...
Sanz-Sanchez I, Ortiz-Vigon A, Sanz-Martin I, Figuero E, Sanz M. Effectiveness of lateral bone augmentation on the alveolar crest dimension: a systematic review and meta-analysis. J Dent Res. 2015;94(9 Suppl):128–42.
Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res. 1983;174:28–42.
Burchardt H, Enneking WF. Transplantation of bone. Surg Clin North Am. 1978;58(2):403–27....
In conclusion and within its limitations, the present clinical study revealed that TR grafts may be associated with improved SA26 values following lateral alveolar ridge augmentation.
When further analyzing the present data, it was also noted that both TR and AB grafts were associated with comparable BI26 values, thus corroborating the clinical observation of a firm graft connection to the host bone at 26 weeks, which allowed for a proper placement of adequately dimensioned titanium implants at all sites investigated [9]. The regression analysis also revealed that BI26 values ...
The present analysis aimed at assessing and comparing CBCT outcomes following lateral alveolar ridge augmentation using TR and AB grafts. After a healing period of 26 weeks, it was observed that TR grafts were associated with significantly higher mean SA26 values when compared with the AB group. A similar tendency was also noted for mean BI26 values; however, this difference did not reach statist...
Mean CWb and GT values were comparable in both groups and amounted to 4.53 ± 1.54 mm (median 4.50; 95% CI 3.68, 5.38) and 5.66 ± 1.75 mm (median 5.0; 95% CI 4.69, 6.64) in the TR group and 5.26 ± 1.25 mm (median 5.00; 95% CI 4.57, 5.95) and 4.96 ± 1.75 mm (median 5.0; 95% CI 4.24, 5.68) in the AB group, respectively. Between-group differences did not reach statistical signi...
All measurements were performed by one previously calibrated investigator.
The sample size calculation considered a standard normal distribution (type I error set at .05; type II error set at .20) and a sigma which was estimated based on the standard deviations observed in a recent preclinical animal study [4]. The clinical width of the alveolar ridge was defined as the primary outcome variable, ...
Each patient was given a detailed description of the study procedures and signed a consent to participate. The study protocol was approved by the ethics committee (4837R) of the Heinrich Heine University, Düsseldorf, Germany, and registered via the Internet Portal of the German Clinical Trials Register (DRKS00009586).
The present reporting considered the checklist items as proposed in the STROBE...
This analysis was based on the radiographic (i.e., cone-beam computed tomographic—CBCT) data derived from a prospective controlled clinical monocenter study including a total of 30 patients [9]. Each participant exhibited either a tooth gap or a free-end situation with an inadequate horizontal ridge width and was in need of an implant-supported fixed restoration.
In brief, lateral ridge augment...
Autogenous bone (AB) blocks harvested from intraoral donor sites (i.e., retromandibular, chin) are the most commonly used procedure for lateral alveolar ridge augmentation [1]. However, despite significant horizontal bone gains, cortical bone blocks were noted to undergo an incomplete replacement resorption [2, 3], thus featuring a composition of non-vital residual and newly formed vital bone in t...
To assess and compare the radiographic outcomes following lateral alveolar ridge augmentation using autogenous tooth roots (TR) and autogenous bone (AB) blocks.
In a total of 30 patients, lateral ridge augmentation was conducted in parallel groups using either (1) healthy autogenous tooth roots (e.g., retained wisdom or impacted teeth) (n = 15) or (2) cortical autogenous bone blocks harvested...
Figure 3. Data from the VAS of patient-related outcome measures at the time of mounting of the implant-supported crown and at the final follow-up of the PRF and control group
Figure 2. Box plot of the radiographic peri-implant marginal bone level at different time points in millimeter. Baseline: the time of implant placement; abutment: the time of abutment operation; impression: the time of impression taking; follow-up: the time of the final follow-up
Figure 1. Intraoperative photos illustrating bone harvesting and lateral bone augmentation in the PRF group. Initially, an incision is made at the lateral aspect of the posterior part of the mandibular corpus (a) followed by exposing the mucoperiosteal flap (b), before making the osteotomy line (c). The bone block (d) is then retrieved before adjusted to the contour at the recipient site and...
Table 4 Patient-related outcome measures at baseline and at the final follow-up
Test group
Control group
Difference
p value
Mean (95% CI)
Mean (95% CI)
Mean (95% CI)
Baseline
9.44 (9.09 to 9.78)
9.57 (9.20 to 9.95)
0.13 (− 0.40 to 0.66)
0.61
Follow-up
9.66 (9.30 to 10.02)
9.55 (9.15 to 9.96)
− 0.10 (-0.66 to 0.46)
0.71
Difference
0.22 (...
Table 3 Radiographic marginal bone level and clinical recession on neighbouring tooth surface
Group
Baseline (mean, 95% CI)
Follow-up (mean, 95% CI)
Difference (mean, 95% CI)
p value
Radiographic marginal bone level in mm
Test
1.94 (1.50 to 2.38)
2.07 (1.64 to 2.51)
− 0.14 (− 0.25 to − 0.02)
p = 0.03
Control
2.34 (1.62 to 3.08)
2.49 (1.73...
Table 2 Radiographic peri-implant marginal bone level in mm
Test group
Control group
Mean difference
95% CI
p value
Obs
Mean
95% CI
Obs
Mean
95% CI
Baseline
14
− 0.24
− 0.48 to 0.00
13
− 0.28
− 0.52 to 0.03
0.04
− 0.314 to 0.39
p = 0.82
Abutment
14
0.07
− 0.17 to 0.30
13
− 0.01
− 0.26 to 0.25
0.08
− 0.278...
Table 1 Demographics and survival rates of implants and implant crowns
Test group (PRF)
Control group
Number of implants
14
13
Mean age, years (range)
47.9 (23–66)
52.3 (24–72)
Gender
Female
6
6
Male
8
7
Smokers
Total
2
1
20 cigarettes per day
1
1
Number of implants
14
13
Implant length (mm) and imp...
Abbreviations
ASC:
Angulated screw channel
BOP:
Bleeding on probing
DBBM:
Deproteinised bovine bone mineral
GBR:
Guided bone regeneration
ICC:
Intraclass correlation coefficient
KT:
Keratinised peri-implant tissue
PCR:
Plaque control record
PD:
Probing depth
PRF:
Platelet-rich fibrin
PROM:
Patient-related outcome measures
RCF:
...
A minor, but statistically significant, radiographic bone loss occurred from baseline to the final follow-up at the neighbouring tooth surfaces in both groups. Moreover, both groups experienced a minor recession of the marginal gingiva from baseline to the final follow-up, but the change was not significant. Recession and the bone level of the neighbouring tooth surfaces to implants placed in ...
The combination of the NobelParallel CC implant launched in 2015 and an abutment with ASC is relatively new and has so far been lined to only few mechanical problems [39, 40], among which rotation of the crown when torqueing the abutment screw was not stated. In both patients, a new implant was placed without any need for additional bone augmentation and without further complications. ...
Discussion
The present study focused on clinical and radiographic characteristics of staged implants placed in autogenous bone grafts covered by either a PRF membrane (PRF group) or a standard procedure (gold standard) involving coverage of the autogenous bone graft using a deproteinised bovine bone mineral and a resorbable collagen membrane (control group).
The PRF group demonstrated a hi...
One patient (control group) expressed minimally changed extraoral sensation in the chin region at both the 1- and 2-week follow-up. However, the extra- and intraoral clinical examination revealed no sensory disturbances. The patient was not affected by this and described the same changed sensation at the final clinical follow-up after 29 months.
Another patient (PRF group) experienced sensory d...
Radiographic peri-implant marginal bone change
The mean peri-implant marginal bone level at the different time points is shown in Table 2 and Fig. 2. The mean marginal bone level at follow-up was 0.26 mm (95% CI: 0.01–0.50 mm) in the PRF group and 0.68 mm (95% CI: 0.41–0.96 mm) in the control group. The difference between the groups was − 0.43 mm (95% CI: − 0.80 to − 0....
Bleeding on probing
The estimated probability or observed proportion of BOP for implants was 0.31 (95% CI: 0.14–0.70) in the PRF group and 0.30 (95% CI: 0.12–0.77) in the control group. The ratio of the probability of observing BOP was 1.046 (95% CI: 0.91–1.20), indicating that the probability of observing BOP is 4.6% higher in the PRF group than in the control group. No statistical differe...
Results
Implant survival
Two of the 27 initially placed implants were lost in the control group (Table 1). Twenty months after placement of the implant-supported crown, one implant (first premolar, regular platform (4.3 mm), length: 13 mm) was lost due to failed osseointegration. No periodontitis or peri-implant marginal bone resorption was obvious at the time of implant removal. A second...
The distance from the implant-abutment connection to the peri-implant marginal bone level was measured mesially and distally in parallel with the long axis of the implant using open-source software (ImageJ, National Institutes of Health, Bethesda, MD, USA). The distance from the cemento-enamel junction to the marginal bone level at the neighbouring tooth surfaces was also measured in parallel with...
Prosthodontic treatment
Forty-nine days (range: 27–113 days) after placement of the healing abutment, the abutment was removed and the implant position was registered by an impression coping on the implant.
The final implant-supported restoration was fabricated by using an individually designed angulated screw channel (ASC) zirconium abutment (Nobel Biocare®, Zürich, Switzerland) and venee...
Methylprednisolone was prescribed the following morning (16 mg) and evening (16 mg). Additionally, postoperative ibuprofen (400 mg, four times daily) and paracetamol (1000 mg, four times daily) were prescribed for 1 week. The patients were instructed to rinse with 0.12% chlorhexidine digluconate twice daily and discontinue the use of their prostheses (if any). Patients were seen for ...
The bone graft was retrieved by making a continuous osteotomy line with a cylindrical and a round bur at the lateral part of the mandible, with a uniform size of approximately 15 × 25 mm (Fig. 1c, d). The bone block containing mainly cortical bone was then gently separated from the mandible using a raspartorium. The block graft was covered with a saline-moistened gauze until used. In the PRF g...
At the time of the bone augmentation procedure, two patients (14%) in the PRF group and one (8%) patient in the control group were smokers. Patients were partially edentulous due to trauma (n = 22), agenesis (n = 3) or marginal periodontitis [2]. Two patients were unavailable for the final follow-up. The referring dentist followed the non-attenders, and telephone interview revealed no subjective o...
Material and methods
The study was performed according to the Declaration of Helsinki and internationally accepted guidelines for RCT, including the CONSORT statement (www.consort-statement.org). The volumetric changes of the augmented bone [26], the histological composition of the augmented bone [27] and pain after the primary bone augmentation procedure [28] were previously described in d...
Despite the shape of a membrane, the PRF membrane does not have the properties of a resorbable barrier membrane [21, 22], due to its fast degradation in the same manner as a natural blood clot (1–2 weeks) [23]. Therefore, the PRF membrane is not believed to replace a barrier membrane in the classic understanding of guide bone regeneration (GBR), but rather to enhance the healing capacity of t...
Background
Implant-supported single crowns are characterised by high long-term survival and few biological and technical complications, which typically includes peri-implant marginal bone loss, screw-loosening and fracture of veneering material complications [1,2,3]. To achieve a successful treatment outcome, the implants must be inserted in sufficient bone volume of an adequate quality to obta...
A clinical and radiographic study of implants placed in autogenous bone grafts covered by either a platelet-rich fibrin membrane or deproteinised bovine bone mineral and a collagen membrane: a pilot randomised controlled clinical trial with a 2-year follow-up
Abstract
Purpose
To compare the survival and clinical performance of implants placed in sites previously augmented with autogenous ...