OHIP domainMinimumMaximumMeanSDFunctional limitation072.341.70Physical pain071.161.51Psychological discomfort081.642.27Physical disability080.751.77Psychological disability081.182.11Social disability080.611.40Handicap080.701.71Total0648.49.7Table 5 Summary of OHIP-14 (N = 44 and response range 0–8)
Outcome variablesCorrelationsSpearman’s rhoP valueOHRQoLOral health compared0.596
QuestionResponseFrequencyOral healthVery good/good81.8%Quality of LifeVery good/good90.9%General healthVery good/good81.8%Pain after hip operationExcessive35.0%Satisfaction hip operationVery85.7%Post op infection in hip siteNo95.3%Visible scar on hipYes48.8%Acceptable scarYes20 of 21aReduced sensibility on hip siteNo86.0%Problem walkingNo92.9%Augmented bone block still presentNo6.8%New augmentatio...
VariableFrequencyN or Mean ± SD%Patients Female2454.5 Male2045.5Age (years)61.16 ± 13.10 Age at operation53.73 ± 13.07 Time from augmentation to completing questionnaire (months)93.55 ± 31.75 Civil status Married3068.2 Single1125.0 Widow(er)36.8Housing Alone1227.3 With another person2352.3 > two persons920.5Education Up to primary711.3 Up to secondary23...
CategoryResponseQuestion (1) Perceived health-status General health“Very good” to “bad” Oral health“Very good” to “bad” Overall quality of life“Excellent” to “bad” (2) Lifestyle-related Smoking“Yes,” “no,” or “sometimes” Appetite“Good” to “bad” (3) Donor site-related Pain“Yes” and “no” Infection“Yes” a...
Gjerde, C.G., Shanbhag, S., Neppelberg, E. et al. Patient experience following iliac crest-derived alveolar bone grafting and implant placement. Int J Implant Dent 6, 4 (2020). https://doi.org/10.1186/s40729-019-0200-8
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Received: 10 October 2019
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Published: 05 February 2020
DOI: https://doi.org/10.1186/s40729-019-0200-8
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...
A self-administered questionnaire.
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The Ethics Committee was contacted in 2015, and no ethical approval was needed since this was then considered a quality control study. Written consent was obtained from all participants.
Not applicable.
Cecilie G Gjerde, Siddharth Shanbhag, Evelyn Neppelberg, Kamal Mustafa, and Harald Gjengedal declare that they have no competing interests.
Correspondence to Cecilie G. Gjerde.
Department of Oral and Maxillofacial Surgery, Institute of Clinical Dentistry, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
Cecilie G. Gjerde & Evelyn Neppelberg
Centre for Clinical Dental Research, Institute of Clinical Dentistry, University of Bergen, Bergen, Norway
Cecilie G. Gjerde, Siddharth Shanbhag & Kamal Mustafa
Department of Oral and Maxillofacial Surgery, Head an...
This work was partially funded by the Research Council of Norway through the BEHANDLING project (grant no. 273551) and TROND MOHN Foundation, Norway (BFS2018TMT10).
The staff and surgeons at the Department of Oral and Maxillofacial Surgery, Head and Neck Clinic, Haukeland University Hospital, Bergen. Randi Aursland, master student, who helped collecting data. The patients included in this study.
Landes CA, Bundgen L, Laudemann K, Ghanaati S, Sader R. Patient satisfaction after prosthetic rehabilitation of bone-grafted alveolar clefts with nonsubmerged ITI Straumann dental implants loaded at three months. Cleft Palate Craniofac J. 2012;49(5):601–8.
Reisine S, Freilich M, Ortiz D, Pendrys D, Shafer D, Taxel P. Quality of life improves among post-menopausal women who received bone augment...
Locker D, Allen F. What do measures of ‘oral health-related quality of life’ measure? Community Dent Oral Epidemiol. 2007;35(6):401–11.
Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011;90(11):1264–70.
Slade GD. Assessing change in quality of life using the Oral Health Impact Profile. Community Dent Oral Epidemiol. 1998;26...
Hill NM, Horne JG, Devane PA. Donor site morbidity in the iliac crest bone graft. Aust N Z J Surg. 1999;69(10):726–8.
Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am. 2002;84-A(3):454–64.
Hernigou P, Desroches A, Queinnec S, Flouzat Lachaniette CH, Poignard A, Allain J, et al. Morbidity of graft harvesting versus bone marrow aspiration in cell regenerative thera...
Schaaf H, Lendeckel S, Howaldt HP, Streckbein P. Donor site morbidity after bone harvesting from the anterior iliac crest. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):52–8.
Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A. Autogenous bone grafts in oral implantology-is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures. Int J I...
Health-related quality of life
Oral Health Impact Profile-14
Oral health-related quality of life
Patient-reported outcome measures
Quality of life
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Favorable OHRQoL and satisfaction were reported after advanced reconstruction with iliac crest-derived grafts and implant treatment in orally compromised patients. However, this treatment requires substantial resources including hospitalization and sick leave.
Patients in our study reported satisfaction with the augmentation and implant installation, and as these patients were orally compromised before the operation, their satisfaction with getting fixed teeth most likely improved their perceived oral health condition. This might also, in part, explain why they reported good OHRQoL. Thus, our findings indicate that a majority of patients tolerate the au...
An important finding in this study is that a majority of patients were very satisfied after iliac crest-derived alveolar bone grafting and implant therapy. Although 90% of the patients in our study had successful bone grafting, only 70.1% reported implant survival together with prosthetic rehabilitation after 1 year. These figures are lower than those reported in previous studies [2, 3, 9]. A rev...
The correlation analyses performed did not show a significant correlation between the complications at the donor site and implant loss (Table 4).
The mean OHIP-14 score (Table 5) was 8.4 ± 9.7 (range 0–56) in 44 patients of whom 35 patients scored 14 or less. Nine patients scored a total sum of 1 [1], i.e. “hardly ever” impact on any single item and “at no time” on the remaining ...
The final sample consisted of 44 patients that responded and completed the questionnaire, giving a response rate of 74.6%: 24 women and 20 men, mean age of 61.2 years ± 13.1 (range 27–82 years). The mean time from augmentation surgery until completing the questionnaire was 7.8 years ± 2.65 (range 1.9–12 years).
Summary of demographic and lifestyle-related data is presented (Tabl...
Implants were placed 4–6 months after the grafting procedure. The implant installations were performed by different oral surgeons (not in the hospital) and different implant systems were used. The implants installed into the augmented bone were allowed to heal for an additional 4–6 months before loading.
The records of the original 69 patients were examined with regard to (1) grafting sit...
This cross-sectional retrospective cohort study was based on records from all patients (n = 69) who underwent advanced alveolar augmentation with autologous iliac bone grafts at the Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway, over 10 years (2002–2012). These patients were orally compromised with severe chewing problems as well as speech diff...
Health-related QoL (HRQoL) is a dynamic concept referring to an individual’s subjective assessment and perspective of current general health condition as well as functional, social, and emotional well-being [23, 24]. Most people regard oral health as important for QoL, and this is mediated through the concept of oral health-related QoL (OHRQoL) [25]. In this regard, OHRQoL is an important PROM i...
Insufficient alveolar bone volume, as a result of periodontal disease, trauma, congenital anomalies and/or resorption atrophy, often presents a clinical challenge for optimal placement of dental implants for prosthetic rehabilitation. In such cases, augmentation of alveolar bone, with either autologous bone, allogeneic, xenogeneic, or alloplastic biomaterials, is a prerequisite for placing implant...
The objective of this study was to assess patient-reported outcomes such as satisfaction and quality of life after advanced alveolar bone augmentation with anterior iliac crest grafting and implant treatment in orally compromised patients.
This cross-sectional retrospective cohort study included 59 patients (29 women and 30 men) with major functional problems, who underwent advanced alveolar augm...
Fig. 8. Photomicrographs of decalcified sections. a Untreated site. Woven bone formed from the sinus walls after 1 week of healing. b Treated site. After 8 weeks, woven bone was still found forming ridges towards residues of provisional matrix, showing that the healing was not completed yet. Scarlet-acid fuchsine and toluidine blue stain. a × 100 magnification. b × 20 magnification
...
Fig. 7. Box-plot representing the new bone percentage and standard deviations (whiskers) found in the various regions evaluated after 8 weeks of healing. (*), a statistical significant difference
Fig. 7. Box-plot representing the new bone percentage and standard deviations (whiskers) found in the various regions evaluated after 8 weeks of healing. (*), a statistical significant difference
Fig. 6. Photomicrographs of decalcified sections illustrating the healing after 8 weeks. a Treated site. Most of the antrostomies presented remaining defects in the outer contour. b, c Untreated sites. Two antrostomies of the treated sites and four of the untreated sites appeared not closed with corticalized bone and presented connective tissue interposed between the edges of the antrostomy. S...
Fig. 5. Photomicrographs of decalcified sections illustrating the healing after 8 weeks. Both at the treated (a) and untreated (b) sites, the antrostomy was closed in most cases, presenting residual defects of various dimensions in the outer side. New bone was connecting the lateral and medial sinus walls. The middle and sub-mucosa regions were not healed completely yet. Scarlet-acid fuchsine ...
Fig. 4. Photomicrographs of ground sections. a) Treated site. Bone residues (examples in yellow asterisks) included in soft tissue containing fibroblast-like cells and inflammatory cells. b) Untreated site. Xenograft residues (examples in red asterisks) surrounded by soft tissue rich in fibroblast-like cells. Scarlet-acid fuchsine and toluidine blue stain. a) 200 x magnification.; b) 100 x magni...
Fig. 3. Photomicrographs of decalcified sections illustrating the healing after 1 week. a Treated site. Bone strips occupying the antrostomy and the subjacent area (close-to-window region). b Untreated site. Note the new bone-forming from the sinus bone walls. Scarlet-acid fuchsine and toluidine blue stain. Images grabbed at × 20 magnification
Fig. 3. Photomicrographs of decalcified sect...
Fig. 2. The various regions evaluated at the histomorphometric analyses. Bone walls (red arrow); middle (white arrow); sub-mucosa (yellow arrow); close-to-window (orange arrow). The antrostomy region was also evaluated at the medial and lateral edges (dark green arrows) and in the middle aspect (light green arrow)
Fig. 2. The various regions evaluated at the histomorphometric analyses. Bone w...
Fig. 1. Clinical view of the surgical procedures. a Tibial bone exposed for autogenous bone harvesting using a bone scraper. b Antrostomies prepared. c Autogenous bone particles placed in the antrostomy. d Xenograft and bone particles (red arrow) at the antrostomies. e Collagen membranes placed on the antrostomies. f Wounds closed with sutures
Fig. 1. Clinical view of the surgical procedures....
AntrostomySinus regions EdgesCenterTotalClose-to-windowMiddleSub-mucosaBone wallsTotalNew boneTreated sites40.3 ± 21.337.8 (27.0;56.0)24.3 ± 23.222.0 (3.4;42.2)35.5 ± 20.927.7 (23.3;52.0)25.8* ± 16.122.9 (15.2;39.7)19.5 ± 16.711.7 (10.1;22.3)22.5 ± 11.620.4 (12.6;31.3)38.0 ± 15.044.8 (31.8;47.5)27.9 ± 12.930.1 (19.6;34.5)Untreated sites32.2 ± 22....
AntrostomySinus regions EdgesCenterTotalClose-to-windowMiddleSub-mucosaBone wallsTotalNew boneTreated sites9.2 ± 10.6 4.6 (3.2;12.5)5.2 ± 13.90.0 (0.0;0.5)7.7 ± 11.22.7 (1.9;7.9)0.6 ± 1.00.0 (0.0;0.7)0.0 ± 0.00.0 (0.0;0.0)1.4 ± 1.80.8 (0.0;2.2)7.7 ± 6.38.2 (1.3;11.1)2.8 ± 2.62.2 (0.7;4.0)Untreated sites8.9 ± 8.5 6.2 (4.0;10.8)1.0 ± 2.70.0 (0....
Favero, G., Viña-Almunia, J., Carda, C. et al. Influence of the use of autogenous bone particles to close the access window after maxillary sinus floor augmentation: an experimental study in rabbits.
Int J Implant Dent 6, 9 (2020). https://doi.org/10.1186/s40729-020-0206-2
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Received: 20 October 2019
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Published: 04 March 2020
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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...
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The present research was approved by the Ethics Committee of Valencia University, Spain. Reference number: A1434714637496.
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Daniele Botticelli declares to be the co-owner of Ariminum Odontologica. Giacomo Favero, Jose Viña-Almunia, Carmen Carda, José Javier Martín de Llano, Berta García-Mira, David Soto-Peñaloza, Daniele Botticelli, and Miguel Peñarrocha-Diago declare that t...
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GF participated in the concept/design, data analysis/interpretation, drafting of the article and surgical procedures. JV-A performed the surgical procedures, made the follow up of the animals, participated in the manuscript revision and ethical committee redaction and approval. BG-M and DS-P performed the surgi...
Private practice, London, UK
Giacomo Favero
Oral Surgery Unit. Department of Stomatology, Faculty of Medicine and Dentistry, Clinica Odontológica, University of Valencia, Valencia, Spain
Jose Viña-Almunia, Berta García-Mira, David Soto-Peñaloza & Miguel Peñarrocha-Diago
Department of Pathology and Health Research Institute of the Hospital Clínico (INCLIVA), Faculty of Medicine and De...
Funds from the present have been provided by ARDEC Academy, by Ariminum Odontologica s.r.l., Rimini, Italy and Tecnoss srl, Giaveno, Italy. The biomaterials use were provided free of charge by Tecnoss srl, Giaveno, Italy.
Favero V, Lang NP, Canullo L, Urbizo Velez J, Bengazi F, Botticelli D. Sinus floor elevation outcomes following perforation of the Schneiderian membrane. An experimental study in sheep. Clin Oral Implants Res. 2016;27(2):233–40.
Scala A, Lang NP, Velez JU, Favero R, Bengazi F, Botticelli D. Effects of a collagen membrane positioned between augmentation material and the sinus mucosa in the eleva...
Kawakami S, Lang NP, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of the height of the antrostomy in sinus floor elevation assessed by cone beam computed tomography- a randomized clinical trial. Int J Oral Maxillofac Implants. 2019;34(1):223–32.
Kawakami S, Lang NP, Iida T, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of the position of the antrostomy in sinus floor elevat...
Tatum, H., Jr. Maxillary sinus grafting for endosseous implants. Lecture presented at the Annual Meeting of the Alabama Implant Study Group (1977); cited in Smiler, D.G., Johnson, P.W., Lozada, J.L., Misch, C., Rosenlicht, J.L., Tatum, O.H. Jr. & Wagner J.R. Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla. Dental clinics of North America. 1992;36:151–186.
...
Animal Research Reporting In Vivo Experiments
Cone beam computed tomography
Deproteinized bovine bone mineral
Tricalcium phosphate
The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
The lower phylogenetic level of the animals compared to humans was the main limitation of the present study. An increased number of animals might allow reaching a statistical difference in favor of the treated sites also in the antrostomy region. Nevertheless, the outcomes obtained, allow to performing studies in humans that might demonstrate the advantages of applying autologous bone on the antro...
In both studies presented above on sinus floor elevation in sheep, all the lateral windows were prepared using a piezoelectric device. In an experiment in rabbits [21], the antrostomies were done with either a sonic instrument or drills to evaluate differences in bone formation in the antrostomy. Elevated space is filled with a collagenated porcine bone similar that used in the present experiment,...
The present experiment aimed to study the influence on the healing after the placement of autogenous bone on the antrostomy and in the subjacent region after maxillary sinus elevation. After 8 weeks of healing, in the antrostomy region, a trend of higher bone formation in the treated compared to the untreated sites was observed. No statistically significant difference was found. In the subjacent ...
After 1 week of healing (Table 1), in the close-to-window region, the proportions of xenograft were 21.3 ± 14.7% and 55.9 ± 19.0 (p = 0.012) in the treated and untreated sites, respectively. After 8 weeks of healing (Table 2), these values decreased to a similar percentage (15.5 ± 14.4% and to 15.5 ± 14.2%; p = 0.917, respectively).
After 1 week of healing (Table...
Biopsies could be harvested from all animals. However, histological sections could not be obtained from one rabbit of the 8 weeks group; therefore, eight and seven were achieved for the 1-week and 8-week periods, respectively.
After 1 week of healing, at the treated sites, the antrostomy and close-to-windows regions were occupied by a high proportion of residues of autogenous bone (Fig. 3a),...
Overlapping calibrated digital images of the tissues were recorded with Leica Applications Suite version 4.4.0 software from a bright field Leica DM4000 B microscope (Leica Microsystems GmbH, Wëtzlar, Germany) equipped with a 5× lens and DFC420 digital camera. Single images were pasted and merged to compose each elevated sinus using the program Photoshop (Adobe Photoshop CC 2015.0.0).
The histo...
Afterward, a trichotomy was performed in the nasal dorsum and, after disinfection of the experimental region using Betadine (MEDA Pharma®, Madrid, Spain), a sagittal incision was carried out. The skin and the periosteum were dissected and shifted laterally to expose the nasal bone. Antrostomies, 4 × 4 mm in dimensions, located about 3–4 mm laterally to the midline and about 10 mm in f...
Prior to the experiment, the protocol was approved by the Ethics Committee of Valencia University, Spain (A1434714637496). The guidelines indicated by the Council Directive of the European Union (53/2013; February 1, 2013) for animal experimentation and the ethical rules proposed by Royal Decree 223, March 14 and October 13, 1988, were fulfilled. The study was reported following the ARRIVE guideli...
Hence, the present experiment aimed to study the influence on healing, of the autogenous bone particle placement in the antrostomy and in the subjacent region after maxillary sinus elevation.
Maxillary sinus floor elevation through lateral access was first proposed in 1977 [1], while the technique was published in 1984 [2]. Several modifications in the surgical approach and the biomaterials used have been introduced over time [3,4,5]. In a systematic review with meta-analysis, it was concluded that the best survival rate was observed when implants with rough surface and membrane to cov...
To study the influence on the healing of the placement of particulate autogenous bone in the antrostomy and in the subjacent region after maxillary sinus elevation.
Sixteen New Zealand rabbits were undergone to bilateral maxillary sinus floor augmentation with 4 × 4 mm antrostomy dimension. The sinus mucosa was elevated, and the space obtained was filled with xenograft. In the test site (tr...
Fig. 6. Graph representing new bone and composite bone percentages within the elevated area
Fig. 6. Graph representing new bone and composite bone percentages within the elevated area
Fig. 5. Graph representing the tissue percentages within the elevated area. No statistically significant differences were found
Fig. 5. Graph representing the tissue percentages within the elevated area. No statistically significant differences were found
Fig. 4. Photomicrographs of ground sections after 4 months of healing. a Bone formed from the base of the sinus. b Bone plate connected by bridges of the new bone to the close-to-window region. c Particle of the graft surrounded by new bone. d Overexposed image to show the new bone ingrowth within the granules of biomaterial
Fig. 4. Photomicrographs of ground sections after 4 months of he...
Fig. 3. a The elevated area was divided into four regions for morphometric analysis. RED: submucosa; GREEN: middle; YELLOW: base; PURPLE: close-to-window. INC: top of the infraorbital nerve canal
Fig. 3. a The elevated area was divided into four regions for morphometric analysis. RED: submucosa; GREEN: middle; YELLOW: base; PURPLE: close-to-window. INC: top of the infraorbital nerve canal
Fig. 2. Clinical view at a bone plate site. a The bone window was removed. b The sinus mucosa was carefully elevated, and a twisted wire was placed. c The elevated sinus was grafted. d The access bony window was repositioned and secured with cyanoacrylate
Fig. 2. Clinical view at a bone plate site. a The bone window was removed. b The sinus mucosa was carefully elevated, and a twisted wire wa...
Fig. 1. Clinical view at a membrane site. a Skin and periosteum were separately elevated, and the facial sinus wall exposed. b A 12 × 8-mm window was cut and removed. c The Schneiderian membrane was carefully elevated. d A twisted wire was inserted in the middle of the long side of the window and the elevated sinus was grafted. e At the control site, a resorbable membrane was placed and secured...
BoneSoft tissuePure graftInterpenetrated graftComposite boneReplaced windowCenter61.5 ± 46.982.5 (22.2; 96.9)21.7 ± 22.6*17.5 (3.1; 34.4)2.3 ± 4.3*0.0 (0.0; 2.3)7.9 ± 19.30.0 (0.0; 0.0)69.3 ± 38.582.5 (57.6; 96.9)Edge37.2 ± 37.021.6 (16.8; 55.8)41.0 ± 39.833.6 (9.2; 64.9)5.3 ± 7.31.6 (0.0; 9.1)13.8 ± 19.0*6.7 (0.0; 19.7)54.8 ± 34.162.9 (37.5; 69.7)MembraneCenter5.8 ± 2.1 (P = 0.116)5....
New boneSoft tissuePure graftInterpenetrated graftComposite boneReplaced windowTotal16.4 ± 5.618.8 (13.8; 20.3)32.9 ± 8.031.2 (27.7; 37.0)13.6 ± 4.212.0 (10.8; 16.2)37.1 ± 7.534.4 (31.7; 43.4)53.5 ± 7.652.4 (50.8; 57.8)Base15.0 ± 7.216.4 (10.1; 20.1)38.6 ± 14.334.5 (28.9; 47.1)13.4 ± 6.415.3 (13.1; 17.0)33.1 ± 11.133.1 (26.8; 40.0)48.0 ± 18.149.9 (36.9; 59.7)Middle16.9 ± 7.318.1 (11.2...
Perini, A., Ferrante, G., Sivolella, S. et al. Bone plate repositioned over the antrostomy after sinus floor elevation: an experimental study in sheep. Int J Implant Dent 6, 11 (2020). https://doi.org/10.1186/s40729-020-0207-1
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Received: 01 October 2019
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Published: 18 March 2020
DOI: https://doi.org/10.1186/s40729-020-0207-1
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...
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The research protocol was submitted to and approved by the Ethical Committee of the University of Medical Sciences, School of Dentistry, Havana, Cuba (prot. 013/2013).
All the authors consent to publication.
Alessandro Perini, Giada Ferrante, Stefano Sivolella, Joaquín Urbizo Velez, Franco Bengazi, and Daniele Botticelli declare that they have no competing interests.
Correspondence to Alessandro Perini.
Department of Neuroscience, Division of Dentistry, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
Alessandro Perini, Giada Ferrante & Stefano Sivolella
Faculty of Dentistry, University of Medical Science, Havana, Cuba
Joaquín Urbizo Velez & Franco Bengazi
ARDEC Academy, Ariminum Odontologica, Rimini, Italy
Daniele Botticelli
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This study was funded by ARDEC Academy, Ariminum Odontologica s.r.l., Rimini, Italy.
Degradable Solutions AG, a Sunstar Group Company, CH-8952 Schlieren ZH, Switzerland, provided free of charge the biomaterials used.
Iida T. Carneiro Martins Neto E, Botticelli D, Apaza Alccayhuaman KA, Lang NP, Xavier SP. Influence of a collagen membrane positioned subjacent the sinus mucosa following the elevation of the maxillary sinus: a histomorphometric study in rabbits. Clin Oral Implants Res. 2017 Dec;28(12):1567–76.
Inal S, Yilmaz N, Nisbet C, Güvenç T. Biochemical and histopathological findings of N-butyl-2-cyano...
Russell WMS, Burch RL. The principles of human experimental technique. London: Methuen; 1959.
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Sohn DS, Kim WS, An KM, Song KJ, Lee JM, Mun YS. Comparative histomorphometric analysis of ...
Nosaka Y, Nosaka H, Arai Y. Complications of postoperative swelling of the maxillary sinus membrane after sinus floor augmentation. J Oral Sci Rehab. 2015;1:26–33.
Tawil G, Tawil P, Khairallah A. Sinus floor elevation using the lateral approach and bone window repositioning I: clinical and radiographic results in 102 consecutively treated patients followed from 1 to 5 years. Int J Oral Maxillof...
Tatum H Jr. Maxillary sinus grafting for endosseous implants. Lecture presented at the Annual Meeting of the Alabama Implant Study Group (1977); cited in Smiler DG, Johnson PW, Lozada JL, Misch C, Rosenlicht JL, Tatum OH Jr., Wagner JR. Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla. Dent Clin North Am. 1992;36:151–86.
Boyne PJ, James RA. Grafting of the ...
Biphasic calcium phosphate
Deproteinized Bovine Bone Mineral
Hydroxyapatite
Infraorbital nerve canal
Standard deviation
Beta-tricalcium phosphate
All data and materials are available for control and consultation contacting the first author (alexperini@studioschweiger.it).
In conclusion, the repositioning of the bone window after sinus floor elevation in sheep, compared with the use of a resorbable membrane, improved the closure of the antrostomy and led to a greater amount of the newly formed bone in the close-to-window zone of the grafted area. The bone window appeared partially bonded to the newly formed bone. Bridges of new bone from the edges of the antrostomy ...
In the present study, a lesser amount of bone was registered subjacent to the sinus mucosa compared with the other regions. This is in agreement with another experiment, in which a similar material was used for sinus augmentation in sheep [24]. A similar outcome was also reported in another study [27] that used DBBM xenograft for sinus augmentation in sheep. In that study, a collagen membrane was ...
In another similar experiment in sheep, the sinuses were augmented using a similar biphasic calcium phosphate (60% HA, 40% β-TCP) [24], the biomaterial used in the present study. The perforation of the sinus mucosa was performed at the test sites and a collagen membrane was placed to protect the perforation, while at control sites the elevated mucosa was left unprotected. After 12 weeks of heal...
The aim of the present study was to compare the healing of the augmented sinus in large animals, where the antrostomy was covered by a polylactic membrane or a repositioned bone plate, both secured with cyanoacrylate.
No statistically significant differences were found between test and control sites in the bone formation within the augmented space. This outcome is in agreement with a similar stud...
In the centre of the window area, at the test sites, in the analysed histological sections, the bone plate was still visible in five out of six sheep. It appeared partly remodelled and connected by the new bone formed in the sub-window area. Out of the five bone plates still present, three were bridged to the edges of the antrostomy, while in the two cases no contact was achieved in the observed s...
During surgery, one sheep showed acute sinusitis at the test site. The sinus mucosa was perforated to allow sinus drainage and surgery was completed. During the healing period, no evident clinical complications were observed.
At the histomorphometric analysis, one sinus of the control group and one of the test group (corresponding to the sinusitis case) appeared to have lost almost all biomateria...
The percentages of the new mineralised bone, soft or connective tissue, pure graft, graft interpenetrated by bone, and remnants of cyanoacrylate were evaluated. The total tissue percentages in the elevated space that included submucosa, middle, base, and sub-window regions were also calculated.
Mean values and standard deviations (SDs) as well as the 25th, 50th (median), and 75th percentiles were...
After 4 months, the animals were anaesthetised and then euthanised with an overdose of pentobarbital sodium and subsequently perfused with 10% formalin. The maxilla was retrieved en bloc, trimmed, and immersed in formalin solution.
All histological procedures were performed in the Laboratorio de Histologıa de la Facultad de Odontologıa de la Universidad de Ciencia Medica in Havana, Cuba. Bila...
Through an extra-oral approach, an oblique incision was made bilaterally along the sagittal axis between the facial tuberosity and the inferior orbital rim. The skin and periosteum were elevated separately, and the bony facial sinus wall was exposed on both sides of the maxilla (Fig. 1a).
A 12-mm large and 8-mm high antrostomy was prepared using a burr (H254E Komet Dental, Trophagener Weg 25, L...
The research protocol was submitted to and approved by the Ethical Committee of the University of Medical Sciences, School of Dentistry, Havana, Cuba (prot. 013/2013).
Eight female Pelibuey sheep, with a mean body weight of approximately 35 kg and a mean age of approximately 3 years, were provided by the Centro Nacional para la Producción de Animales de Laboratorio (CENPALAB) in Havana, Cuba...
To prevent the movement of the bony plate and to gain adequate stability, cyanoacrylate has been suggested to glue the plate to the bony edges of the antrostomy [17]. Cyanoacrylates (as methyl 2-cyanoacrylate or ethyl 2-cyanoacrylate) are widely used in surgery and have shown good compatibility [18] and biomechanical strength for fixation of grafts [19]. In an experiment in rabbits [17], the antro...
Sinus floor elevation is a commonly used technique to increase bone volume in the posterior maxilla prior to implant placement. This procedure was first developed by Tatum in 1977 [1], modified by Boyne and James in 1980 [2], and further modified over time. In this well-described technique, a bony window is created on the lateral wall of the sinus with a round burr, and the membrane elevated. Diff...
The objective of this study was to compare the healing of the augmented sinus at which the antrostomy was covered with a membrane or the repositioned bone plate.
Eight sheep underwent bilateral maxillary sinus floor augmentation. The control site was covered with a resorbable membrane, while at the experimental site the bone plate was repositioned, and both were secured with cyanoacrylate. Animal...
OHIP domainMinimumMaximumMeanSDFunctional limitation072.341.70Physical pain071.161.51Psychological discomfort081.642.27Physical disability080.751.77Psychological disability081.182.11Social disability080.611.40Handicap080.701.71Total0648.49.7Table 5 Summary of OHIP-14 (N = 44 and response range 0–8)
Outcome variablesCorrelationsSpearman’s rhoP valueOHRQoLOral health compared0.596
QuestionResponseFrequencyOral healthVery good/good81.8%Quality of LifeVery good/good90.9%General healthVery good/good81.8%Pain after hip operationExcessive35.0%Satisfaction hip operationVery85.7%Post op infection in hip siteNo95.3%Visible scar on hipYes48.8%Acceptable scarYes20 of 21aReduced sensibility on hip siteNo86.0%Problem walkingNo92.9%Augmented bone block still presentNo6.8%New augmentatio...
VariableFrequencyN or Mean ± SD%Patients Female2454.5 Male2045.5Age (years)61.16 ± 13.10 Age at operation53.73 ± 13.07 Time from augmentation to completing questionnaire (months)93.55 ± 31.75 Civil status Married3068.2 Single1125.0 Widow(er)36.8Housing Alone1227.3 With another person2352.3 > two persons920.5Education Up to primary711.3 Up to secondary23...
CategoryResponseQuestion (1) Perceived health-status General health“Very good” to “bad” Oral health“Very good” to “bad” Overall quality of life“Excellent” to “bad” (2) Lifestyle-related Smoking“Yes,” “no,” or “sometimes” Appetite“Good” to “bad” (3) Donor site-related Pain“Yes” and “no” Infection“Yes” a...
Gjerde, C.G., Shanbhag, S., Neppelberg, E. et al. Patient experience following iliac crest-derived alveolar bone grafting and implant placement.
Int J Implant Dent 6, 4 (2020). https://doi.org/10.1186/s40729-019-0200-8
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Received: 10 October 2019
Accepted: 11 December 2019
Published: 05 February 2020
DOI: https://doi.org/10.1186/s40729-019-0200-8
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 ...
A self-administered questionnaire.
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The Ethics Committee was contacted in 2015, and no ethical approval was needed since this was then considered a quality control study. Written consent was obtained from all participants.
Not applicable.
Cecilie G Gjerde, Siddharth Shanbhag, Evelyn Neppelberg, Kamal Mustafa, and Harald Gjengedal declare that they have no competing interests.
Correspondence to
Cecilie G. Gjerde.
Department of Oral and Maxillofacial Surgery, Institute of Clinical Dentistry, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
Cecilie G. Gjerde & Evelyn Neppelberg
Centre for Clinical Dental Research, Institute of Clinical Dentistry, University of Bergen, Bergen, Norway
Cecilie G. Gjerde, Siddharth Shanbhag & Kamal Mustafa
Department of Oral and Maxillofacial Surgery, Head an...
This work was partially funded by the Research Council of Norway through the BEHANDLING project (grant no. 273551) and TROND MOHN Foundation, Norway (BFS2018TMT10).
The staff and surgeons at the Department of Oral and Maxillofacial Surgery, Head and Neck Clinic, Haukeland University Hospital, Bergen. Randi Aursland, master student, who helped collecting data. The patients included in this study.
Landes CA, Bundgen L, Laudemann K, Ghanaati S, Sader R. Patient satisfaction after prosthetic rehabilitation of bone-grafted alveolar clefts with nonsubmerged ITI Straumann dental implants loaded at three months. Cleft Palate Craniofac J. 2012;49(5):601–8.
Reisine S, Freilich M, Ortiz D, Pendrys D, Shafer D, Taxel P. Quality of life improves among post-menopausal women who received bone augment...
Locker D, Allen F. What do measures of ‘oral health-related quality of life’ measure? Community Dent Oral Epidemiol. 2007;35(6):401–11.
Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011;90(11):1264–70.
Slade GD. Assessing change in quality of life using the Oral Health Impact Profile. Community Dent Oral Epidemiol. 1998;26...
Hill NM, Horne JG, Devane PA. Donor site morbidity in the iliac crest bone graft. Aust N Z J Surg. 1999;69(10):726–8.
Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am. 2002;84-A(3):454–64.
Hernigou P, Desroches A, Queinnec S, Flouzat Lachaniette CH, Poignard A, Allain J, et al. Morbidity of graft harvesting versus bone marrow aspiration in cell regenerative thera...
Schaaf H, Lendeckel S, Howaldt HP, Streckbein P. Donor site morbidity after bone harvesting from the anterior iliac crest. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):52–8.
Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A. Autogenous bone grafts in oral implantology-is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures. Int J I...
Health-related quality of life
Oral Health Impact Profile-14
Oral health-related quality of life
Patient-reported outcome measures
Quality of life
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Favorable OHRQoL and satisfaction were reported after advanced reconstruction with iliac crest-derived grafts and implant treatment in orally compromised patients. However, this treatment requires substantial resources including hospitalization and sick leave.
Patients in our study reported satisfaction with the augmentation and implant installation, and as these patients were orally compromised before the operation, their satisfaction with getting fixed teeth most likely improved their perceived oral health condition. This might also, in part, explain why they reported good OHRQoL. Thus, our findings indicate that a majority of patients tolerate the au...
An important finding in this study is that a majority of patients were very satisfied after iliac crest-derived alveolar bone grafting and implant therapy. Although 90% of the patients in our study had successful bone grafting, only 70.1% reported implant survival together with prosthetic rehabilitation after 1 year. These figures are lower than those reported in previous studies [2, 3, 9]. A rev...
The correlation analyses performed did not show a significant correlation between the complications at the donor site and implant loss (Table 4).
The mean OHIP-14 score (Table 5) was 8.4 ± 9.7 (range 0–56) in 44 patients of whom 35 patients scored 14 or less. Nine patients scored a total sum of 1 [1], i.e. “hardly ever” impact on any single item and “at no time” on the remaining ...
The final sample consisted of 44 patients that responded and completed the questionnaire, giving a response rate of 74.6%: 24 women and 20 men, mean age of 61.2 years ± 13.1 (range 27–82 years). The mean time from augmentation surgery until completing the questionnaire was 7.8 years ± 2.65 (range 1.9–12 years).
Summary of demographic and lifestyle-related data is presented (Tabl...
Implants were placed 4–6 months after the grafting procedure. The implant installations were performed by different oral surgeons (not in the hospital) and different implant systems were used. The implants installed into the augmented bone were allowed to heal for an additional 4–6 months before loading.
The records of the original 69 patients were examined with regard to (1) grafting sit...
This cross-sectional retrospective cohort study was based on records from all patients (n = 69) who underwent advanced alveolar augmentation with autologous iliac bone grafts at the Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway, over 10 years (2002–2012). These patients were orally compromised with severe chewing problems as well as speech diff...
Health-related QoL (HRQoL) is a dynamic concept referring to an individual’s subjective assessment and perspective of current general health condition as well as functional, social, and emotional well-being [23, 24]. Most people regard oral health as important for QoL, and this is mediated through the concept of oral health-related QoL (OHRQoL) [25]. In this regard, OHRQoL is an important PROM i...
Insufficient alveolar bone volume, as a result of periodontal disease, trauma, congenital anomalies and/or resorption atrophy, often presents a clinical challenge for optimal placement of dental implants for prosthetic rehabilitation. In such cases, augmentation of alveolar bone, with either autologous bone, allogeneic, xenogeneic, or alloplastic biomaterials, is a prerequisite for placing implant...
The objective of this study was to assess patient-reported outcomes such as satisfaction and quality of life after advanced alveolar bone augmentation with anterior iliac crest grafting and implant treatment in orally compromised patients.
This cross-sectional retrospective cohort study included 59 patients (29 women and 30 men) with major functional problems, who underwent advanced alveolar augm...
Fig. 8. Photomicrographs of decalcified sections. a Untreated site. Woven bone formed from the sinus walls after 1 week of healing. b Treated site. After 8 weeks, woven bone was still found forming ridges towards residues of provisional matrix, showing that the healing was not completed yet. Scarlet-acid fuchsine and toluidine blue stain. a × 100 magnification. b × 20 magnification
...
Fig. 7. Box-plot representing the new bone percentage and standard deviations (whiskers) found in the various regions evaluated after 8 weeks of healing. (*), a statistical significant difference
Fig. 7. Box-plot representing the new bone percentage and standard deviations (whiskers) found in the various regions evaluated after 8 weeks of healing. (*), a statistical significant difference
Fig. 6. Photomicrographs of decalcified sections illustrating the healing after 8 weeks. a Treated site. Most of the antrostomies presented remaining defects in the outer contour. b, c Untreated sites. Two antrostomies of the treated sites and four of the untreated sites appeared not closed with corticalized bone and presented connective tissue interposed between the edges of the antrostomy. S...
Fig. 5. Photomicrographs of decalcified sections illustrating the healing after 8 weeks. Both at the treated (a) and untreated (b) sites, the antrostomy was closed in most cases, presenting residual defects of various dimensions in the outer side. New bone was connecting the lateral and medial sinus walls. The middle and sub-mucosa regions were not healed completely yet. Scarlet-acid fuchsine ...
Fig. 4. Photomicrographs of ground sections. a) Treated site. Bone residues (examples in yellow asterisks) included in soft tissue containing fibroblast-like cells and inflammatory cells. b) Untreated site. Xenograft residues (examples in red asterisks) surrounded by soft tissue rich in fibroblast-like cells. Scarlet-acid fuchsine and toluidine blue stain. a) 200 x magnification.; b) 100 x magni...
Fig. 3. Photomicrographs of decalcified sections illustrating the healing after 1 week. a Treated site. Bone strips occupying the antrostomy and the subjacent area (close-to-window region). b Untreated site. Note the new bone-forming from the sinus bone walls. Scarlet-acid fuchsine and toluidine blue stain. Images grabbed at × 20 magnification
Fig. 3. Photomicrographs of decalcified sect...
Fig. 2. The various regions evaluated at the histomorphometric analyses. Bone walls (red arrow); middle (white arrow); sub-mucosa (yellow arrow); close-to-window (orange arrow). The antrostomy region was also evaluated at the medial and lateral edges (dark green arrows) and in the middle aspect (light green arrow)
Fig. 2. The various regions evaluated at the histomorphometric analyses. Bone w...
Fig. 1. Clinical view of the surgical procedures. a Tibial bone exposed for autogenous bone harvesting using a bone scraper. b Antrostomies prepared. c Autogenous bone particles placed in the antrostomy. d Xenograft and bone particles (red arrow) at the antrostomies. e Collagen membranes placed on the antrostomies. f Wounds closed with sutures
Fig. 1. Clinical view of the surgical procedures....
AntrostomySinus regions EdgesCenterTotalClose-to-windowMiddleSub-mucosaBone wallsTotalNew boneTreated sites40.3 ± 21.337.8 (27.0;56.0)24.3 ± 23.222.0 (3.4;42.2)35.5 ± 20.927.7 (23.3;52.0)25.8* ± 16.122.9 (15.2;39.7)19.5 ± 16.711.7 (10.1;22.3)22.5 ± 11.620.4 (12.6;31.3)38.0 ± 15.044.8 (31.8;47.5)27.9 ± 12.930.1 (19.6;34.5)Untreated sites32.2 ± 22....
AntrostomySinus regions EdgesCenterTotalClose-to-windowMiddleSub-mucosaBone wallsTotalNew boneTreated sites9.2 ± 10.6 4.6 (3.2;12.5)5.2 ± 13.90.0 (0.0;0.5)7.7 ± 11.22.7 (1.9;7.9)0.6 ± 1.00.0 (0.0;0.7)0.0 ± 0.00.0 (0.0;0.0)1.4 ± 1.80.8 (0.0;2.2)7.7 ± 6.38.2 (1.3;11.1)2.8 ± 2.62.2 (0.7;4.0)Untreated sites8.9 ± 8.5 6.2 (4.0;10.8)1.0 ± 2.70.0 (0....
Favero, G., Viña-Almunia, J., Carda, C. et al. Influence of the use of autogenous bone particles to close the access window after maxillary sinus floor augmentation: an experimental study in rabbits.
Int J Implant Dent 6, 9 (2020). https://doi.org/10.1186/s40729-020-0206-2
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Received: 20 October 2019
Accepted: 21 January 2020
Published: 04 March 2020
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 m...
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The present research was approved by the Ethics Committee of Valencia University, Spain. Reference number: A1434714637496.
Not applicable.
Daniele Botticelli declares to be the co-owner of Ariminum Odontologica. Giacomo Favero, Jose Viña-Almunia, Carmen Carda, José Javier Martín de Llano, Berta García-Mira, David Soto-Peñaloza, Daniele Botticelli, and Miguel Peñarrocha-Diago declare that t...
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GF participated in the concept/design, data analysis/interpretation, drafting of the article and surgical procedures. JV-A performed the surgical procedures, made the follow up of the animals, participated in the manuscript revision and ethical committee redaction and approval. BG-M and DS-P performed the surgi...
Private practice, London, UK
Giacomo Favero
Oral Surgery Unit. Department of Stomatology, Faculty of Medicine and Dentistry, Clinica Odontológica, University of Valencia, Valencia, Spain
Jose Viña-Almunia, Berta García-Mira, David Soto-Peñaloza & Miguel Peñarrocha-Diago
Department of Pathology and Health Research Institute of the Hospital Clínico (INCLIVA), Faculty of Medicine and De...
Funds from the present have been provided by ARDEC Academy, by Ariminum Odontologica s.r.l., Rimini, Italy and Tecnoss srl, Giaveno, Italy. The biomaterials use were provided free of charge by Tecnoss srl, Giaveno, Italy.
Favero V, Lang NP, Canullo L, Urbizo Velez J, Bengazi F, Botticelli D. Sinus floor elevation outcomes following perforation of the Schneiderian membrane. An experimental study in sheep. Clin Oral Implants Res. 2016;27(2):233–40.
Scala A, Lang NP, Velez JU, Favero R, Bengazi F, Botticelli D. Effects of a collagen membrane positioned between augmentation material and the sinus mucosa in the eleva...
Kawakami S, Lang NP, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of the height of the antrostomy in sinus floor elevation assessed by cone beam computed tomography- a randomized clinical trial. Int J Oral Maxillofac Implants. 2019;34(1):223–32.
Kawakami S, Lang NP, Iida T, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of the position of the antrostomy in sinus floor elevat...
Tatum, H., Jr. Maxillary sinus grafting for endosseous implants. Lecture presented at the Annual Meeting of the Alabama Implant Study Group (1977); cited in Smiler, D.G., Johnson, P.W., Lozada, J.L., Misch, C., Rosenlicht, J.L., Tatum, O.H. Jr. & Wagner J.R. Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla. Dental clinics of North America. 1992;36:151–186.
...
Animal Research Reporting In Vivo Experiments
Cone beam computed tomography
Deproteinized bovine bone mineral
Tricalcium phosphate
The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
The lower phylogenetic level of the animals compared to humans was the main limitation of the present study. An increased number of animals might allow reaching a statistical difference in favor of the treated sites also in the antrostomy region. Nevertheless, the outcomes obtained, allow to performing studies in humans that might demonstrate the advantages of applying autologous bone on the antro...
In both studies presented above on sinus floor elevation in sheep, all the lateral windows were prepared using a piezoelectric device. In an experiment in rabbits [21], the antrostomies were done with either a sonic instrument or drills to evaluate differences in bone formation in the antrostomy. Elevated space is filled with a collagenated porcine bone similar that used in the present experiment,...
The present experiment aimed to study the influence on the healing after the placement of autogenous bone on the antrostomy and in the subjacent region after maxillary sinus elevation. After 8 weeks of healing, in the antrostomy region, a trend of higher bone formation in the treated compared to the untreated sites was observed. No statistically significant difference was found. In the subjacent ...
After 1 week of healing (Table 1), in the close-to-window region, the proportions of xenograft were 21.3 ± 14.7% and 55.9 ± 19.0 (p = 0.012) in the treated and untreated sites, respectively. After 8 weeks of healing (Table 2), these values decreased to a similar percentage (15.5 ± 14.4% and to 15.5 ± 14.2%; p = 0.917, respectively).
After 1 week of healing (Table...
Biopsies could be harvested from all animals. However, histological sections could not be obtained from one rabbit of the 8 weeks group; therefore, eight and seven were achieved for the 1-week and 8-week periods, respectively.
After 1 week of healing, at the treated sites, the antrostomy and close-to-windows regions were occupied by a high proportion of residues of autogenous bone (Fig. 3a),...
Overlapping calibrated digital images of the tissues were recorded with Leica Applications Suite version 4.4.0 software from a bright field Leica DM4000 B microscope (Leica Microsystems GmbH, Wëtzlar, Germany) equipped with a 5× lens and DFC420 digital camera. Single images were pasted and merged to compose each elevated sinus using the program Photoshop (Adobe Photoshop CC 2015.0.0).
The histo...
Afterward, a trichotomy was performed in the nasal dorsum and, after disinfection of the experimental region using Betadine (MEDA Pharma®, Madrid, Spain), a sagittal incision was carried out. The skin and the periosteum were dissected and shifted laterally to expose the nasal bone. Antrostomies, 4 × 4 mm in dimensions, located about 3–4 mm laterally to the midline and about 10 mm in f...
Prior to the experiment, the protocol was approved by the Ethics Committee of Valencia University, Spain (A1434714637496). The guidelines indicated by the Council Directive of the European Union (53/2013; February 1, 2013) for animal experimentation and the ethical rules proposed by Royal Decree 223, March 14 and October 13, 1988, were fulfilled. The study was reported following the ARRIVE guideli...
Hence, the present experiment aimed to study the influence on healing, of the autogenous bone particle placement in the antrostomy and in the subjacent region after maxillary sinus elevation.
Maxillary sinus floor elevation through lateral access was first proposed in 1977 [1], while the technique was published in 1984 [2]. Several modifications in the surgical approach and the biomaterials used have been introduced over time [3,4,5]. In a systematic review with meta-analysis, it was concluded that the best survival rate was observed when implants with rough surface and membrane to cov...
To study the influence on the healing of the placement of particulate autogenous bone in the antrostomy and in the subjacent region after maxillary sinus elevation.
Sixteen New Zealand rabbits were undergone to bilateral maxillary sinus floor augmentation with 4 × 4 mm antrostomy dimension. The sinus mucosa was elevated, and the space obtained was filled with xenograft. In the test site (tr...
Fig. 6. Graph representing new bone and composite bone percentages within the elevated area
Fig. 6. Graph representing new bone and composite bone percentages within the elevated area
Fig. 5. Graph representing the tissue percentages within the elevated area. No statistically significant differences were found
Fig. 5. Graph representing the tissue percentages within the elevated area. No statistically significant differences were found
Fig. 4. Photomicrographs of ground sections after 4 months of healing. a Bone formed from the base of the sinus. b Bone plate connected by bridges of the new bone to the close-to-window region. c Particle of the graft surrounded by new bone. d Overexposed image to show the new bone ingrowth within the granules of biomaterial
Fig. 4. Photomicrographs of ground sections after 4 months of he...
Fig. 3. a The elevated area was divided into four regions for morphometric analysis. RED: submucosa; GREEN: middle; YELLOW: base; PURPLE: close-to-window. INC: top of the infraorbital nerve canal
Fig. 3. a The elevated area was divided into four regions for morphometric analysis. RED: submucosa; GREEN: middle; YELLOW: base; PURPLE: close-to-window. INC: top of the infraorbital nerve canal
Fig. 2. Clinical view at a bone plate site. a The bone window was removed. b The sinus mucosa was carefully elevated, and a twisted wire was placed. c The elevated sinus was grafted. d The access bony window was repositioned and secured with cyanoacrylate
Fig. 2. Clinical view at a bone plate site. a The bone window was removed. b The sinus mucosa was carefully elevated, and a twisted wire wa...
Fig. 1. Clinical view at a membrane site. a Skin and periosteum were separately elevated, and the facial sinus wall exposed. b A 12 × 8-mm window was cut and removed. c The Schneiderian membrane was carefully elevated. d A twisted wire was inserted in the middle of the long side of the window and the elevated sinus was grafted. e At the control site, a resorbable membrane was placed and secured...
BoneSoft tissuePure graftInterpenetrated graftComposite boneReplaced windowCenter61.5 ± 46.982.5 (22.2; 96.9)21.7 ± 22.6*17.5 (3.1; 34.4)2.3 ± 4.3*0.0 (0.0; 2.3)7.9 ± 19.30.0 (0.0; 0.0)69.3 ± 38.582.5 (57.6; 96.9)Edge37.2 ± 37.021.6 (16.8; 55.8)41.0 ± 39.833.6 (9.2; 64.9)5.3 ± 7.31.6 (0.0; 9.1)13.8 ± 19.0*6.7 (0.0; 19.7)54.8 ± 34.162.9 (37.5; 69.7)MembraneCenter5.8 ± 2.1 (P = 0.116)5....
New boneSoft tissuePure graftInterpenetrated graftComposite boneReplaced windowTotal16.4 ± 5.618.8 (13.8; 20.3)32.9 ± 8.031.2 (27.7; 37.0)13.6 ± 4.212.0 (10.8; 16.2)37.1 ± 7.534.4 (31.7; 43.4)53.5 ± 7.652.4 (50.8; 57.8)Base15.0 ± 7.216.4 (10.1; 20.1)38.6 ± 14.334.5 (28.9; 47.1)13.4 ± 6.415.3 (13.1; 17.0)33.1 ± 11.133.1 (26.8; 40.0)48.0 ± 18.149.9 (36.9; 59.7)Middle16.9 ± 7.318.1 (11.2...
Perini, A., Ferrante, G., Sivolella, S. et al. Bone plate repositioned over the antrostomy after sinus floor elevation: an experimental study in sheep.
Int J Implant Dent 6, 11 (2020). https://doi.org/10.1186/s40729-020-0207-1
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Received: 01 October 2019
Accepted: 04 February 2020
Published: 18 March 2020
DOI: https://doi.org/10.1186/s40729-020-0207-1
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...
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The research protocol was submitted to and approved by the Ethical Committee of the University of Medical Sciences, School of Dentistry, Havana, Cuba (prot. 013/2013).
All the authors consent to publication.
Alessandro Perini, Giada Ferrante, Stefano Sivolella, Joaquín Urbizo Velez, Franco Bengazi, and Daniele Botticelli declare that they have no competing interests.
Correspondence to
Alessandro Perini.
Department of Neuroscience, Division of Dentistry, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
Alessandro Perini, Giada Ferrante & Stefano Sivolella
Faculty of Dentistry, University of Medical Science, Havana, Cuba
Joaquín Urbizo Velez & Franco Bengazi
ARDEC Academy, Ariminum Odontologica, Rimini, Italy
Daniele Botticelli
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This study was funded by ARDEC Academy, Ariminum Odontologica s.r.l., Rimini, Italy.
Degradable Solutions AG, a Sunstar Group Company, CH-8952 Schlieren ZH, Switzerland, provided free of charge the biomaterials used.
Iida T. Carneiro Martins Neto E, Botticelli D, Apaza Alccayhuaman KA, Lang NP, Xavier SP. Influence of a collagen membrane positioned subjacent the sinus mucosa following the elevation of the maxillary sinus: a histomorphometric study in rabbits. Clin Oral Implants Res. 2017 Dec;28(12):1567–76.
Inal S, Yilmaz N, Nisbet C, Güvenç T. Biochemical and histopathological findings of N-butyl-2-cyano...
Russell WMS, Burch RL. The principles of human experimental technique. London: Methuen; 1959.
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Sohn DS, Kim WS, An KM, Song KJ, Lee JM, Mun YS. Comparative histomorphometric analysis of ...
Nosaka Y, Nosaka H, Arai Y. Complications of postoperative swelling of the maxillary sinus membrane after sinus floor augmentation. J Oral Sci Rehab. 2015;1:26–33.
Tawil G, Tawil P, Khairallah A. Sinus floor elevation using the lateral approach and bone window repositioning I: clinical and radiographic results in 102 consecutively treated patients followed from 1 to 5 years. Int J Oral Maxillof...
Tatum H Jr. Maxillary sinus grafting for endosseous implants. Lecture presented at the Annual Meeting of the Alabama Implant Study Group (1977); cited in Smiler DG, Johnson PW, Lozada JL, Misch C, Rosenlicht JL, Tatum OH Jr., Wagner JR. Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla. Dent Clin North Am. 1992;36:151–86.
Boyne PJ, James RA. Grafting of the ...
Biphasic calcium phosphate
Deproteinized Bovine Bone Mineral
Hydroxyapatite
Infraorbital nerve canal
Standard deviation
Beta-tricalcium phosphate
All data and materials are available for control and consultation contacting the first author (alexperini@studioschweiger.it).
In conclusion, the repositioning of the bone window after sinus floor elevation in sheep, compared with the use of a resorbable membrane, improved the closure of the antrostomy and led to a greater amount of the newly formed bone in the close-to-window zone of the grafted area. The bone window appeared partially bonded to the newly formed bone. Bridges of new bone from the edges of the antrostomy ...
In the present study, a lesser amount of bone was registered subjacent to the sinus mucosa compared with the other regions. This is in agreement with another experiment, in which a similar material was used for sinus augmentation in sheep [24]. A similar outcome was also reported in another study [27] that used DBBM xenograft for sinus augmentation in sheep. In that study, a collagen membrane was ...
In another similar experiment in sheep, the sinuses were augmented using a similar biphasic calcium phosphate (60% HA, 40% β-TCP) [24], the biomaterial used in the present study. The perforation of the sinus mucosa was performed at the test sites and a collagen membrane was placed to protect the perforation, while at control sites the elevated mucosa was left unprotected. After 12 weeks of heal...
The aim of the present study was to compare the healing of the augmented sinus in large animals, where the antrostomy was covered by a polylactic membrane or a repositioned bone plate, both secured with cyanoacrylate.
No statistically significant differences were found between test and control sites in the bone formation within the augmented space. This outcome is in agreement with a similar stud...
In the centre of the window area, at the test sites, in the analysed histological sections, the bone plate was still visible in five out of six sheep. It appeared partly remodelled and connected by the new bone formed in the sub-window area. Out of the five bone plates still present, three were bridged to the edges of the antrostomy, while in the two cases no contact was achieved in the observed s...
During surgery, one sheep showed acute sinusitis at the test site. The sinus mucosa was perforated to allow sinus drainage and surgery was completed. During the healing period, no evident clinical complications were observed.
At the histomorphometric analysis, one sinus of the control group and one of the test group (corresponding to the sinusitis case) appeared to have lost almost all biomateria...
The percentages of the new mineralised bone, soft or connective tissue, pure graft, graft interpenetrated by bone, and remnants of cyanoacrylate were evaluated. The total tissue percentages in the elevated space that included submucosa, middle, base, and sub-window regions were also calculated.
Mean values and standard deviations (SDs) as well as the 25th, 50th (median), and 75th percentiles were...
After 4 months, the animals were anaesthetised and then euthanised with an overdose of pentobarbital sodium and subsequently perfused with 10% formalin. The maxilla was retrieved en bloc, trimmed, and immersed in formalin solution.
All histological procedures were performed in the Laboratorio de Histologıa de la Facultad de Odontologıa de la Universidad de Ciencia Medica in Havana, Cuba. Bila...
Through an extra-oral approach, an oblique incision was made bilaterally along the sagittal axis between the facial tuberosity and the inferior orbital rim. The skin and periosteum were elevated separately, and the bony facial sinus wall was exposed on both sides of the maxilla (Fig. 1a).
A 12-mm large and 8-mm high antrostomy was prepared using a burr (H254E Komet Dental, Trophagener Weg 25, L...
The research protocol was submitted to and approved by the Ethical Committee of the University of Medical Sciences, School of Dentistry, Havana, Cuba (prot. 013/2013).
Eight female Pelibuey sheep, with a mean body weight of approximately 35 kg and a mean age of approximately 3 years, were provided by the Centro Nacional para la Producción de Animales de Laboratorio (CENPALAB) in Havana, Cuba...
To prevent the movement of the bony plate and to gain adequate stability, cyanoacrylate has been suggested to glue the plate to the bony edges of the antrostomy [17]. Cyanoacrylates (as methyl 2-cyanoacrylate or ethyl 2-cyanoacrylate) are widely used in surgery and have shown good compatibility [18] and biomechanical strength for fixation of grafts [19]. In an experiment in rabbits [17], the antro...
Sinus floor elevation is a commonly used technique to increase bone volume in the posterior maxilla prior to implant placement. This procedure was first developed by Tatum in 1977 [1], modified by Boyne and James in 1980 [2], and further modified over time. In this well-described technique, a bony window is created on the lateral wall of the sinus with a round burr, and the membrane elevated. Diff...
The objective of this study was to compare the healing of the augmented sinus at which the antrostomy was covered with a membrane or the repositioned bone plate.
Eight sheep underwent bilateral maxillary sinus floor augmentation. The control site was covered with a resorbable membrane, while at the experimental site the bone plate was repositioned, and both were secured with cyanoacrylate. Animal...
Figure 6.
Figure 6. Cultivation and osteogenic differentiation of DFCs on PA after modification with collagen I. (Left) Relative cell number and (Right) normalized ALP activity.
Figure 5. resentative results are shown for dNC-PCs.
Figure 5. Evaluation of osteogenic differentiation. (A) Clustergram of PCR-array results; (B-C) histology of differentiated dental cells on AP (B) and SB (C). Representative results are shown for dNC-PCs.
Figure 4. dishes for control.
Figure 4. Osteogenic differentiation of dental stem cells. Normalized ALP activity of dNC-PCs and DFCs on AP and SB (A) and on silicone (B). Cells were differentiated on standard cell culture dishes for control.
Figure 3. (black number), apoptotic cells (blue number), and dead cells (red number). (B) Western blot analyses show the expression of the pro-apoptotic marker BAX and the anti-apoptotic marker BCL2.
Figure 3. Evaluation of programmed cell death (apoptosis) in dental stem cells. (A) Flow cytometry analyses (for details materials and methods) show percentage of vital cells (black number), apop...
Figure 2. spheroid cell clusters on silicone (representative pictures for DFCs); Silicone (24 and 48 h).
Figure 2. C ell proliferation of dNC-PCs and DFCs on tested materials. (A) and (B) Relative cell numbers; (C) spheroid cell clusters on silicone (representative pictures for DFCs); Silicone (24 and 48 h).
Figure 1. ative pictures of DFCs.
Figure 1. Cell attachment on tested materials. (A) Relative cell adherence of DFCs and dNC-PCs; (B) dental cells did little adhere on PA; representative pictures of DFCs.
Gosau, M., Viale-Bouroncle, S., Eickhoff, H. et al. Evaluation of implant-materials as cell carriers for dental stem cells under in vitro conditions.
Int J Implant Dent 1, 2 (2015). https://doi.org/10.1186/s40729-014-0002-y
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Received: 17 September 2014
Accepted: 20 November 2014
Published: 12 February 2015
DOI: https://doi.org/10.1186/s40729-014-0002-y
DFCs and dNC-PCs expressed typical markers for dental stem cells.
Martin Gosau, Sandra Viale-Bouroncle, Hannah Eickhoff, Esthera Prateeptongkum, Anja Reck, W Götz, Christoph Klingelhöffer, Steffen Müller and Christian Morsczeck declare that they have no competing interests.
SVB, HE, and EP carried out all cell biology experiments, performed real-time PCRs, Western blots, and the statistical analysis and made figures for the manuscript. AR carried out and ana...
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Christian Morsczeck.
Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
Martin Gosau, Sandra Viale-Bouroncle, Hannah Eickhoff, Esthera Prateeptongkum, Anja Reck, Christoph Klingelhöffer, Steffen Müller & Christian Morsczeck
Department of Oral and Maxillofacial Surgery, Paracelsus Medical University Nuernberg, B...
This study was supported by a grant from the Deutschen Gesellschaft für Implantologie (DGI) e.V.
Marino G, Rosso F, Cafiero G, Tortora C, Moraci M, Barbarisi M, Barbarisi A. Beta-tricalcium phosphate 3D scaffold promote alone osteogenic differentiation of human adipose stem cells: in vitro study. J Mater Sci Mater Med. 2010; 21:353–63.
Arnold U, Lindenhayn K, Perka C. In vitro-cultivation of human periosteum derived cells in bioresorbable polymer-TCP-composites. Biomaterials. 2002; 23:2303...
Felthaus O, Gosau M, Morsczeck C. ZBTB16 induces osteogenic differentiation marker genes in dental follicle cells independent from RUNX2.
J Periodontol. 2014; 85:e144–51.
Viale-Bouroncle S, Gosau M, Küpper K, Möhl C, Brockhoff G, Reichert TE, Schmalz G, Ettl T, Morsczeck C. Rigid matrix supports osteogenic differentiation of stem cells from human exfoliated deciduous teeth (SHED).
Differ Re...
Kagami H, Agata H, Tojo A. Bone marrow stromal cells (bone marrow-derived multipotent mesenchymal stromal cells) for bone tissue engineering: basic science to clinical translation.
Int J Biochem Cell Biol. 2011; 43:286–89.
Robey PG. Cell sources for bone regeneration: the good, the bad, and the ugly (but promising).
Tissue Eng Part B Rev. 2011; 17:423–30.
Morsczeck C, Shi S, Huang G. Stem/...
In conclusion, our work supports our hypothesis that soft implant materials are not suitable for dental tissue engineering. Moreover, our study also supports the results of our previous studies with DFCs and TCP that induction of apoptosis did not impair the proliferation and the differentiation in dental stem cells.
In a previous study, we showed that TCP induced the programmed cell death (apoptosis) in DFCs [11]. Our new study investigated therefore the induction of apoptosis in dental cells. While SB and soft materials did not induce apoptosis or cell death, AP induced obviously cell death and apoptosis in dental cells. Here, the results for dNC-PCs and DFCs were almost the same. Interestingly, neither sili...
Scaffolds play an important role in tissue engineering. However, little is known about the proliferation and differentiation of DFCs and dNC-PCs on different types of materials. As we have learned from previous studies mechanical properties such as surface stiffness are decisive for a successful osteogenic differentiation of dental stem cells [13,14]. Moreover, we showed that bone substitute mater...
The soft material PA was also treated with the extracellular matrix protein collagen to improve cell adherence. We tested representatively DFCs with collagen I modified PA. DFCs adhered and proliferated on modified PA, but, however, the specific ALP activity was reduced in comparison to that of DFCs on standard cell culture dishes (Figure 6). This reduction of the specific ALP activity was simila...
Dental cells were cultivated in standard cell culture media until passage 6. Cell adherence and cell proliferation/growth were measured for the estimation of cell viability on tested rigid and soft materials. In Figure 1, the cell adherence of dNC-PCs on bone substitute materials was better than that of DFCs. However, both dental cells types adhered very well on silicone. Unluckily, dental cells ...
DFCs were cultivated until sub-confluence (>80%) in standard cell culture medium before the differentiation starts with the osteogenic differentiation medium (ODM) comprised DMEM (PAA) supplemented with 10% fetal bovine serum (Sigma-Aldrich), 100 μmol/L ascorbic acid 2-phosphate, 10 mmol/L KH2PO4, 1 × 10−8 mol/L dexamethasone sodium phosphate (Sigma-Aldrich, St. Louis, MO, USA), HEPES (20 ...
Numbers of vital cells were evaluated after days 1, 2, 3, and 6. For cell counting, cell cultures were incubated with the cell counting kit 8 (CCK8) ready to use solution according to manufactures instructions (Dojindo, Rockville, MD, USA). The optical density (O.D.) was measured at a wavelength of 450 nm. For the evaluation of the cell adherence (normalized to standard cell culture dishes), cell...
The bone substitutes Maxgraft® (AP) and Maxresorb® (SB) were obtained from the company Botiss (botiss dental GmbH, Berlin, Germany). Maxgraft® is a sterile, high-safety allograft product (AP), derived from human donor bone. It is processed by an audited and certified bone bank (Cells+ Tissue Bank Austria, Berlin, Germany). In contrast, Maxresorb® is a fully synthetic bone graft substitute (SB)...
The isolation and characterization of DFCs and dNC-PCs were described in previous studies [4,7,12]. DFCs were routinely cultivated in DMEM (Sigma-Aldrich, St. Louis, MO, USA) supplemented with 10% fetal bovine serum (Sigma-Aldrich, St. Louis, MO, USA) and 100 μg/ml penicillin/streptomycin (standard cell culture medium). dNC-PCs were cultivated in DMEM (Sigma-Aldrich) supplemented with 15% fetal ...
Unfortunately, an additional study showed that TCP induced apoptosis in DFCs [11]. However, the induction of apoptosis exposed a risk for cellular therapies. We decided therefore to evaluate additional implant materials for the identification of a suitable scaffold for dental stem cells. Soft materials such as silicone are successfully used in regenerative medicine, and they are suitable for tissu...
While bone substitute materials are routinely used, especially vertical bone, augmentation of the jaws is still a problematic step. Dental stem cells in combination with bone substitute materials may accelerate the augmentation of alveolar bone and perhaps, stem cell-based therapies can become an alternative to autologous, allogenic, or synthetic bone transplants and substitutes [1,2]. However, sc...
Dental stem cells in combination with implant materials may become an alternative to autologous bone transplants. For tissue engineering different types of soft and rigid implant materials are available, but little is known about the viability and the osteogenic differentiation of dental stem cells on these different types of materials. According to previous studies we proposed that rigid bone sub...
Patient
Implant region
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Implant parameters
Dimensions of implant
Diameter [mm]/length [mm]
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Fretwurst, T., Grunert, S., Woelber, J.P. et al. Vitamin D deficiency in early implant failure: two case reports. Int J Implant Dent 2, 24 (2016). https://doi.org/10.1186/s40729-016-0056-0
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Received: 04 August 2016
Accepted: 16 November 2016
Published: 25 November 2016
DOI: https://doi.org/10.1186/s40729-016-0056-0
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 Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg, D-79106, Germany
Tobias Fretwurst, Sebastian Grunert, Katja Nelson & Wiebke Semper-Hogg
Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, USA
Tobias Fretwurst
Department of Operative Dentistr...
We would like to thank Dr. John Nelson for his resourceful and constructive ideas.
The authors Tobias Fretwurst, Sebastian Grunert, Johan Woelber, Katja Nelson, and Wiebke Semper-Hogg declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors Tobias Fretwurst, Sebastian Grunert, Johan Woelber, Katja Nelson, and Wiebke Semper-Hogg do...
Di Rosa M, Malaguarnera M, Nicoletti F, Malaguarnera L. Vitamin D3: a helpful immuno-modulator. Immunology. 2011;134(2):123–39.
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Hewison M, Freeman L, Hughes SV, Evans KN, Bland R, Eliopoulos AG, Kilby MD, Moss PA, Chakraverty R. Differential regulatio...
Hong HH, Chou TA, Yang JC, Chang CJ. The potential effects of cholecalciferol on bone regeneration in dogs. Clin Oral Implants Res. 2012;23(10):1187–92.
Hong HH, Yen TH, Hong A, Chou TA. Association of vitamin D3 with alveolar bone regeneration in dogs. J Cell Mol Med. 2015;19(6):1208–17.
Schulze-Späte U, Dietrich T, Wu C, Wang K, Hasturk H, Dibart S. Systemic vitamin D supplementation and ...
Gallagher JC, Sai AJ. Vitamin D insufficiency, deficiency, and bone health. J Clin Endocrinol Metab. 2010;95(6):2630–3.
Ning Z, Song S, Miao L, Zhang P, Wang X, Liu J, Hu Y, Xu Y, Zhao T, Liang Y, Wang Q, Liu L, Zhang J, Hu L, Huo M, Zhou Q. High prevalence of vitamin D deficiency in urban health checkup population. Clin Nutr. 2016;35(4):859–63.
Spiro A, Buttriss JL. Vitamin D: an overview o...
Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U. Is there an association between periprosthetic joint infection and low vitamin D levels? Int Orthop. 2014;38(7):1499–504.
Alvim-Pereira F, Montes CC, Thomé G, Olandoski M, Trevilatto PC. Analysis of association of clinical aspects and vitamin D receptor gene polymorphism with dental implant loss. Clin Oral Implants Res. 2008;19(8):786–...
Esposito M, Thomsen P, Ericson LE, Lekholm U. Histopathologic observations on early oral implant failures. Int J Oral Maxillofac Implants. 1999;14:798–810.
Olmedo-Gaya MV, Manzano-Moreno FJ, Cañaveral-Cavero E, de Dios Luna-Del Castillo J, Vallecillo-Capilla M. Risk factors associated with early implant failure: a 5-year retrospective clinical study. J Prosthet Dent. 2016;115(2):150–5.
Wenn...
To overcome the shortcomings of this case reports, prospective, multicenter, and controlled studies must follow to affirm a potential relationship between vitamin D deficiency, osteoimmunology, and the early failure of dental implants. Currently, a general recommendation for a standardized vitamin D screening in dental implantology cannot be stated due to lack of evidence.
Nevertheless, the vitamin D deficiency prevalence in the European population indicates that a vitamin D deficiency is probably not a sole causative factor for early implant failure; otherwise, the early implant failure rate would be significantly higher. However, a synergistic effect with other factors is conceivable. Some authors stated that implant osseointegration is not simply a wound healing ...
Local and systemic factors can affect the survival rate of dental implants [30–33]. The causes of early implant failure are not fully clarified and an association between vitamin D and dental implant osseointegration has not been investigated properly [8, 13–16]. Some recent animal studies in rodents demonstrated a relationship between vitamin D supplementation and an increased bone to implant...
In this 51-year-old male patient, no grafting procedure was performed as vertical and horizontal alveolar ridge dimension was adequate for implant placement. The implant placement in regions 36 and 37 was performed as guided surgery (Fig. 2a, Table 1). The implant placement was uneventful and the bone appeared clinically healthy. A cortical bone profiling was performed during implant placement. ...
The medical history of this 48-year-old male patient showed a high blood pressure; otherwise, the patient was healthy. A successfully completed periodontal therapy was done before implant therapy. The patient demonstrated stable marginal bone levels. Autologous retromolar bone grafting using local anesthesia was performed in the left mandible (see Fig. 1a). This patient received a postoperative o...
Patients treated consecutively in one center (Department of Oral- and Craniomaxillofacial Surgery, University Medical Center Freiburg). None of the patients showed systemic disease. Both patients did not take regular medication and were negative for alcohol, nicotine, and drug use. Bothe male patients (48 and 51 years of age) were not immunosuppressed, irradiated or received chemotherapy. Written...
Long-term stable osseointegrated implants are the primary goal in dental implantology. Although dental implants have proven clinical reliable in the long term, the failure of implants at a very early stage of osseointegration has been described [1, 2]. The pursuit to identify the mechanisms leading to early implant failure is ongoing to date and include the following: tobacco usage, diabetes, wear...
An association between vitamin D deficiency and early dental implant failure is not properly verified, but its role in osteoimmunology is discussed. This article illustrates two case reports with vitamin D deficiency and early implant failure. Prior to implant placement, the first patient received crestal bone grafting with autologous material. Both patients received dental implants from different...
Fig. 7. Nine-year follow-up radiograph of the implants
Fig. 7. Nine-year follow-up radiograph of the implants
Fig. 6. Application of final fixed prosthesis
Fig. 6. Application of final fixed prosthesis
Fig. 5. Plate removal and insertion of two implants 6 months after grafting
Fig. 5. Plate removal and insertion of two implants 6 months after grafting
Fig. 4. Preoperative and postoperative radiograph
Fig. 4. Preoperative and postoperative radiograph
ed
Fig. 3. a A paracrestal incision was made on the buccal side, and horizontal and vertical osteotomies were made with a piezo-electric device. b Placement of the ramus bone block as an interpositional graft. c Ramus bone graft fixed
Fig. 2. Septa and thickened sinus membrane within maxillary sinus
Fig. 2. Septa and thickened sinus membrane within maxillary sinus
Fig. 1. Preoperative intraoral photograph and radiograph
Fig. 1. Preoperative intraoral photograph and radiograph
Tanaka, K., Sailer, I., Kataoka, Y. et al. Sandwich bone graft for vertical augmentation of the posterior maxillary region: a case report with 9-year follow-up. Int J Implant Dent 3, 20 (2017). https://doi.org/10.1186/s40729-017-0063-9
Download citation
Received: 15 October 2016
Accepted: 13 January 2017
Published: 19 May 2017
DOI: https://doi.org/10.1186/s40729-017-0063-9
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
Kenko Tanaka, Yoshihiro Kataoka, Shinnosuke Nogami & Tetsu Takahashi
Division of Fixed Prosthodontics and Biomaterials Clinic of Dental Medicine, University of Geneva, 19 rue Barthélemy-Menn, CH-1205, ...
The authors thank Atumu Kouketu for his figure illustration support and Kouhei Shinmyouzu for the clinical support.
Authors Kenko Tanaka, Irena Sailer, Yoshihiro Kataoka, Shinnosuke Nogami, and Tetsu Takahashi declare that they have no competing interests.
Thoma DS, Zeltner M, Hüsler J, Hämmerle CH, Jung RE, EAO Supplement Working Group 4 - EAO CC. Short implants versus sinus lifting with longer implants to restore the posterior maxilla: a systematic review. Clin Oral Implants Res. 2015;26:154–169.
Lee SA, Lee CT, Fu MM, Elmisalati W, Chuang SK. Systematic review and meta-analysis of randomized controlled trials for the management of limited ve...
Adell R, Brånemark PI. A 15-year study of osseointegrated implant in the treatment of the edentulous jaw. Int J Oral Maxillofac Surg. 1981;10:387–416.
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1:11–25.
Cordo L, Terheyden H. ITI treatment guide vo...
We described in the present case a vertical lack of the bone from the alveolar ridge to the opposing teeth, the short distance from the reabsorbed ridge to the floor of the maxillary sinus, and the presence of septa and a thickened sinus membrane within the maxillary sinus. A sandwich bone graft was successfully applied and followed up in the long term. The resulting gains in ridge height and incr...
In this case, the alveolar ridge was Seibert class II, and septa and a thickened sinus membrane were evident within the maxillary sinus. Sinus floor elevation was limited because of the condition of the floor morphology, the presence of septa, and the thickness of sinus floor membrane [22, 23]. Considering these issues, we selected the interpositional bone graft technique using autologous bone in ...
This paper reports on a segmental osteotomy procedure with an interpositional graft in the posterior maxillary region with 9 years of follow-up.
The techniques used to overcome a lack of alveolar bone height rely on the placement supplemented by various vertical guided bone regeneration (GBR) procedures [4, 5] and the use of alveolar distraction osteogenesis [6], titanium mesh [7], or onlay bone...
Six months after surgery, radiological examinations were carried out and the patient underwent implant placement (Fig. 4). The postoperative bone height had increased to 10.1 mm at position 26 and 12.9 mm at position 27 compared with the preoperative heights of 6.1 and 7.5 mm, respectively. Postoperative clearance was reduced by 11 mm compared with the preoperative clearance. Careful separati...
A 67-year-old male patient sought implant rehabilitation for the purposes of restoration of occlusal support and assistance with chewing difficulties. Clinical and radiological examinations revealed that teeth were absent 26–27. The clearance from the alveolar ridge to the opposing teeth was 20 mm (Fig. 1). A CT scan showed that the distance from the reabsorbed ridge to the floor of the maxill...
In the literature, the technique of segmental osteotomy accompanied by interpositional grafting has been reported as a practical and predictable procedure with a low incidence of complications and a high probability of success [15,16,17,18,19]. This approach leaves the soft tissue on the oral side of the midcrestal incision attached to the crestal bone segment. Various studies have shown that alve...
Osseointegrated implants for the replacement of missing teeth have recently become a routine treatment option [1, 2]. However, any tooth loss may be followed by extensive resorption of the alveolar ridge, which usually makes implant placement difficult or impossible because of the lack of bone volume. There are a variety of defect situations with increasing complexity, ranging from fenestrations, ...
The loss of teeth followed by bone resorption often lead to defects in the alveolar ridge, making installation of dental implants difficult. Correction of such bone defects, especially lack of height of the ridge, is a difficult problem for all dental surgeons. This report describes the outcome of treatment after alveolar ridge augmentation in the atrophic posterior maxillary region via segmental ...
Tanaka, K., Sailer, I., Kataoka, Y. et al. Sandwich bone graft for vertical augmentation of the posterior maxillary region: a case report with 9-year follow-up.
Int J Implant Dent 3, 20 (2017). https://doi.org/10.1186/s40729-017-0063-9
Download citation
Received: 15 October 2016
Accepted: 13 January 2017
Published: 19 May 2017
DOI: https://doi.org/10.1186/s40729-017-0063-...
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...
Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
Kenko Tanaka, Yoshihiro Kataoka, Shinnosuke Nogami & Tetsu Takahashi
Division of Fixed Prosthodontics and Biomaterials Clinic of Dental Medicine, University of Geneva, 19 rue Barthélemy-Menn, CH-1205, ...
The authors thank Atumu Kouketu for his figure illustration support and Kouhei Shinmyouzu for the clinical support.
Authors Kenko Tanaka, Irena Sailer, Yoshihiro Kataoka, Shinnosuke Nogami, and Tetsu Takahashi declare that they have no competing interests.
Thoma DS, Zeltner M, Hüsler J, Hämmerle CH, Jung RE, EAO Supplement Working Group 4 - EAO CC. Short implants versus sinus lifting with longer implants to restore the posterior maxilla: a systematic review. Clin Oral Implants Res. 2015;26:154–169.
Lee SA, Lee CT, Fu MM, Elmisalati W, Chuang SK. Systematic review and meta-analysis of randomized controlled trials for the management of limited ve...
Adell R, Brånemark PI. A 15-year study of osseointegrated implant in the treatment of the edentulous jaw. Int J Oral Maxillofac Surg. 1981;10:387–416.
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1:11–25.
Cordo L, Terheyden H. ITI treatment guide vo...
We described in the present case a vertical lack of the bone from the alveolar ridge to the opposing teeth, the short distance from the reabsorbed ridge to the floor of the maxillary sinus, and the presence of septa and a thickened sinus membrane within the maxillary sinus. A sandwich bone graft was successfully applied and followed up in the long term. The resulting gains in ridge height and incr...
In this case, the alveolar ridge was Seibert class II, and septa and a thickened sinus membrane were evident within the maxillary sinus. Sinus floor elevation was limited because of the condition of the floor morphology, the presence of septa, and the thickness of sinus floor membrane [22, 23]. Considering these issues, we selected the interpositional bone graft technique using autologous bone in ...
This paper reports on a segmental osteotomy procedure with an interpositional graft in the posterior maxillary region with 9 years of follow-up.
The techniques used to overcome a lack of alveolar bone height rely on the placement supplemented by various vertical guided bone regeneration (GBR) procedures [4, 5] and the use of alveolar distraction osteogenesis [6], titanium mesh [7], or onlay bone...
Six months after surgery, radiological examinations were carried out and the patient underwent implant placement (Fig. 4). The postoperative bone height had increased to 10.1 mm at position 26 and 12.9 mm at position 27 compared with the preoperative heights of 6.1 and 7.5 mm, respectively. Postoperative clearance was reduced by 11 mm compared with the preoperative clearance. Careful separati...
A 67-year-old male patient sought implant rehabilitation for the purposes of restoration of occlusal support and assistance with chewing difficulties. Clinical and radiological examinations revealed that teeth were absent 26–27. The clearance from the alveolar ridge to the opposing teeth was 20 mm (Fig. 1). A CT scan showed that the distance from the reabsorbed ridge to the floor of the maxill...
In the literature, the technique of segmental osteotomy accompanied by interpositional grafting has been reported as a practical and predictable procedure with a low incidence of complications and a high probability of success [15,16,17,18,19]. This approach leaves the soft tissue on the oral side of the midcrestal incision attached to the crestal bone segment. Various studies have shown that alve...
Osseointegrated implants for the replacement of missing teeth have recently become a routine treatment option [1, 2]. However, any tooth loss may be followed by extensive resorption of the alveolar ridge, which usually makes implant placement difficult or impossible because of the lack of bone volume. There are a variety of defect situations with increasing complexity, ranging from fenestrations, ...
The loss of teeth followed by bone resorption often lead to defects in the alveolar ridge, making installation of dental implants difficult. Correction of such bone defects, especially lack of height of the ridge, is a difficult problem for all dental surgeons. This report describes the outcome of treatment after alveolar ridge augmentation in the atrophic posterior maxillary region via segmental ...
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
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
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Received: 27 February 2017
Accepted: 22 May 2017
Published: 01 June 2017
DOI: https://doi...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
Andreas Sakkas, Frank Wilde, Marcus Heufelder & Alexander Schramm
Institute of Anatomy, Medical Faculty of Leipzig University, Leipzig, Germany
Karsten Winter
Department of Oral and Plastic Maxillofacial Surgery, University Hospit...
The authors thank the patients for their kindness to participate as study cases and the whole medical team at the Bundeswehrkrankenhaus Ulm.
AS participated in its design and coordination, carried out the data selection, and drafted the manuscript, and is the corresponding author. FW participated in its design and coordination and helped in drafting the manuscript. MH participated in its design a...
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 ...
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
...
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. 7. ing a trephine bur. a Overview image of coronal-apical cut through the entire core biopsy showing formation of new bone (NB) next to old bone of the extraction socket (B). easy-graft CRYSTAL particles (Gr) are embedded in well perfused connective tissue (CT) and new bone (NB) (Azur II and Pararosanilin, original magnification ×50). b Integration of easy-graft CRYSTAL particle (Gr) into ...
Fig. 6. ntegration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 6. a–c Four-month postoperative CBCT showing graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 4. excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 4. a Second stage surgery followed by impression making. Note the excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 2. ssue approximation. A good width of keratinized tissue is visible along with ridge preservation. Ready for implant placement in the grafted areas. b Implant placed in 45 area. Core biopsy sample taken from area 46. Note the integration of graft particles in the preserved alveolar ridge also inside the osteotomy site of 46. c Two Xive (Dentsply) implants placed in the preserved ridge. d. ...
Fig. 1. ft tissue and no flap reflection on the surgical site. c Graft material condensed into the extraction sockets showing good initial graft stability. d Black silk sutures placed with tissue approximation and no releasing incision in the flaps
Fig. 1. a Clinical occlusal view with fractured 45 and 46. b Post-extraction view of the socket. Note minimal trauma to the soft tissue and no fla...
Patient no.
Gender
Patient’s age
Tooth no.
Time post extraction [month]
% New bone
...
Patient no.
Tooth no.
Ridge width baseline [mm]
Ridge width implant placement [mm]
Ridge width changes [mm]
...
ISQ level at implant placement
ISQ level at loading
Patient no.
Tooth no.
Buccal
Palatal
...
Kakar, A., Rao, B.H.S., Hegde, S. et al. Ridge preservation using an in situ hardening biphasic calcium phosphate (β-TCP/HA) bone graft substitute—a clinical, radiological, and histological study.
Int J Implant Dent 3, 25 (2017). https://doi.org/10.1186/s40729-017-0086-2
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Received: 31 December 2016
Accepted: 25 May 2017
Published: 22 June 2017
DOI: htt...
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...
Correspondence to
Ashish Kakar.
Yenepoya University Dental College, University Road, Mangalore, 575018, India
Ashish Kakar, Bappanadu H. Sripathi Rao & Shashikanth Hegde
Dental Foundations and Research Centre, Malad, Mumbai, 400064, India
Nikhil Deshpande
Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
Annette ...
We acknowledge Sunstar Suisse SA, Etoy, Switzerland, for partly supporting this clinical study with a study grant. The authors declare that there is no conflict of interest regarding the publication of this paper.
Ashish Kakar, Bappanadu H. Sripathi Rao, Shashikanth Hegde, Nikhil Deshpande, Annette Lindner, Heiner Nagursky, Aditya Patney, and Harsh Mahajan declare that they have no competing inte...
Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012;23 Suppl 5:39–66.
Smukler H, Landi L, Setayesh R. Hostomorphometric evaluation of extraction sockets and deficient alveolar ridges treated with allografts and barrier membrane. A pilot study. In...
Nair PNR, Luder H-U, Maspero FA, Fischer JH, Schug J. Biocompatibility of beta-tricalcium phosphateroot replicas in porcine tooth extraction sockets—a correlativehistological, ultrastructural, and x-ray microanalytical pilotstudy. J Biomater Appl. 2006;20(4):307–24.
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different...
Araujo MG, Sukekava F, Wennstrom J, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005;32:645–52.
Van der Weijden F, Dell'Acqua F, Slot DE DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048–58.
Schropp L, Wenzel A, Kos...
The results of this clinical study support the use of a biphasic in situ hardening alloplastic bone graft substitute for ridge preservation in intact post-extraction sites without the use of a dental membrane. Therefore, grafting of sockets without primary wound closure or using dental membranes or a soft tissue punch can be an effective minimally invasive method of preserving the contour and arch...
Likewise, the reported amount of residual grafting material in the defect site was similar. In average, only 26.2 ± 9.4% of the defect was occupied with residual graft material in this study which is well in line with 26.6 ± 5.2% reported for BCP but below the 37.7 ± 8.5% reported for xenograft [14].
All 15 implants could be placed without the need for additional bone augmentation....
As previously reported, secondary intention soft tissue healing of grafted post-extraction sites can be well achieved when using an in situ hardening and in situ stabilizing bone graft substitutes without the need of a dental membrane [18, 20]. Findings of the present report corroborate these results. The authors found that all sites healed uneventfully with coverage of soft tissue and no local co...
Ridge preservation following dental extractions is fundamental, preserving the ridge profile for subsequent implant placement and providing a sustained function and esthetics. This clinical trial reports on the successful application of an in situ hardening biphasic alloplastic bone graft substitute for ridge preservation and subsequent implant placement in 15 healthy patients. A routine but minim...
Cone beam computer tomography (CBCT) was performed before tooth extraction and at the time point of implant placement. Mean ridge width reduction before tooth extraction to implant placement was calculated to effect in 0.79 ± 0.73 mm horizontal bone loss (Table 2). Primary implant stability was achieved in all 15 cases, showed in average high ISQ levels 70.3 ± 9.7 (buccal/palatal), and...
Fifteen patients (4 females and 11 males) with a mean age of 51.3 + 14.8 years (range: 27 to 75 years) participated in this randomized clinical trial. The site specific areas and teeth numbers for the study are shown in Table 1.
In all cases, the postoperative healing was uneventful. Clinically, the soft tissue healing pattern observed was very similar in all cases. The soft tissue on all ...
Bone biopsies were harvested using a trephine bur at the site of implant placement. The trephine burs including the bone biopsies were fixed in 4% formalin for 5–7 days, rinsed in water, and dehydrated in serial steps of ethanol (70, 80, 90, and 100%), remaining for 1 day in each concentration. Specimens were then infiltrated, embedded, and polymerized in resin (Technovit 9100, Heraeus Kulzer,...
Antibiotic therapy consisting of 1 g amoxicillin every 12 h for 4 days and mouth rinsing with 0.2% chlorhexidine every 8 h for 10 days were prescribed. The suture was removed 1 week postoperatively. After 3 to 8 months (average 5.2 ± 2 months), the sites (Fig. 2a) were reentered for implant placement. A site-specific full thickness mucoperiosteal flap was elevated to expose the regen...
This study was approved by the Yenepoya University Ethics committee, Mangalore, India (Approval Number YOEC83/8/3/2014). Fifteen patients who required extraction of a maxillary or mandibular tooth and subsequent single-tooth implant placement and who met the inclusion and exclusion criteria were included in this prospective single-arm clinical study. The patients (4 females and 11 males) had a mea...
To our knowledge, this is the first systematic clinical, radiographic, and histological evaluation that assesses bone formation and ridge width preservation after socket grafting using an in situ hardening biphasic bone graft substitute in healthy patients.
Following tooth extraction, the alveolar ridge will decrease in volume and change its morphology [1, 2]. These changes are clinically significant [3] and can complicate the placement of a conventional bridge or an implant-supported crown. Post-extraction maintenance of the alveolar ridge following the principles of ridge preservation using bone graft substitutes minimizes ridge resorption and, thu...
Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/β-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane.
A total of 15 patients reported for tooth extraction were enrolled in t...
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...
Tanaka, K., Sailer, I., Kataoka, Y. et al. Sandwich bone graft for vertical augmentation of the posterior maxillary region: a case report with 9-year follow-up.
Int J Implant Dent 3, 20 (2017). https://doi.org/10.1186/s40729-017-0063-9
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Received: 15 October 2016
Accepted: 13 January 2017
Published: 19 May 2017
DOI: https://doi.org/10.1186/s40729-017-0063-...
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...
Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
Kenko Tanaka, Yoshihiro Kataoka, Shinnosuke Nogami & Tetsu Takahashi
Division of Fixed Prosthodontics and Biomaterials Clinic of Dental Medicine, University of Geneva, 19 rue Barthélemy-Menn, CH-1205, ...
The authors thank Atumu Kouketu for his figure illustration support and Kouhei Shinmyouzu for the clinical support.
Authors Kenko Tanaka, Irena Sailer, Yoshihiro Kataoka, Shinnosuke Nogami, and Tetsu Takahashi declare that they have no competing interests.
Thoma DS, Zeltner M, Hüsler J, Hämmerle CH, Jung RE, EAO Supplement Working Group 4 - EAO CC. Short implants versus sinus lifting with longer implants to restore the posterior maxilla: a systematic review. Clin Oral Implants Res. 2015;26:154–169.
Lee SA, Lee CT, Fu MM, Elmisalati W, Chuang SK. Systematic review and meta-analysis of randomized controlled trials for the management of limited ve...
Adell R, Brånemark PI. A 15-year study of osseointegrated implant in the treatment of the edentulous jaw. Int J Oral Maxillofac Surg. 1981;10:387–416.
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1:11–25.
Cordo L, Terheyden H. ITI treatment guide vo...
We described in the present case a vertical lack of the bone from the alveolar ridge to the opposing teeth, the short distance from the reabsorbed ridge to the floor of the maxillary sinus, and the presence of septa and a thickened sinus membrane within the maxillary sinus. A sandwich bone graft was successfully applied and followed up in the long term. The resulting gains in ridge height and incr...
In this case, the alveolar ridge was Seibert class II, and septa and a thickened sinus membrane were evident within the maxillary sinus. Sinus floor elevation was limited because of the condition of the floor morphology, the presence of septa, and the thickness of sinus floor membrane [22, 23]. Considering these issues, we selected the interpositional bone graft technique using autologous bone in ...
This paper reports on a segmental osteotomy procedure with an interpositional graft in the posterior maxillary region with 9 years of follow-up.
The techniques used to overcome a lack of alveolar bone height rely on the placement supplemented by various vertical guided bone regeneration (GBR) procedures [4, 5] and the use of alveolar distraction osteogenesis [6], titanium mesh [7], or onlay bone...
Six months after surgery, radiological examinations were carried out and the patient underwent implant placement (Fig. 4). The postoperative bone height had increased to 10.1 mm at position 26 and 12.9 mm at position 27 compared with the preoperative heights of 6.1 and 7.5 mm, respectively. Postoperative clearance was reduced by 11 mm compared with the preoperative clearance. Careful separati...
A 67-year-old male patient sought implant rehabilitation for the purposes of restoration of occlusal support and assistance with chewing difficulties. Clinical and radiological examinations revealed that teeth were absent 26–27. The clearance from the alveolar ridge to the opposing teeth was 20 mm (Fig. 1). A CT scan showed that the distance from the reabsorbed ridge to the floor of the maxill...
In the literature, the technique of segmental osteotomy accompanied by interpositional grafting has been reported as a practical and predictable procedure with a low incidence of complications and a high probability of success [15,16,17,18,19]. This approach leaves the soft tissue on the oral side of the midcrestal incision attached to the crestal bone segment. Various studies have shown that alve...
Osseointegrated implants for the replacement of missing teeth have recently become a routine treatment option [1, 2]. However, any tooth loss may be followed by extensive resorption of the alveolar ridge, which usually makes implant placement difficult or impossible because of the lack of bone volume. There are a variety of defect situations with increasing complexity, ranging from fenestrations, ...
The loss of teeth followed by bone resorption often lead to defects in the alveolar ridge, making installation of dental implants difficult. Correction of such bone defects, especially lack of height of the ridge, is a difficult problem for all dental surgeons. This report describes the outcome of treatment after alveolar ridge augmentation in the atrophic posterior maxillary region via segmental ...
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
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Received: 27 February 2017
Accepted: 22 May 2017
Published: 01 June 2017
DOI: https://doi...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
Andreas Sakkas, Frank Wilde, Marcus Heufelder & Alexander Schramm
Institute of Anatomy, Medical Faculty of Leipzig University, Leipzig, Germany
Karsten Winter
Department of Oral and Plastic Maxillofacial Surgery, University Hospit...
The authors thank the patients for their kindness to participate as study cases and the whole medical team at the Bundeswehrkrankenhaus Ulm.
AS participated in its design and coordination, carried out the data selection, and drafted the manuscript, and is the corresponding author. FW participated in its design and coordination and helped in drafting the manuscript. MH participated in its design a...
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 ...
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. 7. image of coronal-apical cut through the entire core biopsy showing formation of new bone (NB) next to old bone of the extraction socket (B). easy-graft CRYSTAL particles (Gr) are embedded in well perfused connective tissue (CT) and new bone (NB) (Azur II and Pararosanilin, original magnification ×50). b Integration of easy-graft CRYSTAL particle (Gr) into newly formed bone (NB) and conn...
Fig. 6. graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 6. a–c Four-month postoperative CBCT showing graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 4. lant crowns placed and loaded after 3 months of placement
Fig. 4. a Second stage surgery followed by impression making. Note the excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 2. ximation. A good width of keratinized tissue is visible along with ridge preservation. Ready for implant placement in the grafted areas. b Implant placed in 45 area. Core biopsy sample taken from area 46. Note the integration of graft particles in the preserved alveolar ridge also inside the osteotomy site of 46. c Two Xive (Dentsply) implants placed in the preserved ridge. d. Postoperat...
Fig. 1. traction sockets showing good initial graft stability. d Black silk sutures placed with tissue approximation and no releasing incision in the flaps
Fig. 1. a Clinical occlusal view with fractured 45 and 46. b Post-extraction view of the socket. Note minimal trauma to the soft tissue and no flap reflection on the surgical site. c Graft material condensed into the extraction sockets sho...
Patient no.
Gender
Patient’s age
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Time post extraction [month]
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Tooth no.
Ridge width baseline [mm]
Ridge width implant placement [mm]
Ridge width changes [mm]
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ISQ level at implant placement
ISQ level at loading
Patient no.
Tooth no.
Buccal
Palatal
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Kakar, A., Rao, B.H.S., Hegde, S. et al. Ridge preservation using an in situ hardening biphasic calcium phosphate (β-TCP/HA) bone graft substitute—a clinical, radiological, and histological study.
Int J Implant Dent 3, 25 (2017). https://doi.org/10.1186/s40729-017-0086-2
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Received: 31 December 2016
Accepted: 25 May 2017
Published: 22 June 2017
DOI: htt...
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...
Correspondence to
Ashish Kakar.
Yenepoya University Dental College, University Road, Mangalore, 575018, India
Ashish Kakar, Bappanadu H. Sripathi Rao & Shashikanth Hegde
Dental Foundations and Research Centre, Malad, Mumbai, 400064, India
Nikhil Deshpande
Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
Annette ...
We acknowledge Sunstar Suisse SA, Etoy, Switzerland, for partly supporting this clinical study with a study grant. The authors declare that there is no conflict of interest regarding the publication of this paper.
Ashish Kakar, Bappanadu H. Sripathi Rao, Shashikanth Hegde, Nikhil Deshpande, Annette Lindner, Heiner Nagursky, Aditya Patney, and Harsh Mahajan declare that they have no competing inte...
Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012;23 Suppl 5:39–66.
Smukler H, Landi L, Setayesh R. Hostomorphometric evaluation of extraction sockets and deficient alveolar ridges treated with allografts and barrier membrane. A pilot study. In...
Nair PNR, Luder H-U, Maspero FA, Fischer JH, Schug J. Biocompatibility of beta-tricalcium phosphateroot replicas in porcine tooth extraction sockets—a correlativehistological, ultrastructural, and x-ray microanalytical pilotstudy. J Biomater Appl. 2006;20(4):307–24.
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different...
Araujo MG, Sukekava F, Wennstrom J, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005;32:645–52.
Van der Weijden F, Dell'Acqua F, Slot DE DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048–58.
Schropp L, Wenzel A, Kos...
The results of this clinical study support the use of a biphasic in situ hardening alloplastic bone graft substitute for ridge preservation in intact post-extraction sites without the use of a dental membrane. Therefore, grafting of sockets without primary wound closure or using dental membranes or a soft tissue punch can be an effective minimally invasive method of preserving the contour and arch...
Likewise, the reported amount of residual grafting material in the defect site was similar. In average, only 26.2 ± 9.4% of the defect was occupied with residual graft material in this study which is well in line with 26.6 ± 5.2% reported for BCP but below the 37.7 ± 8.5% reported for xenograft [14].
All 15 implants could be placed without the need for additional bone augmentation....
As previously reported, secondary intention soft tissue healing of grafted post-extraction sites can be well achieved when using an in situ hardening and in situ stabilizing bone graft substitutes without the need of a dental membrane [18, 20]. Findings of the present report corroborate these results. The authors found that all sites healed uneventfully with coverage of soft tissue and no local co...
Ridge preservation following dental extractions is fundamental, preserving the ridge profile for subsequent implant placement and providing a sustained function and esthetics. This clinical trial reports on the successful application of an in situ hardening biphasic alloplastic bone graft substitute for ridge preservation and subsequent implant placement in 15 healthy patients. A routine but minim...
Cone beam computer tomography (CBCT) was performed before tooth extraction and at the time point of implant placement. Mean ridge width reduction before tooth extraction to implant placement was calculated to effect in 0.79 ± 0.73 mm horizontal bone loss (Table 2). Primary implant stability was achieved in all 15 cases, showed in average high ISQ levels 70.3 ± 9.7 (buccal/palatal), and...
Fifteen patients (4 females and 11 males) with a mean age of 51.3 + 14.8 years (range: 27 to 75 years) participated in this randomized clinical trial. The site specific areas and teeth numbers for the study are shown in Table 1.
In all cases, the postoperative healing was uneventful. Clinically, the soft tissue healing pattern observed was very similar in all cases. The soft tissue on all ...
Bone biopsies were harvested using a trephine bur at the site of implant placement. The trephine burs including the bone biopsies were fixed in 4% formalin for 5–7 days, rinsed in water, and dehydrated in serial steps of ethanol (70, 80, 90, and 100%), remaining for 1 day in each concentration. Specimens were then infiltrated, embedded, and polymerized in resin (Technovit 9100, Heraeus Kulzer,...
Antibiotic therapy consisting of 1 g amoxicillin every 12 h for 4 days and mouth rinsing with 0.2% chlorhexidine every 8 h for 10 days were prescribed. The suture was removed 1 week postoperatively. After 3 to 8 months (average 5.2 ± 2 months), the sites (Fig. 2a) were reentered for implant placement. A site-specific full thickness mucoperiosteal flap was elevated to expose the regen...
This study was approved by the Yenepoya University Ethics committee, Mangalore, India (Approval Number YOEC83/8/3/2014). Fifteen patients who required extraction of a maxillary or mandibular tooth and subsequent single-tooth implant placement and who met the inclusion and exclusion criteria were included in this prospective single-arm clinical study. The patients (4 females and 11 males) had a mea...
To our knowledge, this is the first systematic clinical, radiographic, and histological evaluation that assesses bone formation and ridge width preservation after socket grafting using an in situ hardening biphasic bone graft substitute in healthy patients.
Following tooth extraction, the alveolar ridge will decrease in volume and change its morphology [1, 2]. These changes are clinically significant [3] and can complicate the placement of a conventional bridge or an implant-supported crown. Post-extraction maintenance of the alveolar ridge following the principles of ridge preservation using bone graft substitutes minimizes ridge resorption and, thu...
Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/β-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane.
A total of 15 patients reported for tooth extraction were enrolled in t...
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...
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Grafted ridge width
Ridge width at the re-entry
Grafted ridge reduction (mm)
Exposed (test)
...
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Ridge width at re-entry (mm)
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...
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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...
Fig. 1. Search strategy for BMAC
Fig. 1. Search strategy for BMAC
Study
Treatment groups
No. of patients (age range)
No. of maxillary sinuses evaluated
Donor site for BMAC
C...
Study
de Oliveira et al. [12]
Pasquali et al. [7]
Payer et al. [2]
Sauerbier et al. [11]
...
Ting, M., Afshar, P., Adhami, A. et al. Maxillary sinus augmentation using chairside bone marrow aspirate concentrates for implant site development: a systematic review of histomorphometric studies.
Int J Implant Dent 4, 25 (2018). https://doi.org/10.1186/s40729-018-0137-3
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Received: 20 February 2018
Accepted: 21 May 2018
Published: 03 September 2018
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 m...
This is a systematic review of published data; no patients were involved in the conduct of this review.
Miriam Ting, Philip Afshar, Arik Adhami, Stanton M. Braid, and Jon B. Suzuki declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Miriam Ting.
Private practice in Periodontology, and Think Dental Learning Institute, Paoli, PA, 19301, USA
Miriam Ting
Temple University Kornberg School of Dentistry, 3223 North Broad Street, Philadelphia, PA, 19140, USA
Philip Afshar & Arik Adhami
Division of Oral and Maxillofacial Surgery, Department of Oral Medicine, Pathology and Surgery, Temple University Kornberg School of Dentistry, 3223 North Br...
All the data generated during this systematic review were included in this manuscript.
Rooney AA, Boyles AL, Wolfe MS, Bucher JR, Thayer KA. Systematic review and evidence integration for literature-based environmental health science assessments. Environ Health Perspect. 2014;122(7):711–8.
Sauerbier S, Rickert D, Gutwald R, Nagursky H, Oshima T, Xavier SP, et al. Bone marrow concentrate and bovine bone mineral for sinus floor augmentation: a controlled, randomized, single-blinded...
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30(2):207–29.
Payer M, Lohberger B, Strunk D, Reich KM, Acham S, Jakse N. Effects of directly autotransplanted tibial bone marrow aspirates on bone regeneration and osseointegration of dental implants. Clin Oral Implants Res. 2014;25(4):468–74.
Chaushu G, Vered M, Mardinger O, Nissan J. Histomorphometric analysis a...
Bone marrow aspirate concentrate
Confidence limits
Ethylenediaminetetraacetic acid
Technique involving bone marrow-derived mononuclear cell isolation by synthetic polysaccharide
Mononuclear cells
Mesenchymal stem cells
Office of Health Assessment and Translation
Standard deviation
Within the limits of this systematic review, the chairside method to harvest BMAC is a viable option for maxillary sinus augmentation for implant site development. The implant survival of the BMAC group was similar to the laboratory FICOLL concentration of BMAC group, without the additional cost and time of laboratory cell isolation techniques. Single or double centrifugation of BMAC does not appe...
In addition, the parameters to evaluate new bone formation were variable. New bone formation and percentage of vital bone are different methods to measure bone formation, and the data from different methods could not be combined or analyzed together. Furthermore, the BMAC evaluated in test groups were prepared differently and were harvested from different sources (tibia or iliac). The control grou...
Although the variations of the materials and methods for BMAC preparation were discussed, this review was not aimed to compare materials and methods for BMAC preparation, but rather the end clinical result for new bone formation and implant survival. Although implant survival and new bone formation were not the only parameters to consider when evaluating sinus augmentation, these parameters were t...
It appears that BMAC offers no statistically significant advantage for regeneration of bone in the maxillary sinus for site preparation of dental implants. BMAC + bovine bone graft results in similar regeneration outcome measures histologically as alveolar bone alone at 3–4 months. Measured histomorphometrically MSCs treated by FICOLL–Hypaque centrifugation to consolidate osteogenic and osteo...
Pasquali et al. [7], in eight patients compared BMAC + bovine bone graft (test group) with bovine bone graft alone (control group). New bone (55.15%) was reported in the test group compared with new bone (27.3%) in the control group based on histomorphometric analyses. This reported observation indicating statistically more new bone regeneration in the BMAC + bovine bone graft group compared with ...
Sauerbier et al. [14] further compared BMAC + bovine bone grafts (test group) with alveolar bone, autologous + bovine bone grafts (control group) for maxillary sinus site preparation. New bone (31.3%) for the test group compared with new bone (19.3%) for the control group statistically indicated equivalence in histomorphometric outcome. Histologic images showing impressive new bone formation were ...
Mesenchymal stem cells (MSCs) in BMAC have the potential to renew, experience clonal expansion, and differentiate into musculoskeletal tissues [16]. MSCs are also known to have an immunoregulatory role and may enhance the normal healing response and angiogenesis [10]. BMAC has been used in bone, cartilage, and tendon injuries with encouraging results [16]. BMAC is a minimally invasive procedure, a...
The search generated 797 reviews in PubMed, 114 in Web of Science, 97 in Cochrane Library, and 319 in Google Scholar (Fig. 1). The following were selected after the title and abstract screening: 18 were selected from PubMed, 23 from Web of Science, 6 from Cochrane Library, 2 from Google Scholar, and 2 from hand searching the reference list of the selected article. After the duplicates were remove...
What are the histomorphometric outcomes of sinus augmentation with bone marrow aspirate concentrates obtained chairside?
PubMed, Web of Science, Cochrane Library, and Google Scholar were searched up to January 2017. Google scholar was searched for gray literature. The following keywords were used: “bone marrow aspirate concentrates,” “stem cells,” “histomorphometric,” and “bone graf...
Maxillary sinus augmentation is indicated when there is an inadequate vertical alveolar bone height to effectively support surgically placed dental implants. The sinus elevation procedure requires grafting bone material onto the sinus floor to regenerate sufficient vertical alveolar bone height [1, 2]. The ideal bone grafting material should be biocompatible, possess no risk of disease transmissio...
Maxillary sinus pneumatization following dental tooth extractions and maxillary alveolar bone resorption frequently leaves inadequate bone levels for implant placement. The objectives of this systematic review are to evaluate the effects of bone marrow aspirate concentrates (BMACs) used in maxillary sinus augmentation for implant site development.
A systematic search was conducted using PubMed, E...
Maiorana, C., Pivetti, L., Signorino, F. et al. The efficacy of a porcine collagen matrix in keratinized tissue augmentation: a 5-year follow-up study.
Int J Implant Dent 4, 1 (2018). https://doi.org/10.1186/s40729-017-0113-3
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Received: 06 September 2017
Accepted: 20 December 2017
Published: 10 January 2018
DOI: https://doi.org/10.1186/s40729-017-0113-3
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...
This study was conducted in compliance with the principles of the Declaration of Helsinki, and the approval of the ethics committee required for the study was obtained from the Ethics Committee of the IRCCS Ospedale Maggiore Policlinico di Milano, Fondazione Ca’ Granda. The procedures to be performed were explained in detail, and the patients signed the consent form.
Carlo Maiorana, Luca Pivett...
Correspondence to
F. Signorino.
Oral Surgery, Center for Edentulism and Jaw Atrophies, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda—Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
C. Maiorana
Center for Edentulism and Jaw Atrophies, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda—Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 10, 20122,...
The authors declare no funds for the research.
Schmitt CM, Moest T, Lutz R, Wehrhan F, Neukam FW, Schlegel KA. Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft®) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Impl Res. 2016;27:e125–33.
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Harris RJ. Gingival augmentation with an acellular dermal matrix: human histologic evaluation of a case—placement of the graft on periosteum. Int J Periodontics Restorative Dent. 2004;24(4):378–85.
Wei PC, Laurell L, Geivelis M, Lingen MW, Maddalozzo D. Acellular dermal matrix allografts to achieve increased attached gingiva. Part 1. A clinical study. J Periodontol. 2000;71(8):1297–305.
Ha...
Vignoletti F, Nuñez J, Discepoli N, De Sanctis F, Caffesse R, Muñoz F, et al. Clinical and histological healing of a new collagen matrix in combination with the coronally advanced flap for the treatment of Miller class-I recession defects: an experimental study in the minipig. J Clin Periodontol. 2011;38(9):847–55.
Jepsen K, Jepsen S, Zucchelli G, Stefanini M, de Sanctis M, Baldini N, et al. ...
Forman G. Presenile mandibular atrophy: its aetiology, clinical evaluation and treatment by jaw augmentation. Br J Oral Surg. 1976;14(1):47–56.
Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24(Suppl):237–59.
Grusovin MG, Coulthard P, Worthington HV, Esposito M. Maintaining and recovering soft tissue health around...
With the limits of this study, it can be assessed that the CM is an effective option for the keratinized tissue augmentation. The percentage of shrinkage of the graft is comparable to data recovered from other studies and does not represent a problem also after 5 years. The CM integration is slow and constant, providing the necessary scaffold to regenerate keratinized mucosa and ensuring a perfec...
The study was carried out to evaluate the efficacy of a xenogeneic CM when used as a soft tissue substitute in the reconstruction of an adequate amount (at least 2 mm) of keratinized tissue around dental implants. The xenogeneic CMs have already been investigated in order to check their compatibility and effectiveness as scaffold [19, 20]. One of the first studies was conducted by Schoo and Coppe...
A total of 15 patients were enrolled for the study, 12 females and 3 males, aged between 43 and 72 years old. Of these patients, 11 received surgery in the mandible and 4 in the maxilla. No complications were registered during surgeries and the immediate post-operative course was uneventful for all patients. At 1 year, 2 patients dropped out of the study: the first patient experienced a peri-imp...
Since a split-mouth design was not feasible and the defects being corrected by the mucosa particularly in the vestibular portion of the study are not usually symmetrical or bilateral, the use of paired subjects was not a reliable format. All the data were analyzed with IBM’s SPSS Statistics using ANOVA Repeated Measurements statistical method. Mean values for keratinized mucosal width and probin...
The primary endpoints were to evaluate the shrinkage degree of the width of keratinized mucosa and length of the re-epithelization process. The secondary endpoints assessed clinical evaluation of the grafted area, post-operative hemostatic effect, pain level, and length of surgery. Follow-up control visits were scheduled at 3 days after surgery and then 10 days, 2 weeks, 3 weeks, 1 month, 2 ...
The study was designed as a multicentered (Milan University—School of Dentistry/Loma Linda University—School of Dentistry) prospective observational (non-controlled) clinical study according to the STROBE criteria. The participants of the study presented areas of deficient attached and unattached mucosa precluding the construction of effective functioning prosthesis. The study included a total...
A variety of factors can lead to teeth loss. From periodontal disease to trauma, the bone remodeling that always follows this event can complicate the subsequent prosthetical rehabilitation [1]. Both removable and implant-fixed restorations require both an adequate quantity of bone and sorrounding soft tissue. Even in severe atrophies of the jaw, nowadays, many bone augmentation techniques are app...
When keratinized tissue width around dental implants is poorly represented, the clinician could resort to autogenous soft tissue grafting. Autogenous soft tissue grafting procedures are usually associated with a certain degree of morbidity. Collagen matrices could be used as an alternative to reduce morbidity and intra-operatory times. The aim of this study was to assess the efficacy of a xenogene...
Fig. 1. Treatment strategies for OAF closure
Fig. 1. Treatment strategies for OAF closure
Author year
No. of participants
Method
Autogenous soft tissue flaps
Lin et al. 1991
16
...
Parvini, P., Obreja, K., Sader, R. et al. Surgical options in oroantral fistula management: a narrative review.
Int J Implant Dent 4, 40 (2018). https://doi.org/10.1186/s40729-018-0152-4
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Received: 14 August 2018
Accepted: 02 November 2018
Published: 27 December 2018
DOI: https://doi.org/10.1186/s40729-018-0152-4
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...
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Puria Parvini, Karina Obreja, Robert Sader, Jürgen Becker, Frank Schwarz, and Loutfi Salti declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Karina Obreja.
Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
Puria Parvini, Karina Obreja, Frank Schwarz & Loutfi Salti
Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
Robert Sader
Department of Oral Surgery, Universitätsklinikum Düsseldorf,...
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No funding to declare.
All data generated or analyzed during this study are included in this published article.
Waldrop TC, Semba SE. Closure of oroantral communication using guided tissue regeneration and an absorbable gelatin membrane. J Periodontol. 1993;64:1061–6.
Götzfried HF, Kaduk B. Okklusion der Mund-Antrum-Verbindung durch eine: alkoholische Prolaminelösung; Tierexperimentelle Studie und erste klinische Erfahrungen. Dtsch Z Mund Kiefer Gesichts Chir. 1985;9:390.
Grzesiak-Janas G, Janas A. Co...
Shaker MA, Hindy AM, Mounir RM, Geaisa KM. Competent closure of chronic oroantral fistula with Zenoderm. Egypt Dent J. 1995;41:1237–42.
Ogunsalu C. A new surgical management for oro-antral communication: the resorbable guided tissue regeneration membrane—bone substitute sandwich technique. West Indian Med J. 2005;54:261–3.
Goldman EH, Stratigos GT, Arthur AL. Treatment of oroantral fistula...
Joshi A, Kostakis GC. An investigation of post-operative morbidity following iliac crest graft harvesting. Br Dent J. 2004;196:167–71.
Misch CM. Harvesting of ramus bone in conjunction with third molar removal for onlay grafting before placement of dental implants. J Oral Maxillofac Surg. 1999;57:1376–9.
Nkenke E, Radespiel-Tröger M, Wiltfang J, Schultze-Mosgau S, Winkler G, Neukam FW. Morb...
El-Hakim IE, El-Fakharany AM. The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication and palatal defects. J Laryngol Otol. 1999;113:834–8.
Singh J, Prasad K, Lalitha RM, Ranganath K. Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009. Oral Surg Oral Med O...
Awang MN. Closure of oroantral fistula. Int J Oral Maxillofac Surg. 1988;17:110–5.
Hynes W. Fistula in the hard palate following cleft surgery. Br J Plast Surg. 1957:377–84.
Genden EM, Lee BB, Urken ML. The palatal island flap for reconstruction of palatal and retromolar trigone defects revisited. Arch Otolaryngol Head Neck Surg. 2001;127(7):837–41.
Salins PC, Kishore SK. Anteriorly based...
Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula: experience with 27 cases. Am J Otolaryngol. 2003;24:221–3.
Borgonovo AE, Berardinelli FV, Favale M, Maiorana C. Surgical options in oroantral fistula treatment. Open Dent J. 2012;6:94–8.
Güven O. A clinical study on oroantral fistulae. J Craniomaxillofac Surg. 1998;26:267–71.
Amaratunga NADES. Oro-antral fistulae- a study of c...
Buccal fat pad
Bone graft transplantation
Connective tissue grafts
Free mucosal graft
Guided tissue regeneration
Oroantral fistula
Platelet-rich fibrin
By reviewing the literature, we can conclude that in selecting the surgical approach to close an oroantral fistula, different parameters have to be taken into account, including location and size of fistula as well as its relationship to the adjacent teeth, height of the alveolar ridge, persistence, sinus inflammation and the general health of the patient.
A small oroantral fistula of less than 5...
Logan and Coates described a procedure that provided closure of OAF in immunocompromised patients [74].
The oroantral fistula was de-epithelialized under local anesthesia, and the patient wore an acrylic surgical splint continuously for an 8-week period. The acrylic surgical splint covered the fistula and the edentulous area including the hard palate. The investigators reported complete healing o...
Use of guided tissue regeneration has been documented by Waldrop and Semba [71]. This method uses an absorbable gelatin membrane, allogenic bone graft material, and a nonresorbable expanded polytetrafluoroethylene (ePTFE) membrane. After flap reflection, an absorbable gelatin membrane is placed over the OAF with its edges on the bony margins of the perforation, which serve as a barrier for the bon...
The use of a bioabsorbable root analog made of β-tricalcium phosphate for closure of oroantral fistulas was proposed by Thoma et al. [68]. The root replicas were fabricated chair side, using a mold of the extracted tooth [10]. The investigators reported that the healing was uneventful. However, fragmentary roots or overly large defects prevent replica fabrication or accurate fitting of the analog...
Polymethylmethacrylate has been introduced as an alternative technique for closing OAFs [64]. After 24 h of immersion in a sterilizing solution, the polymethylmethacrylate plate is placed over the defect. Mucoperiosteal flaps are then replaced without attempting to cover the acrylic plate. The polymethylmethacrylate plate is removed as soon as the edges become exposed. One of the common disadvant...
Various synthetic materials have been used for OAF closures. Use of gold foil and gold plate for the closure of OAFs was reported for the first time by Goldman and Salman, respectively [59, 60]. It is a simplified technique for the closure of oroantral fistulas. The technique consists of elevating the mucoperiosteum to expose the bony margins of the fistula. Then, the opening is covered with an ov...
Multiple techniques have been described for the closure of OAFs using lyophilized fibrin glue of human origin [53]. In this technique, the fibrin glue is prepared and injected into the socket, together with the collagen sheet. Stajčić et al. stressed the importance of inserting the syringe above the floor of the antrum to protect the clot from airflow [53]. The technique is simple with few posto...
An autogenous bone graft and platelet-rich fibrin (PRF) membrane as a treatment strategy for closure of OAF has also been proposed [50]. PRF is a product of centrifuged blood. The biochemical components of PRF are well-known as factors acting synergistically in the healing process. This includes platelet-derived growth factor (PDGF), whose components are the reason why PRF has anti-inflammatory pr...
Recently, auricular cartilage graft has been used for the closure of OAFs. A full-thickness flap is raised at the defect site [47]. A semicircular incision is then made posteriorly over the conchal cartilage. The conchal cartilage with overlying perichondrium is exposed with a blunt dissection. The harvested auricular graft is then adapted on the defect site and sutured with the surrounding tissue...
A retromolar bone graft is a viable procedure for OAF closure. However, harvesting of a retromolar bone can occasionally be combined with removal of the third molar, which may affect acceptance of the procedure by patients [44]. When compared to chin bone grafts, the significant disadvantage of the retromolar donor area is the confined amount of bone available [45]. The incision is made medial to ...
The tongue is an excellent donor site for soft tissue defects of the oral cavity, due to its pliability, position, and abundant vascularity. Tongue flaps can be created from the ventral, dorsal, or lateral part of the tongue [36]. The surgical design of the flap is dictated by the location of the defect. A lateral tongue flap has been described as a suitable method for the closure of large OAF [37...
Free mucosal grafts (FMG) or connective tissue grafts (CTG) are suitable for the closure of small to moderate size defects in the premolar area as well as small to medium size-persistent defects. In contrast to the techniques described so far, the harvested grafts are not directly vascularized. The flap initially receives its nutrients within the first three postoperative days by diffusion alone, ...
The palatal straight advancement flap is of limited use due to the inelastic nature of the palatal tissue, which reduces its lateral mobility. For the same reason, it is suitable for the closure of minor palatal or alveolar defects [17].
The palatal hinged flap has been used successfully to close small fistula of the hard palate, i.e., those less than 2 cm in diameter in a one-stage operation [1...
Môczáir [14] described closing alveolar fistulas by the buccal sliding flap, shifting the flap one tooth distally. This technique produces only a negligible change in the depth of the buccal vestibule. A drawback of this approach is that it requires a large amount of dentogingival detachment in order to facilitate the shift, which may result in gingival recession and periodontal disease.
The fi...
A narrative literature review of articles and case reports for oroantral fistula has been conducted in the PubMed databases of published English literature. Articles published until April 2018 were reviewed. In addition to 262 articles on the closure of oroantral, 4 articles on the closure of antrooral fistula in humans, and 5 articles in animals, citations were referenced to identify further rele...
Radiologically, in the computed tomography (CT) or cone beam computed tomography (CBCT), the oroantral fistula might show as sinus floor discontinuity, opacification of the sinus, or communication between the oral cavity and the sinus. In addition, focal alveolar atrophy and associated periodontal disease may be observed [6]. In chronic OAF, there is generalized mucosal thickening. Recent studies ...
An oroantral fistula (OAF) can be defined as an epithelialized pathological unnatural communication between the oral cavity and the maxillary sinus [1]. The term oroantral fistula is used to indicate a canal lined by epithelium that may be filled with granulation tissue or polyposis of the sinus membrane [2]. They can arise as late sequelae from perforation and last at least 48–72 h. An oroantr...
Fig. 4. Statistical analysis for different variables. a Weighted mean survival rate. b Implant survival rate according to degree of penetration. c Analysis of clinical complications. d Analysis of radiographic complications
Fig. 4. Statistical analysis for different variables. a Weighted mean survival rate. b Implant survival rate according to degree of penetration. c Analysis of clinical com...
Fig. 3. Graphic representation of group 1 ≤ 4 mm penetration and group 2 > 4 mm penetrations
Fig. 3. Graphic representation of group 1 ≤ 4 mm penetration and group 2 > 4 mm penetrations
Fig. 1. Graphic representation of implants intruding sinus perforating or not the Schneiderian membrane
Fig. 1. Graphic representation of implants intruding sinus perforating or not the Schneiderian membrane
Fig. 2. PRISMA flowchart of the screening process
Fig. 2. PRISMA flowchart of the screening process
Reason for exclusion
Investigations
Study design (case series or case report)
Kim et al. (2017), Hatano et al. (2007)
Different grafting techn...
Author (year)
Study design
Follow-up (months)
N of patients
N of implants
Smokers
Le...
Clinical complications
Radiographic complications
Sinusitis
Thickening of Schneiderian membrane
Nasal bleeding, nasal obstruction, nasal secre...
Ragucci, G.M., Elnayef, B., Suárez-López del Amo, F. et al. Influence of exposing dental implants into the sinus cavity on survival and complications rate: a systematic review.
Int J Implant Dent 5, 6 (2019). https://doi.org/10.1186/s40729-019-0157-7
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Received: 09 October 2018
Accepted: 06 January 2019
Published: 05 February 2019
DOI: https://doi.org/10...
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...
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Gian Maria Ragucci, Basel Elnayef, Fernando Suárez López del Amo, Hom-Lay Wang, Federico Hernández-Alfaro, and Jordi Gargallo-Albiol declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Basel Elnayef.
Department of Oral and Maxillofacial Surgery, International University of Catalonia, C/Josep Trueta Sn, Sant Cugat del Vallés, C.P 08195, Barcelona, Spain
Gian Maria Ragucci, Basel Elnayef, Federico Hernández-Alfaro & Jordi Gargallo-Albiol
Department of Periodontics, University of Oklahoma Health Sciences Center – College of Dentistry, Oklahoma City, OK, USA
Fernando Suárez-López del ...
The authors want to thank Mr Juan Luis Gómez Martínez for the support in the statistical analysis.
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The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper.
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk factors of membrane perforation and postoperative complications in sinus floor elevation surgery: review of 407 augmentation procedures. J Oral Maxillofac Surg. 2015;73:1275–82.
Jung JA, Choi BH, Zhu SJ, Lee SH, Huh JY, You TM, Lee HJ, Li J. The effects of exposing dental implants to the maxillary sinus cavity on sinus complications....
Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus. J Oral Maxillofac Surg. 2006 Feb;64(2):277–82.
Anavi Y, Allon DM, Avishai G, Calderon S. Complications of maxillary sinus augmentations in a selective series of patients. Oral Surg Oral Med Oral Patho Oral RadiolEndod. 2008;106(1):34–8.
Van den Ber...
Curi MM, Cardoso CL, de Ribeiro C. Retrospective study of pterygoid implants in the atrophic posterior maxilla: implant and prosthesis survival rates up to 3 years. Int J Oral Maxillofac Implants. 2015;30(2):378–83.
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38(8):613–6.
Tatum H.Jr. Maxillary and sinus implant reconstructions....
Roccuzzo M, Bonino L, Dalmasso P, Aglietta M. Long-term results of a three arms prospective cohort study on implants in periodontally compromised patients: 10-year data around sandblasted and acid-etched (SLA) surface. Clin Oral Implants Res. 2014;25(10):1105–12.
Esposito M, Grusovin MG, Rees J, Karasoulos D, Felice P, Alissa R, Worthington H, Coulthard P. Effectiveness of sinus lift procedures...
The current review showed that the exposure of dental implants in the sinus cavity without the augmentation procedure or graft materials shows a high survival rate of 95.6%, without statistically significant differences according to the level of penetration (lower or higher to 4 mm). Changes in maxillary sinuses in relation to protruding implants within the sinus cavity do not statically affect ...
Consequently, it seems that maxillary sinus changes in relation to protruded implants inside the sinus cavity and does not statically affect to implant survival rate neither to clinical nor radiographic complications.
Several limitations could be described for the present review. Firstly, there is a lack of a control group in the included studies, to compare outcomes and complications, with impla...
Pneumatization of the maxillary sinus and resorption of the residual alveolar ridge following tooth extraction can compromise the dental implant placement. Similarly, extension of the dental implants inside the maxillary sinus cavity is not rare. Some studies have observed some differences in relation to the depth of the implant extension inside the sinus cavity. When the implants penetrate inside...
Seven studies [27,28,29,30,31,32,33] provide information on clinical complications with a global sample of 232 patients. Clinical complications among the different authors range from 0 to 14.3%, being the weighted mean complication rate 3.4% with an IC 95% [0 7.5] (Fig. 4c) Clinical complications analyzed in the studies were sinusitis, nasal bleeding, nasal obstruction, nasal secretion, mucopurul...
An initial screening yielded a total of 3551 publications of which 26 potentially relevant articles were selected after an evaluation of their titles and abstracts. Full text of these articles was obtained and evaluated thoroughly. Of these, eight articles [26,27,28,29,30,31,32,33] (Table 2) fulfilled the inclusion criteria and subsequently were included in the qualitative analysis (Fig. 2). Rea...
Heterogeneity was assessed based on calculation of the I2 statistic (percentage variability of estimated effect that can be attributed to the heterogeneity of the effects) and the null statistic test. Galbraith graphs displayed the degree of heterogeneity. In studies where great heterogeneity was detected, a sensitivity analysis was performed to determine its source. Funnel plots and the Egger tes...
Articles were included in this systematic review if they met the following inclusion criteria: human prospective or retrospective studies, reporting outcomes of implant placed perforating the sinus floor with implant burs, and without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material. The intrusion into the sinus cavity can occur during drilling or implant p...
This systematic review and subsequent meta-analysis follow the guidelines of the PRISMA statement.
The following focus question was developed: Is the intrusion of dental implants into the sinus cavity during implant drilling or implant placement, without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material, has an effect on implant survival or increase clinica...
Intrusion of dental implants into the maxillary sinus perforating through the Schneiderian membrane is considered a cause of undesirable complications [24, 25]. However, this phenomenon has never been properly evaluated and systematically studied. For this reason, the aim of this systematic review was to assess the implant survival and complication rates of implants intruding into the sinus cavity...
The edentulous posterior maxillary region often presents with unique challenging conditions in implant dentistry [1]. Limited bone height secondary to pneumatization of the maxillary sinus and the resorption of the alveolar ridge preclude in many instances the installation of dental implants. To compensate for the lack of bone height, several treatment options have been proposed.
The most conserv...
The overall survival rate of the implants into the sinus cavity was 95.6%, without statistical differences according to the level of penetration. The clinical and radiological complications were 3.4% and 14.8% respectively. The most frequent clinical complication was the epistaxis, and the radiological complication was thickening of the Schneiderian membrane, without reaching statistical significa...
After tooth loss, the posterior maxilla is usually characterized by limited bone height secondary to pneumatization of the maxillary sinus and/or collapse of the alveolar ridge that preclude in many instances the installation of dental implants. In order to compensate for the lack of bone height, several treatment options have been proposed. These treatment alternatives aimed at the installation o...
RDX
No RDX
Author
Year of publication
No. of implants placed into autogenous bone grafts with RDX (and failures)
Overall implant survival of implants placed into autogenous bone grafts with RDX
No. of patients who had implants placed into autogenous bone grafts with RDX (and failures)
Patient based implant survival of implant placed into autogenous bone grafts with RDX
No. of...
Non-vascularised bone graft
Vascularised bone graft
Author
Year of publication
No. of patients who had implants placed into non-vascularised autogenous bone grafts (and failures)
Overall patient implant survival in non-vascularised autogenous bone grafts
No. of implants placed into non-vascularised autogenous bone grafts (and failures)
Overall implant survival in non-vasculari...
Implant survival
Implant success
Author
Year of publication
Donor site of autogenous bone graft
Radiotherapy/chemotherapy to bone graft site
Complications
No. of patients who had implants placed into autogenous bone grafts (and failures)
Overall patient implant survival in autogenous bone grafts
No. of implants placed into autogenous bone grafts (and failures)
Overall i...
Author
Year of publication
Study design
Outcome measure
Criteria—survival
Criteria—success
Quality assessment using the MINORS assessment tool
Head and neck cancer diagnosis
Patients age range
Follow-up period
Implant site
Implant system
Implant placement protocol
Prosthodontic rehabilitation
Studies with an average follow-up of 3 years or greater
Watzinger et...
Figure 1. Flow chart of study selection procedure
References
Schoen PJ, Reintsema H, Raghoebar GM, Vissink A, Roodenburg JLN. The use of implant retained mandibular prostheses in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning. Oral Oncol. 2004;40:862–71.
Müller F, Schädler M, Wahlmann U, Newton JP. The use of implant-supported prostheses in the functional and psychosocial rehabi...
Conclusion
Within the limitations of the current review, it can be concluded that implant survival in autogenous bone grafts in H&N oncology patients appears to be promising with implant survival being reported at over 80% in 16 of the 20 studies included with 11 of these reporting implant survival of over 90% in follow-up ranging from 3 months [28] to 15 years [5]. However, there i...
A clear deficiency of many of the studies was the imprecise and inconsistent definitions of implant survival or implant success, as detailed in Table 1. In addition, in a number of studies, the terminology ‘implant success’ and ‘implant survival’ were used interchangeably within the narrative making comparison of the studies challenging and rendering statistical analysis of the surv...
The implant placement protocol with regard to primary (immediate) or secondary (delayed) implant placement was also reviewed, and there is limited evidence from Fenlon et al. that implant failure is significantly worse in immediately placed implants in comparison with a delayed approach in free vascularized grafts.
Implant success was shown to be lower than implant survival and was related ...
Discussion
Summary of evidence
Dental implants are now perceived to be a vital part of the clinician’s armamentarium in the provision of oral and dental rehabilitation for patients with acquired deformity following management of their H&N cancer, and therefore, this systematic review is relevant to clinicians and stakeholders involved in the treatment and management of H&N cancer patient...
Six of these studies (Schultes et al., Wang et al., Zou et al., Chiapasco et al., Chiapasco et al., Wu et al.) reported some of this lack of success to the peri-implant soft tissue which was most frequently the soft tissue component of a combined bone and soft tissue free flap (most commonly the external skin).
Complications
A variety of implant-based complications were documented. Complicatio...
Implant survival and Peri-implant soft tissue
Only one study (Linsen et al. ) reported on the effect of the peri-implant soft tissue and implant survival of implants placed into autogenous bone grafts. Linsen et al. reported a higher implant failure of implants placed into bone and soft tissue grafts in comparison to implants placed into a bone grafts with residual soft tissues. This difference...
However, in two studies (Teoh et al., Burgess et al.), no statistical significance was found despite higher implant failure.
Primary and secondary implant placement and implant survival
Six studies clearly reported the use of both primary and secondary implant placement within their study (Fenlon et al., Ch’ng et al., Zou et al., Burgess et al., Watzinger et al., Wu et al.); however, only on...
Two studies (Fenlon et al., Burgess et al. ) reported no significant effect on implant survival in varying graft donor sites; however, three studies (Hessling et al., Shaw et al., Chiapasco et al.) reported varying implant survival rates within different autogenous bone grafts but only one study (Hessling et al.) reported that implant loss was significant with this being for implants placed into...
Autogenous bone graft type and implant survival
Seventeen studies reported on the specific bone graft type (non-vascularised or vascularised) into which the implants were placed. In the remaining three studies (Buddula et al., Fierz et al., Yerit et al.), this distinction was not possible.
Of these 17 studies, 8 studies reported on implant survival in non-vascularised bone grafts and 14 studie...
The surgical and loading implant protocols were reported in 17 studies with no description given in 3 studies (Barrowman et al., Fierz et al., Hessling et al.). The implant placement protocols were diverse with variables including the use of surgical templates/guides, primary and/or secondary implant placement following autogenous bone grafting, and immediate and/or delayed implant loading; howe...
These 20 studies were published over a range of 21 years (1996 to 2017) and provide cumulative data on 1905 implants placed into autogenous bone grafts in H&N cancer patients with both benign and malignant tumours being reported. The exact patient number for this intervention within some of the studies was unclear as a result of the studies reporting on implant rather than patient number or ther...
Results
Study selection
Searches of EMBASE, the Cochrane Central Register of Controlled Trials, Science Direct and MEDLINE generated 619 articles. After duplicate articles were removed, 566 unique articles were remaining. After the review of the titles and abstracts, 151 articles were accepted for further consideration, and 415 were rejected. After the full text was attained and reviewed for t...
Data items
Data was collected for implant survival, implant success, implant failure, implant complications, surgical implant placement protocol, implant system used, clinical follow-up, how the author defined success/survival, the type of autogenous bone graft, implant site, the prosthodontic rehabilitation and type of cancer, and the use of radiotherapy were documented where possible.
Risk of ...
Information sources
Four electronic databases were used to systematically search the available literature: (1) The National Library of Medicine (MEDLINE via PubMed), (2) EMBASE, (3) Cochrane Central Register of Controlled Trials and (4) Science Direct. The searches were limited to studies involving human subjects and publication dates from January 1980 to August 2017 that satisfied the inclusion ...
Methods
Protocol
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for describing and summarising the results of our review was used.
A quality assessment of all selected full-text articles was performed using the Methodological Index for Non-Randomized Studies (MINORS) assessment tool to assess the risk of bias of the included studies. The MINORS scoring list co...
Introduction
Rationale
The use of implants to retain prostheses as part of oral and dental rehabilitation of head and neck (H&N) cancer patients is becoming an increasingly common treatment approach. A number of benefits advocating implant anchorage over conventionally secured prostheses have been proposed but importantly include a significant improvement in the reported quality of life (QoL) of...
Survival of dental implants placed in autogenous bone grafts and bone flaps in head and neck oncology patients: a systematic review
Abstract
Using implants to retain prostheses as part of the oral rehabilitation of head and neck cancer patients is an increasingly common treatment modality, particularly in transported bone which is used to reconstruct defects following oncological surgical ...
Patient
Implant region(FDI)
Implant parameters
Dimensions of implantDiameter [mm]/length [mm]
Explantation[Days after placement]
1
3637
First placementStraumannRN SLactive®(TiZr)
First placementØ: 4.1; L: 10Ø: 4.1; L: 8
3
3637
Second placementStraumannTissue level(TiZr)
Second placementØ :4.1, L: 8Ø :4.1, L: 8
3
36
Third placementConelog ScrewLine(...
Figure 2. a Patient 2. Postoperative orthopantomogram one day after implant placement. b Patient 2. Postoperative orthopantomogram after second Implant placement
Figure 1. a Patient 1. Post grafting orthopantomogram. The bone block was secured with a single microscrew. b Patient 1. The radiograph demonstrates veritable inserted Straumann bone level implants after the first implant placement (1 day after implant placement). A peri-implant osteolysis is not visible. c Patient 1. Postoperative orthopantomogram (1 day after implant placement) afte...
References
Esposito M, Thomsen P, Ericson LE, Lekholm U. Histopathologic observations on early oral implant failures. Int J Oral Maxillofac Implants. 1999;14:798–810.
Olmedo-Gaya MV, Manzano-Moreno FJ, Cañaveral-Cavero E, de Dios Luna-Del Castillo J, Vallecillo-Capilla M. Risk factors associated with early implant failure: a 5-year retrospective clinical study. J Prosthet Dent. 2016;115...
However, a synergistic effect with other factors is conceivable. Some authors stated that implant osseointegration is not simply a wound healing phenomenon but rather complex foreign body reaction with activation of the immune system. Titanium and metal particle release is discussed as cause for implant failure as well as implant dentistry. It is assumed that metal particles influence the ma...
However, a present human study cannot confirm an effect due to vitamin D supplementation on bone formation or graft resorption after maxillary sinus augmentation. Satue et al. found a positive influence of 7-dehydrocholesterol (7-DHC), the precursor of vitamin D, coated implants on osteoblast differentiation in vitro. But whether vitamin D-coated dental implants have an effect of osseo...
Discussion
This article demonstrated that implant placement was successful after vitamin D supplementation in patients with vitamin D deficiency and early failed implants. None of the patients showed systemic disease or did take regular medication, alcohol, nicotine, or drugs. The patients were not immunosuppressed, irradiated, or received chemotherapy. All implants were inserted with the s...
After vitamin D supplementation and a healing period of 6 months, a third surgical intervention was planned and one implant (Conelog ScrewLine) was inserted in region 36 (see Table 1 and Fig. 1d). During implant placement, the former explantation site appeared clinically fully re-ossified. The patient received an intraoperative intravenous single-dose antibiotic therapy with Isocillin 1.2 mega. At...
Patient
The medical history of this 48-year-old male patient showed a high blood pressure; otherwise, the patient was healthy. A successfully completed periodontal therapy was done before implant therapy. The patient demonstrated stable marginal bone levels. Autologous retromolar bone grafting using local anesthesia was performed in the left mandible (see Fig. 1a). This patient received a pos...
Case presentation
Patients and surgical procedure
Patients treated consecutively in one center (Department of Oral- and Craniomaxillofacial Surgery, University Medical Center Freiburg). None of the patients showed systemic disease. Both patients did not take regular medication and were negative for alcohol, nicotine, and drug use. Bothe male patients (48 and 51 years of age) were not immunosu...
Background
Long-term stable osseointegrated implants are the primary goal in dental implantology. Although dental implants have proven clinical reliable in the long term, the failure of implants at a very early stage of osseointegration has been described. The pursuit to identify the mechanisms leading to early implant failure is ongoing to date and include the following: tobacco usage, diabete...
Abstract
An association between vitamin D deficiency and early dental implant failure is not properly verified, but its role in osteoimmunology is discussed. This article illustrates two case reports with vitamin D deficiency and early implant failure. Prior to implant placement, the first patient received crestal bone grafting with autologous material. Both patients received dental implants fr...
Figure 6. Cultivation and osteogenic differentiation of DFCs on PA after modification with collagen I. (Left) Relative cell number and (Right) normalized ALP activity.
Figure 6. Cultivation and osteogenic differentiation of DFCs on PA after modification with collagen I. (Left) Relative cell number and (Right) normalized ALP activity.
Figure 5. Evaluation of osteogenic differentiation. (A) Clustergram of PCR-array results; (B-C) histology of differentiated dental cells on AP (B) and SB (C). Representative results are shown for dNC-PCs.
Figure 5. Evaluation of osteogenic differentiation. (A) Clustergram of PCR-array results; (B-C) histology of differentiated dental cells on AP (B) and SB (C). Representative result...
Figure 4. Osteogenic differentiation of dental stem cells. Normalized ALP activity of dNC-PCs and DFCs on AP and SB (A) and on silicone (B). Cells were differentiated on standard cell culture dishes for control.
Figure 4. Osteogenic differentiation of dental stem cells. Normalized ALP activity of dNC-PCs and DFCs on AP and SB (A) and on silicone (B). Cells were differentiated on standar...
Figure 3. Evaluation of programmed cell death (apoptosis) in dental stem cells. (A) Flow cytometry analyses (for details materials and methods) show percentage of vital cells (black number), apoptotic cells (blue number), and dead cells (red number). (B) Western blot analyses show the expression of the pro-apoptotic marker BAX and the anti-apoptotic marker BCL2.
Figure 2. Cell proliferation of dNC-PCs and DFCs on tested materials. (A) and (B) Relative cell numbers; (C) spheroid cell clusters on silicone (representative pictures for DFCs); Silicone (24 and 48 h).
Figure 1. Cell attachment on tested materials. (A) Relative cell adherence of DFCs and dNC-PCs; (B) dental cells did little adhere on PA; representative pictures of DFCs.
In a previous study, we showed that TCP induced the programmed cell death (apoptosis) in DFCs. Our new study investigated therefore the induction of apoptosis in dental cells. While SB and soft materials did not induce apoptosis or cell death, AP induced obviously cell death and apoptosis in dental cells. Here, the results for dNC-PCs and DFCs were almost the same. Interestingly, neither sil...
Discussion
Scaffolds play an important role in tissue engineering. However, little is known about the proliferation and differentiation of DFCs and dNC-PCs on different types of materials. As we have learned from previous studies mechanical properties such as surface stiffness are decisive for a successful osteogenic differentiation of dental stem cells. Moreover, we showed that bone substi...
Results
Cell viability
Dental cells were cultivated in standard cell culture media until passage 6. Cell adherence and cell proliferation/growth were measured for the estimation of cell viability on tested rigid and soft materials. In Figure 1, the cell adherence of dNC-PCs on bone substitute materials was better than that of DFCs. However, both dental cells types adhered very well on silicone...
Cells positive for Caspase3/7 Green Detection Reagent were identified as apoptotic cells, while dead cells were positive for SYTOX® AADvanced dead cell stain. However, vital cells were negatively stained for both staining solutions.
Western blotting
For protein isolation, cells were treated with lysis buffer (250 μl phosphatase, 100 mM Na3VO4, 137 mM NaCl, 200 mM Tris, 480 mM NaF, 1% NP-4...
This incubation step with the implant material was repeated twice with fresh cell culture media. Three eluates were pooled for cell culture experiments. DFCs were seeded onto cell culture plates and cultivated in standard cell culture media. After cell seeding (12 to 24 h), cell culture media were changed, and cells were cultivated in cell culture media with material eluates. After 24 h of cultiva...
After washing with PBS, the gels were stored in PBS at 4°C. Before platting the cells, the gel was exposed to UV for 15 min for the sterilization and replace PBS with complete culture medium for 1 h at 37°C.
Implant materials
The bone substitutes Maxgraft® (AP) and Maxresorb® (SB) were obtained from the company Botiss (botiss dental GmbH, Berlin, Germany). Maxgraft® is a sterile, high-saf...
Methods
Cell culture
The isolation and characterization of DFCs and dNC-PCs were described in previous studies. DFCs were routinely cultivated in DMEM (Sigma-Aldrich, St. Louis, MO, USA) supplemented with 10% fetal bovine serum (Sigma-Aldrich, St. Louis, MO, USA) and 100 μg/ml penicillin/streptomycin (standard cell culture medium). dNC-PCs were cultivated in DMEM (Sigma-Aldrich) supplemented ...
Background
While bone substitute materials are routinely used, especially vertical bone, augmentation of the jaws is still a problematic step. Dental stem cells in combination with bone substitute materials may accelerate the augmentation of alveolar bone and perhaps, stem cell-based therapies can become an alternative to autologous, allogenic, or synthetic bone transplants and substitutes. How...
Abstract
Background
Dental stem cells in combination with implant materials may become an alternative to autologous bone transplants. For tissue engineering different types of soft and rigid implant materials are available, but little is known about the viability and the osteogenic differentiation of dental stem cells on these different types of materials. According to previous s...
Reason for exclusion
Investigations
Study design (case series or case report)
Kim et al. (2017), Hatano et al. (2007)
Different grafting technique (lateral sinus lift or transalveolar technique)
Jensen et al. (1994), Winter et al. (2002), Toffler et al. (2004), Chappuis et al. (2009), Soltan et al. (2011), Xiao et al. (2011), Cricchio et al. (2011), Scala et al. (2012), Brus...
Author (year)
Study design
Follow-up (months)
N of patients
N of implants
Smokers
Length and diameter (mm)
Implant system
Shihab 2017
Retrospective
60
35
70
NA
5–12 × 3.0–5.7
IDI FMD Nucleoss
Ghanem 2014
Retrospective
72
10
10
NA
NA
NA
Nooh 2013
Prospective
12
56
63
0
4 × 8 4.3 × 10 5 × 8 5 × 10
Nobel Biocare
...
Clinical complications
Radiographic complications
Sinusitis
Thickening of Schneiderian membrane
Nasal bleeding, nasal obstruction, nasal secretion
Bone reaction to the implants
Headache and pain or tenderness in the region of the sinus
Sinus pathology
Decreased sense of smell
Figure 4. Statistical analysis for different variables. a Weighted mean survival rate. b Implant survival rate according to degree of penetration. c Analysis of clinical complications. d Analysis of radiographic complications
Figure 3. Graphic representation of group 1 ≤ 4 mm penetration and group 2 > 4 mm penetrations
Figure 2. PRISMA flowchart of the screening process
The secondary outcome of this review was the analysis of the clinical and radiological complications related to the penetration of implants in the maxillary sinus. Clinical complication among the different authors ranges from 0 to 14.3%, with a weighted mean complication rate of 3.4%, without finding statistical difference according to the level of implant penetration. The most common clinic...
Figure 1. Graphic representation of implants intruding sinus perforating or not the Schneiderian membrane
Analysis of clinical complications
Seven studies provide information on clinical complications with a global sample of 232 patients. Clinical complications among the different authors range from 0 to 14.3%, being the weighted mean complication rate 3.4% with an IC 95% [0 7.5] (Fig. 4c) Clinical complications analyzed in the studies were sinusitis, nasal bleeding, nasal obstruction, nasal sec...
Results
Study screening
An initial screening yielded a total of 3551 publications of which 26 potentially relevant articles were selected after an evaluation of their titles and abstracts. Full text of these articles was obtained and evaluated thoroughly. Of these, eight articles (Table 2) fulfilled the inclusion criteria and subsequently were included in the qualitative analysis (Fig. 2). Re...
Eligibility criteria
Articles were included in this systematic review if they met the following inclusion criteria: human prospective or retrospective studies, reporting outcomes of implant placed perforating the sinus floor with implant burs, and without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material. The intrusion into the sinus cavity can occur du...
Materials and methods
This systematic review and subsequent meta-analysis follow the guidelines of the PRISMA statement.
Focus question
The following focus question was developed: Is the intrusion of dental implants into the sinus cavity during implant drilling or implant placement, without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material, has an effec...
Introduction
The edentulous posterior maxillary region often presents with unique challenging conditions in implant dentistry. Limited bone height secondary to pneumatization of the maxillary sinus and the resorption of the alveolar ridge preclude in many instances the installation of dental implants. To compensate for the lack of bone height, several treatment options have been proposed.
The ...
Influence of exposing dental implants into the sinus cavity on survival and complications rate: a systematic review
Abstract
Background
After tooth loss, the posterior maxilla is usually characterized by limited bone height secondary to pneumatization of the maxillary sinus and/or collapse of the alveolar ridge that preclude in many instances the installation of dental implants. In order ...
Tabel 2. Faktor-faktor yang memengaruhi morbiditas dan penyembuhan luka situs donor palatal pasca panen graft gusi bebas
Faktor-faktor yang bisa mengurangi morbiditas pasca bedah
Dimensi graft (tinggi ≤4 mm, lebar 4 mm, lebar ≥14 mm, tebal >2 mm)
Ketebalan mukosa palatal ≤4 mm
Faktor-faktor yang bisa mempercepat penyembuhan luka
Penggunaan agen-agen biologi (...
Graft autogenous
Intension healing
Indikasi
Referensi
Graft gusi bebas
Primer
Augmentasi KTW di seputar gigi
Agudio et al. 200972
Augmentasi KTW peri-implant
Roccuzzo et al. 2016,21 Oh et al. 201722
Peningkatan kedalaman vestibulum
Yadav et al. 201473
Sekunder
Cakupan akar
Cortellini et al. 2012,16 Zucchelli and De Sancti...
Bukti yang signifikan mendukung penggunaan pencangkokan jaringan lunak autologus untuk rekonstruksi bedah plastik periodontal dan peri-implant untuk kesarasan dan estetika jaringan lunak. Meskipun teknik graft gusi bebas masih dianggap sebagai pendekatan pilihan untuk meningkatkan ketebalan jaringan lunak dan jaringan / mukosa keratin pada gigi dan tempat implant gigi, teknik graft jaringan ikat...
Morbiditas pasien telah dilaporkan sebagai salah satu kekurangan utama dari prosedur pengambilan graft jaringan lunak autologus. Selain itu, komplikasi pasca operasi lebih lanjut telah dijelaskan, termasuk perdarahan di tempat donor, disfungsi sensorik palatal, infeksi, dan / atau peningkatan kala operasi. Utamanya, perdarahan intraoperatif dan pasca operasi yang berkepanjangan dari langit-langit ...
Sebaliknya, ketika merawat dehisens jaringan lunak peri-implant, penggunaan CTG sangat dianjurkan, terlepas dari lebar atau ketebalan mukosa berkeratin. Sementara itu, pengganti graft autogen sering digunakan untuk meningkatkan ketebalan jaringan dan meminimalkan resesi mukosa pasca operasi selama penempatan implant segera atau pada pembukaan implant.
Beberapa pendekatan pengambilan graft, sepert...
Graft gusi bebas pada gigi seri sentral bawah
A) keadaan mula; B) segera pasca operasi; C) 5 bulan pasca operasi; D) kelepak tahap lanjut pada arah korona; E) 6 bulan pasca operasi menunjukkan penutupan akar lengkap di tempat kerusakan resesi dengan meningkatnya keratinisasi gusi.
Graft gusi bebas di seputar implant posterior dengan mukosa keratin minimal pada aspek bukal.
F) keadaa...
Graft jaringan lunak yang diambil dari langit-langit dengan epitel yang meliputinya didefinisikan sebagai graft gusi bebas atau cangkok gusi bebas (FGG, Free Gingival Graft). FGG pertama kali diperkenalkan untuk meningkatkan jaringan keratin yang kurang atau hilang pada masa perkembangan. Peristiwa penyembuhan dan prinsip-prinsip yang memengaruhi weton FGG yang telah diselidiki secara luas, telah ...
Cangkok jaringan lunak autogenous untuk rekonstruksi bedah periodontal & bedah plastik peri‐implant
Abstrak
Tinjauan canggih ini menyajikan bukti yang relatif baru dan status terkini pencangkokan jaringan lunak autogenous untuk augmentasi jaringan lunak dan cakupan resesi pada gigi dan situs implant gigi. Indikasi dan prediktabilitas dari teknik cangkok gusi bebas dan teknik cangkok jaring...
Setelah bertahun-tahun melakukan percobaan klinis, Jepang wusananya membolehkan komersialisasi OCP/Col untuk bedah oral.
OCP/ Col kepanjangan dari Octacalcium Phospate/ Collagen. Selama 15 tahun pungkasan, Octacalcium Phosphate menjadi kandidat alternatif baru untuk menyediakan basis kristal mineral yang menyusun tulang dalam kombinasinya dengan kolagen. Bahan ini menjadi kandidat yang cenderung ...
Operasi bone graft-nya saja hanya berlangsung antara 1 sampai 2 jam, tergantung tingkat kesulitan kasus per individu pasien. Karena tubuh pasien tidak ada yang sama persis, maka lama operasi bone graft juga tidak ada yang sama persis.Setelah operasi selesai, Anda perlu waktu sampai bone graft jadi. Kasus yang paling ringan bisa sembuh hanya dalam waktu 2 minggu. Kasus yang paling berat bisa ...
Alograft kulit dapat digabungkan ke dalam luka di kulit dengan ketebalan penuh. Namun, alograft itu pada akhirnya mengalami penolakan karena sel-sel jaringan epidermal dan dermal yang dicangkokkan mendapat respon imun dari tubuh pasien. sel-sel jaringan epidermal dan dermal tersebut bertanggungjawab atas respon penolakan ini. Komponen-komponen kulit non-selular terdiri dari protein matriks ekstra...
Kesannya, bone graft itu teknologi baru. Padahal, perawatan ini ditemukan pertama kali pada sekitar pertengahan abad 17 Masehi, kira-kira 3,5 abad yang lalu.Sejarahnya, seorang dokter Belanda yang bernama Jacob van Meekeren merawat seorang pasien tentara dengan tengkorak kepala terbuka karena bertempur. Dokter mencari tulang apa yang bisa menyatu dengan tengkorak manusia. Singkat cerita, dokter ...
Bone graft alloplastis dikembangkan untuk mengatasi perkara yang berpotensi timbul dari penggunakan autograft. Alloplas terutama bersifat osteokonduktif tanpa potensi osteogenesis atau pun osteoinduksi.KeuntunganKeuntungan utama bahan alloplastis adalah:bahan baku tersedia berlimpah ruahtidak ada risiko transmisi penyakitantigenisitas sangat rendahdapat diproduksi dengan aneka bentuk dengan beraga...
Anda mungkin ingin pasang implant tapi dokter berkata, tulang rahang Anda tidak cukup besar untuk menopang implan. Jangan kuatir. Sekarang ada teknologi bone graft untuk memperbesar tulang penyangga implan. Asalkan kondisi tulang rahang Anda belum parah, tulang Anda masih bisa diperbesar dengan metode ini.Xenograft didefinisikan sebagai graft jaringan yang berasal dari spesies selain manusia. Misa...
Autograft dan allograft punya persamaan, yaitu sama-sama diambil dari manusia. Perbedaan di antara keduanya adalah autograf diambil dari tubuh pasien itu sendiri, sementara allograft diambil dari orang lain lalu dipasangkan pada pasien. Orang lain yang dimaksud bisa orang yang masih hidup atau orang yang sudah meninggal (kadaver). Alograft ada 3 jenis, yaitu:Tulang segar atau segar bekuFDBADFDBAT...
Bone graft berbasis allograft menggunakan tulang allograft. Bone graft ini digunakan sendirian atau digunakan bersama-sama dengan materi lain. Kelebihan autograftKelebihan autograft meliputi:Autogenous bone graft memanfaatkan tulang yang diperoleh dari pasien itu sendiri.Rendahnya risiko penolakan graft oleh tubuh (reaksi imunologi), mengingat graft diambil dari tubuh pasien sendiri. Ini sebab...
Di bidang kedokteran gigi implan, materi bone graft merujuk pada materi yang ditanam dalam mulut pasien untuk meningkatkan pembentukan tulang baru melalui proses osteogenik, osteoinduktif, atau osteokonduktif. Osteogenik berarti materi bone graft mengandung sel-sel osteoprogenitor yang hidup dan yang mampu berdiferensiasi menjadi osteoblas sehingga menghasilkan tulang baru. Osteoinduktif berarti ...
Tanya:Tulang rahang saya sudah menciut. Apa masih bisa dipasangi implan?Jawab:Ada teknologi bone graft (cangkok tulang). Dengan teknologi masa kini, pasien yang mengalami penciutan tulang rahang masih punya kemungkinan untuk menerima implan. Hal itu tergantung pada seberapa parah penciutan yang terjadi, kualitas tulang, tebal tulang, dsb.Dokter akan memeriksa foto rontgen panoramik, foto 3D, atau...