Full block or split block?-Comparison of two different autogenous block grafting techniques for alveolar ridge reconstruction

Assessment of Modified Ridge Split With Autogenous Versus Xenogenic Augmentation: Randomized Clinical Trial

BACKGROUND

The horizontally insufficient posterior mandibular ridge frequently restrains dental implant insertion.

PATIENTS AND METHODS

A modified ridge split procedure was innovated to separate, convey laterally, and fix the buccal cortical plate in 20 patients with posterior horizontal mandibular alveolar deficiency. Meanwhile, the intercancellous space was obliterated with autogenous bone particulates for the test group patients and Anorganic bone bovine mineral (ABBM) for those of the control group. Following a comparison of the horizontal bone gain and the histomorphometric bone area percent among both groups after 6 months of graft consolidation, 40 implants were inserted during the second surgical stage.

RESULTS

All of the grafts were consolidated. A statistically insignificant difference was found between the control group's mean 6-month postoperative horizontal bone width of (8.10 ± 0.83) and that of the study one of (7.90 ± 0.77). The control group's mean bone gain was recorded (4.76 ± 0.81) versus (4.63 ± 0.78) for the study group, with a statistically insignificant difference. Both groups showed histological evidence of a moderate number of osteoblasts, mature trabecular bone, and lamellae encircling large fatty marrow spaces. A statistically significant difference (p = 0.021) was found between the control group's mean bone area percentage of new bone formation (38.83% ± 1.17%) and that of the study group (34.40% ± 3.71%).

CONCLUSION

The modified ridge split with either autogenous or (ABBM) graft was deemed reliable for reconstructing the horizontally deficient posterior alveolar ridge with appropriate volumetric stability and bone quality.

TRIAL REGISTRATION

The study was registered on www.

CLINICALTRIALS

gov (Registration #: NCT05286541).

The Use of the Facial Sinus Wall as Bone Shell Onlay Graft for Maxillary Posterior Ridge Reconstruction: A Retrospective Case Series

PURPOSE

To evaluate the performance and clinical outcome of vertical and horizontal bone augmentation (VHBA) in posterior maxillary regions combining lateral window sinus floor elevation (LWSFE) with a horizontal bone shell technique applying the maxillary facial sinus wall as a bone plate.

MATERIALS AND METHODS

In 18 patients, LWSFE was combined with a horizontal bone shield augmentation procedure utilizing the maxillary facial sinus bone wall as a lateral bone plate. Both the sinus cavity and the lateral bone box created were grafted with a mixture of autogenous bone/venous blood and bovine bone mineral. The primary aim was to assess the performance of combined techniques enabling subsequent implant placement. Using radiographic measurements (preoperative, after VHBA, at implant placement, and at follow-up), bone gain/reduction of augmented horizontal ridge width (HRW) and vertical bone height (VBH) were evaluated. Additionally, clinical outcome assessing implant survival/success rate, marginal bone loss (MBL), and implant health (mucositis/peri-implantitis) was evaluated.

RESULTS

For the combined VHBA techniques, HRW and VBH increased significantly (p < 0.001) from preoperative 3.5 ± 1.4 mm/3.6 ± 2.1 mm to 9.7 ± 1.9 mm/18.0 ± 1.6 mm post-augmentation. However, HRW and VBH dimensions decreased up to 8.9 ± 1.8 mm/17.1 ± 1.4 mm at implant placement and 8.6 ± 1.7 mm/16.7 ± 1.3 mm at follow-up evaluation (3.8 ± 1.8 years; p < 0.001, respectively). Augmented bone reduction was significantly higher (-7.7%) between the augmentation procedure and implant placement than in the post-implant-placement period (-2.5%). All implants survived (100%) representing peri-implant MBL of -0.9 ± 0.7 mm, pocket depth of 3.4 + 1.8 mm, and prevalences of 5%/0% for peri-implant mucositis/peri-implantitis.

CONCLUSION

The combination of horizontal bone augmentation using local bone shield transfer from the maxillary facial sinus wall with LWSFE enables sufficient reconstruction of maxillary posterior ridge.

Comparative evaluation of allograft particulate bone and cortical bone blocks combined with xenograft bone for labial bone defects in the aesthetic zone: a prospective cohort study

PURPOSE

This study aimed to evaluate the osteogenic performance of allograft particulate bone and cortical bone blocks combined with xenograft under bovine pericardium membranes, for treating different degrees of labial bone defects in the aesthetic zone.

MATERIALS AND METHODS

Twenty-four patients with bone defects were divided into two groups based on defect severity (Terheyden 1/4 and 2/4 groups). The Terheyden 1/4 group received granular bone grafts alone, while the Terheyden 2/4 group received cortical bone blocks combined with granular bone grafts. Cone beam computed tomography scans were taken preoperatively, immediately postoperatively, and six months postoperatively. Primary outcomes included labial bone formation, alveolar bone formation, bone resorption rate, osteogenic efficiency, and complications.

RESULTS

Labial bone thickness in both groups exceeded 2 mm after six months. Labial bone formation at the implant shoulder in the Terheyden 1/4 group was 2.35 ± 2.68 mm, and 2.26 ± 1.66 mm in the Terheyden 2/4 group (p > 0.05). Labila and alveolar bone formation at 2-5 mm below the implant shoulder was significantly greater in the Terheyden 2/4 group (p < 0.05). Alveolar bone resorption and the bone resorption rate at 2-5 mm below the implant shoulder was lower in the Terheyden 2/4 group (p < 0.05). Osteogenic efficiency was 64.43 ± 2.76%, with no significant difference between groups (p > 0.05). No complications were observed.

CONCLUSION

Both treatment approaches achieved satisfactory bone regeneration, but combining cortical bone blocks with granular grafts provided better outcomes for larger defects, with greater bone formation and less resorption. Further research with longer follow-up is required to confirm long-term stability.

TRIAL REGISTRATION

The study was retrospectively registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) with the registration number ChiCTR2300070538 on April 14, 2023.

Assessment of the application of a novel three-dimension printing individualized titanium mesh in alveolar bone augmentation: A retrospective study

OBJECTIVE

To assess the clinical and radiographic outcomes of alveolar ridge augmentation using a novel three-dimensional printed individualized titanium mesh (3D-PITM) for guided bone regeneration (GBR).

MATERIALS AND METHODS

Preoperative cone-beam computed tomography (CBCT) was used to evaluate alveolar ridge defects, followed by augmentation with high-porosity 3D-PITM featuring circular and spindle-shaped pores. Postoperative CBCT scans were taken immediately and after 6 months of healing. These scans were compared with preoperative scans to calculate changes in bone volume, height, and width, along with the corresponding resorption rates. A statistical analysis of the results was then conducted.

RESULTS

A total of 21 patients participated in the study, involving alveolar ridge augmentation at 38 implant sites. After 6 months of healing, the average bone augmentation volume of 21 patients remained at 489.71 ± 252.53 mm3, with a resorption rate of 16.05% ± 8.07%. For 38 implant sites, the average vertical bone increment was 3.63 ± 2.29 mm, with a resorption rate of 17.55% ± 15.10%. The horizontal bone increment at the designed implant platform was 4.43 ± 1.85 mm, with a resorption rate of 25.26% ± 15.73%. The horizontal bone increment 2 mm below the platform was 5.50 ± 2.48 mm, with a resorption rate of 16.03% ± 9.57%. The main complication was exposure to 3D-PITM, which occurred at a rate of 15.79%.

CONCLUSION

The novel 3D-PITM used in GBR resulted in predictable bone augmentation. Moderate over-augmentation in the design, proper soft tissue management, and rigorous follow-ups are beneficial for reducing the graft resorption and the incidence of exposure.

Iliac crest vertical block grafts -placing outside or inside the bone contour: A cohort study

OBJECTIVE AND AIM

Challenging defect configurations and dimensions arise from severe, localized vertical alveolar ridge defects caused by trauma or prior surgery. This study aims to analyze three-dimensional bone gain, assess marginal bone stability in such defect configurations, and evaluate the impact of grafting outside the bone contour on the overall outcome, with a focus on iliac crest block grafts as a valid treatment option.

MATERIALS AND METHODS

The prospective cohort study evaluated patients who required vertical block grafting due to localized bone defects in the maxilla or mandible and who had received iliac grafts. Three-dimensional bone gain was analyzed using cone beam computed tomography (CBCT) after 3 months of bone healing for each treated site and implant position. A comparison between bone grafts inside and outside the bone contour was conducted. Marginal bone stability was measured using intraoral radiographs during routine annual follow-up visits.

RESULTS

Seventy patients with 89 treated sites were evaluated. After 3 months of graft healing, the mean vertical bone gain was 11.03 ± 3.54 mm, the mean horizontal bone gain was 7.18 ± 2.00 mm, and the mean graft length was 28.19 ± 11.01 mm. A total of 217 implants were placed in the augmented regions. On implant level, a mean vertical bone gain of 10.44 ± 3.44 mm and a mean horizontal bone gain of 6.54 ± 1.86 mm were measured. Over a 43-month observation period, mesial and distal marginal bone loss averaged 0.44 ± 0.92 mm and 0.49 ± 1.05 mm, respectively. Eight implants were diagnosed with periimplantitis, resulting in the loss of four implants, while no early implant losses were reported.

CONCLUSION

Within the limitations of this study, vertical bone grafts with iliac crest block grafts were found to be a dependable treatment option for dental implant placement, and placing block grafts outside the bone contour did not lead to inferior outcomes.

Assessment of bone gain and neurosensory affection with the sandwich osteotomy technique for vertically deficient posterior mandible using a full digital workflow versus conventional protocol: A randomized split mouth study

BACKGROUND

Using the sandwich osteotomy technique in the posterior mandible is delicate. This study aimed to assess the safety and the amount of bone gain using a full digital workflow versus the conventional procedure.

PATIENTS AND METHODS

This split mouth study included 10 patients with bilateral vertically deficient posterior mandible. One side received conventional sandwich interpositional bone grafting (control group), while the other side received the same protocol using two patient-specific guides. The first guide (cutting guide) was used to place the osteotomies safely and accurately according to the predetermined dimensions and locations, and the second guide was used to fix the mobilized bony segment, leaving the desired gap to be filled with a particulate xenogenic bone graft.

RESULTS

Full neurosensory recovery was documented at 2 months postoperative for all patients and bilaterally. After 4 months, there was a statistically significant difference in vertical bone gain between both groups (p = 0.001), measuring an average of 3.76 ± 0.72 mm in the study group and 2.69 ± 0.37 mm in the control group. No statistically significant difference was found between the planned vertical augmentation (3.85 ± 0.58 mm) and the obtained vertical bone gain (3.76 ± 0.72 mm) in the study group (p = 0.765) proving the accuracy of the guided procedure.

CONCLUSION

Computer-guided sandwich interpositional grafting is predictable regarding the execution of the osteotomies and the accuracy of fixation of the transport segment.