A clinical study of anterior alveolar bone reconstruction achieved through autogenous block bone in combination with guided bone regeneration(GBR) technique

Abstract

Abstract: PURPOSE: To evaluate and compare the differences of bone resorption between implant placement sites (IPS) and non-implant placement sites(NIPS) after anterior alveolar bone reconstruction achieved through autogenous block bone in combination with guided bone regeneration(GBR) technique. METHODS: From Dec. 2010 to Aug. 2011, a consecutive series of 14 patients (73 edentulous sites) with anterior alveolar bone atrophy were treated with autogenous block bone grafts in combination with GBR technique and delayed implant placement 6 months after augmentation. CT scans were performed preoperatively(T0), immediately after augmentation(T1), 3 months after augmentation (T2), 6 months after augmentation before implant placement (T3), 9 months after augmentation (T4), and the longest postoperative follow-up point (mean. 13.8 months) (T5). Alveolar crestal bone height (ACBW), alveolar midway bone width (AMBW), and alveolar bone height (ABH) were selected as measurement parameters in Simplant 11.04 software. All results were divided into two groups: implant placement sites (IPS) and non-implant placement sites (NIPS), and compared by the paired t test using SAS 9.0 software package. RESULTS: All block bone grafts and implant placement surgeries were completed successfully. Dizziness, headache and other uncomfortable conditions didn't occur and the incisions healed excellently. All implants remained clinically osseointegrated at the longest postoperative follow-up point. The bone remodelling of both groups for these three parameters were as follows: a) there were significant differences for the bone augmentation and resorption of ACBW and AMBW at T1 and T2 (P<0.05) and ABH at T1, T2 and T3 (P<0.05) in IPS; b) there were significant differences for the bone augmentation and resorption of ACBW and ABH at T1, T2, T3 and T4 (P<0.05) and AMBW at T1, T2 and T3 (P<0.05) in NIPS; c) there were no significant differences at other time periods for these three parameters of both groups (P>0.05). CONCLUSIONS: A more rapid and initial loss of alveolar bone in NIPS resulted from the mucoperiosteal flap reflection during implant placement surgery, while a less bone loss of alveolar happened in IPS due to implant placement. This reminded us of the importance of bone grafts in combination with immediate or early implant placement.

Key words: Bone deficiency, Implant surgery, Block bone, Bone remodelling

CLC Number:

R782.6

ZHENG Ji-si, ZHANG Shan-yong, YANG Chi, ZHANG Ying, ZHAO Jing-yong, YU Fei. A clinical study of anterior alveolar bone reconstruction achieved through autogenous block bone in combination with guided bone regeneration(GBR) technique[J]. China Journal of Oral and Maxillofacial Surgery, 2014, 12(2): 144-151.

References

[1] Isaksson S, Alberius P. Maxillary alveolar ridge augmentation with onlay bone-grafts and immediate implants[J]. J Craniomaxillofac Surg, 1992, 20(1): 2-7.
[2] Hollinger JO, Brekke J, Gruskin E, et al. Role of bone substitutes[J]. Clin Orthop Relat Res, 1996,(324):55-65.
[3] Wang S, Zhang Z, Xia L, et al. Systematic evaluation of a tissue-engineered bone for maxillary sinus augmentation in large animal canine model [J]. Bone, 2010, 46(1): 91-100.
[4] Zhang W, Wang X, Wang S, et al. The use of injectable sonication-induced silk hydrogel for VEGF(165) and BMP-2 delivery for elevation of the maxillary sinus floor [J]. Biomaterials, 2011, 32(35): 9415-9424.
[5] Block MS, Ducote CW, Mercante DE. Horizontal augmentation of thin maxillary ridge with bovine particulate xenograft is stable during 500 days of follow-up: preliminary results of 12 consecutive patients [J]. J Oral Maxillofac Surg, 2012, 70(6): 1321-1330.
[6] Barone A, Toti P, Piattelli A, et al. Extraction socket healing in humans after ridge preservation techniques: a comparison between flapless and flapped procedure in a randomized clinical trial [J]. J Periodontol, 2014,85(1):14-23.
[7] Sbordone C, Toti P, Guidetti F, et al. Volume changes of iliac crest autogenous bone grafts after vertical and horizontal alveolar ridge augmentation of atrophic maxillas and mandibles: a 6-year computerized tomographic follow-up [J]. J Oral Maxillofac Surg, 2012, 70(11): 2559-2565.
[8] Cordaro L, Torsello F, Miuccio MT, et al. Mandibular bone harvesting for alveolar reconstruction and implant placement: subjective and objective cross-sectional evaluation of donor and recipient site up to 4 years[J].Clin Oral Implants Res,2011,22(11): 1320-1326.
[9] Nissan J, Gross O, Mardinger O, et al. Post-traumatic implant-supported restoration of the anterior maxillary teeth using cancellous bone block allografts [J]. J Oral Maxillofac Surg, 2011, 69(12): e513-518.
[10] Wakimoto M, Matsumura T, Ueno T, et al. Bone quality and quantity of the anterior maxillary trabecular bone in dental implant sites [J]. Clin Oral Implants Res, 2012, 23(11): 1314-1319.
[11] Nkenke E, Schultze-Mosgau S, Radespiel-Troger M, et al. Morbidity of harvesting of chin grafts: a prospective study [J]. Clin Oral Implants Res, 2001, 12(5): 495-502.
[12] Dasmah A, Thor A, Ekestubbe A, et al. Particulate vs . block bone grafts: three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up [J]. J Craniomaxillofac Surg, 2012, 40(8): 654-659.
[13] Nyström E, Legrell PE, Forssell A, et al. Combined use of bone grafts and implants in the severely resorbed maxilla. Postoperative evaluation by computed tomography [J]. Int J Oral Maxillofac Surg, 1995, 24(1 Pt 1): 20-25.
[14] Her S, Kang T, Fien MJ. Titanium mesh as an alternative to a membrane for ridge augmentation [J]. J Oral Maxillofac Surg, 2012,70(4):803-810.
[15] Thor A. Reconstruction of the anterior maxilla with platelet gel, autogenous bone, and titanium mesh [J]. Clin Implant Dent Relat Res, 2002, 4(3): 150-155.
[16] Esposito M, Hirsch JM, Lekholm U, et al. Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology [J]. Eur J Oral Sci,1998,106(1): 527-551.
[17] Cosyn J, Sabzevar MM, De Bruyn H. Predictors of inter-proximal and midfacial recession following single implant treatment in the anterior maxilla: a multivariate analysis [J]. J Clin Periodontol, 2012, 39(9): 895-903.
[18] Ishikawa T, Salama M, Funato A, et al. Three-dimensional bone and soft tissue requirements for optimizing esthetic results in compromised cases with multiple implants [J]. Int J Periodont Restorative Dent, 2010, 30(5): 503-511.
[19] Dasmah A, Thor A, Ekestubbe A, et al. Marginal bone-level alterations at implants installed in block versus particulate onlay bone grafts mixed with platelet-rich plasma in atrophic maxilla. a prospective 5-year follow-up study of 15 patients [J]. Clin Implant Dent Relat Res, 2013, 15(1): 7-14.
[20] Johannsen A, Westergren A, Johannsen G. Dental implants from the patients perspective: transition from tooth loss, through amputation to implants - negative and positive trajectories [J]. J Clin Periodontol, 2012, 39(7): 681-687.
[21] Ortega-Martínez J, Pérez-Pascual T, Mareque-Bueno S, et al. Immediate implants following tooth extraction. A systematic review [J]. Med Oral Patol Oral Cir Bucal,2012, 17(2): e251-261.
[22] Lundgren S, Sjöström M, Nyström E, et al. Strategies in reconstruction of the atrophic maxilla with autogenous bone grafts and endosseous implants[J]. Periodontol 2000,2008,47:143-161.
[23] Nyström E, Lundgren S, Gunne J, et al. Interpositional bone grafting and Le Fort I osteotomy for reconstruction of the atrophic edentulous maxilla. A two-stage technique [J]. Int J Oral Maxillofac Surg, 1997, 26(6): 423-427.
[24] Cosyn J, De Rouck T. Aesthetic outcome of single-tooth implant restorations following early implant placement and guided bone regeneration: crown and soft tissue dimensions compared with contralateral teeth [J]. Clin Oral Implants Res, 2009, 20(10): 1063-1069.
[25] Davis WH, Martinoff JT, Kaminishi RM. Long-term follow up of transoral rib grafts for mandibular atrophy [J]. J Oral Maxillofac Surg, 1984, 42(9): 606-609.
[26] Donovan MG, Dickerson NC, Hellstein JW, et al. Autologous calvarial and iliac onlay bone grafts in miniature swine [J]. J Oral Maxillofac Surg, 1993, 51(8): 898-903.
[27] Bhandari S, Chaturvedi R. Immediate natural tooth pontic: a viable yet temporary prosthetic solution: a patient reported outcome [J]. Indian J Dent Res, 2012, 23(1): 59-63.
[28] Lin KY, Bartlett SP, Yaremchuk MJ, et al. The effect of rigid fixation on the survival of onlay bone grafts: an experimental study [J]. Plast Reconstr Surg, 1990, 86(3): 449-456.
[29] 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 [J]. Clin Oral Implants Res, 2006, 17(4): 359-366.