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Three-dimensional microplate-enhanced alveolar ridge augmentation--an alternative to nerve transposition.

The placement of endosseous implants in the atrophic posterior mandible has presented a challenge to the surgeon and restorative dentist. Traditional procedures either require nerve transposition or utilization of implants placed at less than favorable angles. A technique is presented for the three-dimensional augmentation of the atrophic alveolar ridge utilizing microplate-enhanced guided bone regeneration technology. The applications of this technique in other intraoral and extraoral sites are currently under investigation by the authors.

Alveolar Process↗

Alveolar ridge augmentation with tricalcium phosphate ceramic.

Tricalcium phosphate ceramic, with 50% porosity and 400 to 500 micrometer pore diameter, was used to augment the edentulous alveolar ridge of 10 adult mongrel dogs. The implants were evaluated histologically at different time intervals (7, 30, 90, 180, and 360 days). Preoperative and postoperative blood chemistry studies were also evaluated. The results showed that, other than for the expected acute nonspecific inflammatory response due to the surgery, the material was well tolerated by the tissues and was nontoxic. Bone and soft tissues grew into the pores, thereby creating an excellent biomechanical bond between the ceramic implant and surrounding structures. Preoperative and postoperative blood chemistry studies demonstrated no significant change.

Alveolar Process↗

The TIME technique: a new method for localized alveolar ridge augmentation prior to placement of dental implants.

Sufficient bone volume is still considered the most important prerequisite for the osseointegration of dental implants. The TIME technique (autogenous bone grafting combined with stabilization using a titanium mesh) for localized alveolar ridge augmentation was evaluated in 20 patients who had insufficient bone volumes for the primary placement of dental implants. Different clinical recordings were evaluated at TIME stage 1 (augmentation surgery) and at TIME stage 2 (reentry surgery with mesh removal and simultaneous dental implant placement). In most patients, single- or extended-tooth gaps (up to four units) were augmented with autogenous bone harvested from the chin or retromolar area. With the exception of temporary disturbances of tooth sensibility, no morbidity at the donor sites was observed. In one patient, the stabilizing titanium micromesh had to be removed prematurely because of graft infection. At the reentry surgery, the bone grafts were found to be completely incorporated in 75% of the patients. In 15% of the patients, only minimal graft resorption was observed (less than 10% of the graft volume). Subsequently, 28 implants could be placed in 19 patients. The stabilizing titanium mesh was best suited for vertical ridge augmentations. Another feature of the mesh was the excellent tissue compatibility, with little clinical or histologic inflammation, even when the mesh had become exposed.

Adult↗

Clinical and experimental results of a sandwich-technique for mandibular alveolar ridge augmentation.

During the past two and a half years, thirteen patients have been operated upon using a "sandwich-technique" for mandibular alveolar ridge augmentation. This new technique was advocated by Schettler in 1974. In 3 cases, autologous rib cartilage was used, in 6 cases an autologous transplant from the iliac crest, and on four occasions, autologous "cialit"-conserved bone chips were inserted. All transplants healed without complications and no resorption was found in either the autologous or homologous transplants at the late follow-up examinations. These findings are supported by animal experiments in rabbits with the aid of the polychrome sequence marking technique using fluorochromes.

Animals↗

Alveolar ridge augmentation in rats by Bio-Oss.

The purpose of the study was to examine if Bio-Oss initiated osteoinduction or osteoconduction when implanted into rats. Sintered and unsintered granules of the anorganic bovine bone Bio-Oss was implanted subperiosteally for alveolar ridge augmentation purposes and heterotopically in the abdominal muscles of rats. Light microscopic evaluation revealed no osteoinduction or osteoconduction in connection with sintered or unsintered Bio-Oss. A foreign body reaction was observed around both forms.

Abdominal Muscles↗

[Initial experiences with a new distraction implant system for alveolar ridge augmentation].

The masticatory rehabilitation of patients is dependent on the quality and volume of residual jaw bone. Loss of volume caused by tumor-related mandibular ridge resection or age-related atrophies may cause considerable problems. Reconstructive methods using free iliac bone, external tabula, or sandwich plasties are only a few examples of the common surgical treatment modalities. Doing without bone grafts, alveolar ridge augmentation by means of distraction osteogenesis might become a value method to improve the denture-bearing area. A new distraction implant system is shown and its first clinical use reported. Two distraction implants were inserted after an anterior segmental osteotomy. The alveolar ridge was then elevated 1 mm each day until the required augmentation of about 8 mm was achieved. After a latency period for pre-ossification of the callus, the distraction implants were replaced by the endosseous implants. The implant system and the surgical technique are shown, and the results are discussed. We believe that the implant distraction procedure will make useful contribution to the management of masticatory rehabilitation.

Alveolar Bone Loss↗

Alveolar ridge augmentation in rats by combined hydroxylapatite and osteoinductive material.

The purpose of this study was to examine if increased bony ingrowth developed when hydroxylapatite was implanted together with an osteoinductive substrate. Dense hydroxylapatite granules (HA) (Calcitite, Calcitek, San Diego, CA, USA) were mixed with equal volumes of allogenic, demineralized, lyophilized dentin or bone and implanted subperiosteally for alveolar ridge augmentation purposes and heterotopically in the abdominal muscles in rats. Light microscopic evaluation revealed that HA was surrounded by fibrous connective tissue containing foreign body giant cells and it had neither an osteoinductive nor an osteoconductive effect. The newly formed bone induced from the implanted allogenic, demineralized, lyophilized dentin or bone was never found in close contact with the HA and did not incorporate the implant.

Abdominal Muscles↗

Porous hydroxylapatite granules and blocks as alveolar ridge augmentation materials: a preliminary report.

Porous hydroxylapatite (PHA) blocks and granules were used in the augmentation of 30 maxillary and mandibular ridges in 28 patients. The postoperative evaluation period was 2 years in all cases. The patients were evaluated clinically and radiographically, and by patient questionnaires. An increased incidence of dehiscence was noted with the blocks as compared with the granules. Overall prosthodontic assessment showed 95% improvement among the granule cases when compared with the preoperative ridge, and 88% improvement noted among the block cases. Patient rating of their general satisfaction with their dentures showed 82% improvement in the granule patients, and 55% in the block cases. Radiographically, the granules showed an average decrease of 8%. The results of this study show that PHA granules can be used as satisfactory alveolar ridge augmentation material, while the blocks show an increased number of complications and should be used only in very selected cases.

Adult↗

Changes in the volume and density of calvarial split bone grafts after alveolar ridge augmentation.

OBJECTIVES: One main problem occurring after bone grafting is resorption, leading to insufficient bone volume and quality, and may subsequently cause dental implant failure. Comparison of graft volume and bone density of iliac crest and calvarial transplants determined by animal studies demonstrates significantly lower resorption of bone grafts harvested from the skull. This paper is the first clinical study evaluating bone volume and density changes of calvarial split bone grafts after alveolar ridge reconstruction. MATERIAL AND METHODS: Bone volume and density were determined using CT scans and the software program Dicom Works in a total of 51 calvarial grafts after alveolar ridge augmentation in 15 patients. CT scans were taken in all 15 patients immediately after grafting (T0) and before implantation after a postoperative period of 6 months (T1). In five patients (26 calvarial grafts), a 1-year follow-up was performed (T2). RESULTS: A mean volume reduction of 16.2% at T1 (15 patients) and 19.2% at T2 (five patients) was observed. Bone density was high--about 1000 Hounsfield units--and did not change during the 1-year period. At the time of implantation, 41 transplants were classified as quality 1 bone and 10 as quality 2-3 bone. Grafting area and the technique used for grafting (inlay or onlay graft) did not affect the postoperative bone volume reduction. Generalized osteoporosis did not increase the resorption rate of calvarial transplants. CONCLUSION: Based on these findings, calvarial split bone grafts are a promising alternative for alveolar ridge reconstruction in dental implantology.

Adolescent↗

[Experimental investigation on application of hydroxyapatite implant to alveolar ridge augmented by porous hydroxyapatite granules--histological observation on implant and implant covered with autogenous iliac bone].

UNLABELLED: The purpose of this study was to investigate the possibility of applying the hydroxyapatite implant and the hydroxyapatite implant covered with autogenous iliac bone to the augmented mandible. Three months after the extractions of the lower P3, P4, and M1 of mongrel dogs, alveolar ridge augmentations were performed widely with porous hydroxyapatite granules. After one month, the hydroxyapatite implants were inserted in the iliac bone of the same dog. Four months after the augmentation, the hydroxyapatite implant and the hydroxyapatite implant covered with autogenous iliac bone were implanted only in the augmented area with the granules of the mandible. Two months later, specimens were taken out and fixed by 10% formalin alcohol. They were embedded in polyester resin and undecalcified sections were prepared. The sections were stained with toluidine blue and observed under light microscope. RESULTS: 1) Bone ingrowth was seen in most parts of the intergranular spaces and in some spaces fibrous connective tissues were observed. 2) The hydroxyapatite implant was partly attached to the bone. But a large surface of the implant was connected to the fibrous tissues among the granules. 3) The hydroxyapatite implant covered with the iliac bone was combined with the bone of the intergranular spaces.

Alveolar Process↗

Fluorescent labeling analysis and electron probe microanalysis for alveolar ridge augmentation using calcium phosphate cement.

Our previous histopathological study showed that the augmentation block, prepared from a calcium phosphate cement (CPC) mixed with H2O at powder to liquid ratio of 5 g/mL, placed on the alveolar bone ridge, was gradually replaced by natural bone. In the present study, fluorescent labeling analysis (FLA) and electron probe microanalysis (EPMA) were performed on the same surgical site of the above histopathological study. Fluorescent labeling agents, that would be incorporated into newly formed mineralized tissues, were injected into dogs intramuscularly twice a week during the 3 week period that ended 1 week before sacrifice. The specimens obtained from the block were subjected to FLA for assessing the extent of new bone formation and to EPMA for measuring the elemental (Ca, P, Mg) distributions. FLA results showed the presence of newly formed bone at 1 month after surgery. EPMA results showed that the elemental distributions in the augmentation site were similar to those of the residual bone area at 6 months after surgery. FLA and EPMA examinations also indicated that the implants were surrounded and fixed by natural bone chronologically. A CPC augmentation block is clearly useful for alveolar ridge augmentation and osteointegrated implant fixation.

Alveolar Process↗

Surgical success of intraoral autogenous block onlay bone grafting for alveolar ridge augmentation.

This article evaluates the surgical success of alveolar bone augmentation using intraoral block bone graft prior to dental implantation and measures the amount of bone accumulation using this technique. A consecutive retrospective study was conducted on patients who had onlay bone grafts from 1999 to 2001. Files of 56 healthy patients reporting 64 bone graft operations were reviewed. Medical history, smoking status, area of surgery, bone origin (donor sites) and complications were recorded. Panoramic and tomographic radiographs were measured for the vertical and horizontal bone addition and mesiodistal dimension of the graft. Graft exposure or/and graft removal were defined as failure; hematoma, swelling, inflammation, or temporary paresthesia were defined as complications. The average vertical addition was 5.6 mm measured from the bottom of the vertical lesion before bone grafting to the top of the graft. The average faciolingual addition was 3.8 mm. The mesiodistal graft length ranged from 4 mm to 67 mm (average 15.2 mm). According to our criteria, 56 (87.5%) of the 64 bone grafts were successful, 46 (71.9%) were totally uneventful, and 10 (15.6%) had complications. Smoking and diabetes were associated with a high rate of complications and graft failure. More complications were observed in the vertical than in the horizontal bone grafts. Intraoral bone block graft is a predictable operation with high success rates that provides faciolingual and vertical bone addition. Onlay bone grafting has a low rate of complications and failures. Intraoral bone graft should not be recommended for diabetic patients and smokers.

Adolescent↗

Current status of tissue expanders in alveolar ridge augmentation: a review.

The need for major surgery involving bone and skin grafting procedures in the treatment of severe alveolar atrophy has, for many patients, been obviated by the advent of reliable endosseous implant systems. However, some patients, usually for medical, psychological, or financial reasons are unsuitable for endosseous implant therapy. In such patients, ridge augmentation with particulate hydroxyapatite may result in significantly improved denture function. However, hydroxyapatite tends to disseminate throughout any surgically created subperiosteal space, resulting in an undesirable ridge form. This problem may be overcome by the use of tissue expanders in a two-stage surgical procedure. This article briefly reviews the concept of tissue expansion and describes its application to the technique of alveolar ridge augmentation.

Alveolar Ridge Augmentation↗