Comportamiento del injerto autólogo de diente en preservación alveolar: evaluación clínica, radiográfica e histomorfométrica de un caso clínico tras un año de seguimiento / Behavior of the autologous tooth graft in alveolar preservation: clinical, radiographic and histomorphometric evaluation of a clinical case after one year of follow-up

Introducción: tras las extracciones, se producen una serie de cambios dimensio nales en sentido horizontal y vertical de la cresta alveolar, los cuales pueden ser minimizados mediante algunas técnicas quirúrgicas, como la preservación alveo lar, que utiliza diferentes sustitutos óseos, entre los que se encuentra actualmente el injerto autólogo de diente. Caso clínico: se presenta el caso clínico de una mujer de 61 años, que acudió a consulta presentando dolor intenso en la zona del segundo premolar superior de recho (1.5). Se realizó la exodoncia del 1.5, usándose como diente donante para realizar una preservación del alveolo tras la extracción. Cuatro meses tras el proce dimiento, se colocó un implante y se tomó una biopsia para realizar un análisis histo morfométrico. Un año tras la carga del im plante se observaron buenos resultados clínicos y radiográficos. Discusión: el diente y el tejido óseo tie nen similitudes en su composición quími ca, tanto en sus componentes inorgáni cos y orgánicos como en la cantidad de agua. En cuanto al contenido orgánico destacan los factores de crecimiento, la proteína morfogenética ósea 2 (BMP-2) y el colágeno tipo 1, dotando al diente como biomaterial de la propiedad de os teoinducción. El empleo del diente como sustituto en preservación alveolar consi gue porcentajes altos de hueso neofor mado, variando entre 37,55% cuando se usa el diente completo, al 48,40% usando dentina desmineralizada. Además de los buenos resultados histomorfométricos, goza de una buena aceptación por parte de los pacientes, fundamentalmente en determinadas ra zas o culturas, y consigue una reducción de las dimensio nes óseas evaluadas mediante escáner de haz cónico. Sin embargo, requiere un tiempo de preparación, que aumenta si el diente tiene restauraciones o tratamientos de conduc tos asociados (AU)

Introduction: following tooth extraction, horizontal and vertical resorption of bone volume occurs, but they can be reduced by many surgical procedures, such as alveolar ridge preservation, which uses different bone substitutes, being one of them autogenous tooth-graft. Clinical case: a 61-year-old woman is presented, who came to private dental clinic presenting intense pain in the area of an upper bicuspid of the first quadrant (1.5). Exodontia of the 1.5 was performed, using it as a donor tooth to obtain the biomaterial to preserve its alveolus. After 4 months re-entry was performed and an implant was placed, harvesting a bone biopsy for histomorphometric analysis. One year post-loading, good clinical and radiographic results were shown. Discussion: human bone and tooth have similarities in their chemical composition, both in their inorganic and organic components and in the amount of water. The organic content, growth factors, bone morphogenetic protein 2 (BMP-2) and type 1 collagen stand out, give the tooth the property of osteoinduction. The use of the tooth as a substitute in alveolar preservation achieves high percentages of neoformed bone, varying between 37.55% when the whole tooth is used, to 48.40% using demineralized dentin. In addition, it is well accepted by patients, especially in certain races or cultures, and achieves a reduction in bone dimensions evaluated by cone beam computed tomography. However, it has a drawback, requiring a long preparation time, which increases if the tooth has associated restorations or root canals. Conclusions: Autologous tooth-graft has a high biocompatibility, a low rate of intraoperative complications and good patient acceptance. It requires 25 minutes for preparation, which increases if there are restorations, root canals and caries. The percentage of vital bone obtained in the present clinical case shows new bone formation of 20% 4 months after alveolar ridge preservation (AU)

Efficacy of stem cells in bone rehabilitation in patients with alveolar bone atrophy: a systematic review

Background: Biomedical engineering proposes the use of stem cells as a bone rehabilitation treatment in patients with alveolar bone defects. Many authors suggest that this innovative technique could represent the future of bone regeneration in dentistry. The present study systematically reviewed the efficacy of stem cells in bone regeneration in patients with alveolar bone atrophy. Material and methods: The study was developed following the criteria of the PRISMA guideline (2020). The literature review was conducted in Pubmed, Medline Complete, and Scopus. The search algorithms used the following key words: stem cells, bone regeneration, and alveolar ridge augmentation. To assess the risk of bias, the CASPe methodology was used. Results: Seven clinical trials in humans were included in this systematic review. In all the studies, the proposed objective of bone regeneration by using stem cells was achieved, although in a different way with different results. Although the authors of the analysed clinical trials achieved favourable results, they highlighted the presence of multiple limitations throughout bone regeneration treatments, such as scarce scientific literature on stem cells, a reduced number of follow-up studies, and a lack of a standardized international protocol. Conclusions: Based on the analysed studies, it is concluded that the therapy proposed by tissue engineering through the use of stem cells to rehabilitate patients with bone atrophies can be considered effective. In addition, the need for further studies and standardization of protocols is highlighted. (AU)

Intraoral onlay block bone grafts versus cortical tenting technique on alveolar ridge augmentations: a systematic review

Background : To review systematically the bone gain and superficial resorption rate of the onlay block bone grafts versus the cortical tenting technique, as well as secondarily study the postoperative complications, implant survival and success rates, and peri-implant marginal bone loss. Material and Methods: Following the recommended methods for systematic reviews and meta-analyses (PRISMA), an electronic search was performed in the PubMed (MEDLINE), EMBASE and the Cochrane Library of the Cochrane Collaboration (CENTRAL) databases to identify all relevant articles published up to March 2021 on onlay block bone grafts and cortical tenting technique. Results: Eighteen papers complied with the inclusion criteria. In onlay grafts, the vertical bone gain mean was 4.24 mm, and resorption 20.91%; and 4.29 mm in the horizontal augmentation with a resorption of 10.28%. The complication rate was 14.8%. The implant survival and success rates were 100% and 92%; and the mean peri-implant bone loss ranged from 0.6 to 1.26 mm. In cortical tenting technique, the vertical bone gain mean was 6.17 mm and the resorption of 9.99%; and 5.55 mm in the horizontal augmentation with a 6.12% of resorption. The complication rate was 24.6%. The implant survival and success rates were 96.63% and 100%; and the mean peri-implant bone loss ranged from 0.27 to 0.77mm. Conclusions: Despite the limitations, both techniques offer a predicTable way to reconstruct atrophic alveolar ridges, though the cortical tenting technique seems to achieve a greater bone gain and a lower surface resorption. Current evidence is still limited due to the inadequate follow-up, lack of information referred to methodological quality and sample attrition.(AU)

Eficacia de los concentrados plaquetarios en distracción ósea alveolar: una revisión de la bibliografía / Efficacy of platelet concentrate application in alveolar distraction osteogenesis technique: a review

INTRODUCCIÓN: La distracción ósea alveolar (DOA), es una técnica de aumento óseo predecible, con resultados exitosos a medio y largo plazo. El uso de concentrados plaquetarios (CP) ha demostrado ser beneficioso en la cicatrización de tejidos blandos y la reparación y regeneración ósea, mediante liberación de factores de crecimiento. Se ha probado el uso de CP durante la distracción de huesos largos, obteniéndose resultados beneficiosos. El objetivo de esta revisión bibliográfica fue analizar los resultados clínicos de la combinación de la DOA y el uso de CP. MATERIAL Y MÉTODO: Se realizó una revisión bibliográfica en tres bases de datos electrónicas sin restricciones. Además, la búsqueda electrónica fue completada con una manual, para identificar cualquier artículo adicional de relevancia. RESULTADOS: Se seleccionaron 6 artículos; dos ensayos clínicos aleatorizados en humanos, dos estudios de experimentación animal y dos casos clínicos. Los artículos incluyeron un total de 27 pacientes y 50 conejos, y utilizaron diferentes protocolos para la obtención de CP. Se registraron ganancias óseas de entre 6,3 mm a 25 mm. Además, tres artículos reportaron complicaciones como parestesia transitoria, infección o inclinación del segmento de transporte. CONCLUSIONES: El uso de CP durante la DOA presenta efectos positivos, disminuir el riesgo de infección y la respuesta inflamatoria, aumentar la vascularización del callo de fractura, producir una aceleración en la regeneración ósea y disminuir el periodo de consolidación. Ante la heterogeneidad de los artículos incluidos, son necesarios más estudios que esclarezcan el papel de los CP y su influencia durante la DOA

INTRODUCTION: Alveolar distraction osteogenesis (ADO) is a predictable bone augmentation technique, with successful results in the medium and long term. The use of platelet concentrates (PC) has been demonstrated to be beneficial in soft tissue healing, in bone repair and regeneration, through the release of growth factors. The use of PC has been used in combination with osteogenesis distraction of long bones, obtaining positive results. The aim of this literature review was to analyze the clinical outcomes of the combination of the alveolar distraction technique and the use of PCs. MATERIAL AND METHODS: A bibliographic review was performed in three electronic databases without time or language restrictions. In addition, the electronic search was completed by a manual, to find any additional relevant articles. RESULTS: 6 articles were selected; two human randomized clinical trials, two animal experimentation and two clinical cases. The articles included a total of 27 patients and 50 rabbits and used different protocols to obtain PCs. Bone gains of between 6.3mm to 25mm were reported. In addition, three articles reported complications such as transient paresthesia, infection, or inclination of the transport segment. CONCLUSIONS: The use of PCs during ADO has positive effects, by decreasing the risk of infection and the inflammatory response, enhancing the vascularization of the fracture callus, causing an acceleration in bone regeneration and reducing the consolidation period. Due the heterogeneity of the articles included, more studies are needed to clarify the role of PCs and their influence during ADO

Material de injerto en elevación de seno atraumática: ¿es necesario? Parte I / Graft material in atraumatic sinus lift elevation: ¿is it necessary? Part I

INTRODUCCIÓN: la reabsorción vertical de la zona posterior del maxilar supone un reto terapéutico para el profesional, ya que son necesarias técnicas regenerativas para poder colocar implantes den-tales. La elevación de seno atraumática permite la colocación de implantes dentales de manera simultánea al procedimiento regenerativo, pero hay controversia en la necesidad o no de emplear materiales de injerto asociados a esta técnica. Ganancia ósea: al comparar la utilización o no de materiales de injerto en elevaciones de seno atraumáticas, se obtiene una ganancia ósea de 1-6.8 mm cuando no se emplean biomateriales, y 3.07-8.5 mm al utilizarlos. Pérdida ósea marginal: los estudios reflejan una pérdida ósea marginal de 0.5-1.54 mm al no emplear materiales de injerto, respecto a 0.7-1.67 mm cuando se utilizan. Supervivencia de implantes: ambas técnicas de elevación de seno atraumática presentan tasas de supervivencia imlantarias similares, superiores al 90 %.Complicaciones: la tasa de complicaciones en esta técnica regenerativa es baja, siendo la más frecuente la perforación de la membrana de Schneider, no suponiendo en la mayoría de los casos un impedimento para la colocación de implantes dentales. CONCLUSIONES: la técnica de elevación de seno sin relleno presenta menor ganancia ósea y pérdida ósea marginal en comparación a la técnica de elevación de seno con relleno, pero ambas técnicas presentan tasas de supervivencia implantarias similares, y una baja tasa de complicaciones, por lo que la utilización o no de biomateriales asociados debe decidirse en función de todas estas variables

INTRODUCTION: vertical resorption of posterior maxilla is a therapeutic challenge for dentists, since regenerative techniques are necessary to be able to place dental implants. Atraumatic sinus lift augmentation allows simultaneous dental implants placement to regenerative procedure, but it is not clear nowadays if it is or not necessary to use associated graft materials. Bone gain: scientific evidence reports a bone gain of 1-6.8 mm without using graft materials, versus 3.07-8.5 mm when authors use graft materials in atraumatic sinus lift augmentations procedures. Marginal bone loss: similar bone loss is expected in both techniques, but atraumatic sinus lift augmentation presents 0.5-1.54 mm when graft material is not used, versus 0.7-1.67 mm when graft material is used. Implant survival: both techniques present similar survival implant rates, greater than 90 %.Complications: low complications rate is reported, being the most frequent complication Schneider membrane perforation. Nevertheless, dental implant placement is possible in spite of this complication. CONCLUSIONS: atraumatic sinus lifting without graft materials presents lower bone gain and marginal bone loss in comparison to atraumatic sinus lifting with graft materials. Both techniques present similar survival implant rates and low complication rates, so using or not grafting materials should be decided analyzing all these variables

Assessment of clinical outcomes and histomorphometric findings in alveolar ridge augmentation procedures with allogeneic bone block grafts: A systematic review and meta-analysis

BACKGROUND: This systematic literature review aimed to evaluate the efficacy of allogeneic bone blocks for ridge augmentation by assessing block survival rates and subsequent implant survival, including post-surgical complications and histomorphometric analysis. MATERIAL AND METHODS: An electronic and manual search among references, was conducted up to April 2019 by two independent authors. Inclusion criteria were: human clinical trials in which the outcomes of allogeneic bone block grafts were evaluated by means of their survival rates and subsequent implant success rates. RESULTS: Seven articles fulfilled the inclusion criteria and were analyzed. A total of 323 allogeneic block grafts were monitored for a minimum of 12 months follow-up after surgery, of which thirteen (4.02%) failed. Regarding the cumulative implant survival rate, the weighted mean was 97.36%, computed from 501 implants. Histologic and histomorphometric analysis showed that allogeneic block grafts presented some clinical and microstructural differences in comparison with autologous block grafts. CONCLUSIONS: Atrophic alveolar crest reconstruction with allogeneic bone block grafts would appear a feasible alternative to autologous bone block grafts, obtaining a low block graft failure rate, similar implant survival rate and fewer postoperative complications. Further investigations generating long term data are needed to confirm these findings

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Resultados del uso de la fibrina rica en plaquetas y rellenos óseos en la regeneración ósea guiada. Revisión sistemática / Results of platelet rich fibrin and bone grafts in guided bone regeneration. A systematic review

OBJETIVO: El propósito de esta revisión fue evaluar sistemáticamente la literatura científica sobre los resultados que se obtienen al combinar la fibrina rica en plaquetas (PRF) y rellenos óseos en la regeneración ósea guiada. MATERIALES Y MÉTODOS: Búsqueda detallada en las bases de datos PubMed, Scopus, Web of Science, ScienceDirect, Cochrane y SciELO para obtener la información más actualizada de los resultados (grado de relleno óseo, éxito de la cirugía, movilidad del implante, complicaciones posquirúrgicas, supervivencia del implante) entre los casos tratados con PRF y los casos donde se combinó PRF con algún tipo de relleno óseo. RESULTADOS: De las 965 publicaciones identificadas inicialmente, se excluyeron reportes clínicos, revisiones, estudios observacionales, etc. Se incluyeron 12 ensayos clínicos que contrastaron las variables entre la técnica con PRF solo y la combinación con un relleno óseo. CONCLUSIÓN: La combinación entre PRF más rellenos óseos promueve la neoformación ósea, aumenta el trabeculado y mejora los tiempos de cicatrización; sin embargo, al cabo de 6 meses de control los resultados no son diferentes significativamente de los de los grupos que no utilizaron PRF en el procedimiento de levantamiento de piso de seno maxilar con técnica de ventana lateral. Respecto a la preservación de reborde alveolar, los distintos estudios no son concluyentes: algunos indican que la mezcla de PRF con un relleno óseo parece mejorar las proporciones volumétricas; sin embargo, otros refirieron pérdidas óseas en anchura e incluso mayor grado de inflamación

OBJECTIVE: To evaluate systematically the results obtained by combining platelet rich fibrin (PRF) and bone fill in guided bone regeneration, according to scientific literature. MATERIALS AND METHOD: Detailed search of database from PubMed, Scopus, Web of Science, ScienceDirect, Cochrane and SciELO to obtain the most updated information of clinical results (bone filling degree, surgical success, implant mobility, post-surgical complications, and implant survival) of the cases treated with PRF and the cases where the platelet rich fibrin was combined with a bone filler. Those results registered and compared. RESULTS: From the 965 files initially identified, were excluded clinical reports, reviews, observational studies, comments, studies with pediatric patients and so on. There were included 12 clinical essays where the variables of the technique with PRF and the technique where the PRF was combined with a bone filler were contrasted. CONCLUSION: The combination of PRF plus bone filler promotes bone neoformation, increased trabecular bones, and improved healing times; however, after 6 months of monitoring, the results were not significantly different with the groups that did not use the PRF in the procedure of maxillary sinus floor lift with lateral window technique. Regarding the preservation of alveolar ridge the different studies are not conclusive: some indicate that the mixture of a concentrate with a bone filling seems to improve the volumetric proportions; however, other studies report bone loss in width and even greater degree of inflammation

Alveolar distraction osteogenesis for dental implant treatments of the vertical bone atrophy: A systematic review

Background: To determine if alveolar vertical distraction osteogenesis obtains better results compared to other bone regeneration treatments (guided bone regeneration with membranes and / or filling material, or autogenous bone graft) in terms of bone gain, complications, and implant survival and success rates. Material and Methods: An electronic search was performed in Pubmed (MEDLINE), Cochrane Library and Scopus databases in March 2017. Besides, a manual search was carried out. Inclusion criteria were randomized controlled trials published within the last 10 years with at least 1 year of follow-up after implant placement. No language restriction was applied. Exclusion criteria were studies in patients with bone defects produced by trauma, congenital malformation or oncologic surgical treatment. The methodological quality of the selected studies was evaluated by means of the Cochrane Collaboration’s Tool for assessing risk of bias. The reports were classified into different levels of recommendation according to the "Strength of Recommendation Taxonomy ". Results: Out of 221 articles, two randomized controlled trials were finally selected for the inclusion in the systematic review. Bone gain and complications were higher with the alveolar vertical distraction osteogenesis compared to the autologous bone graft. There was higher bone resorption with the autologous bone graft. Implant survival and success rates were similar between studies, despite of the used technique. Conclusions: Both alveolar distraction osteogenesis and autogenous bone graft are effective bone regeneration techniques for the treatment of mandibular vertical bone atrophy. A level B recommendation can be established for the use of alveolar vertical distraction osteogenesis for the treatment of the mandibular vertical bone atrophy

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20 years of alveolar distraction: A systematic review of the literature

BACKGROUND: The Vertical Alveolar Distraction Osteogenesis (VADO) technique is an excellent solution for bone and soft tissue neoformation in areas in which there has been significant bone atrophy that hinders normal rehabilitation using dental implants. The goal of this systematic review is to analyze the most relevant articles published on VADO in the literature over the past 20 years. MATERIAL AND METHODS: The review was performed by using the keywords: "alveolar ridge", "distraction ostegenesis" and "dental implant". This search produced a total result of 240 articles. The clinical studies and cases reported in humans amounted to 113 articles, 18 articles referred to studies developed on animals and 33 review articles. The presentation of this systematic analysis follows the criteria described in the PRISMA declaration. RESULTS: 22 articles complied with the inclusion criteria and 7 articles more were added manually, reaching a total sample of 29 studies. Following the analysis of the studies, they were classified into 18 high-quality, 10 mediumquality and 1 low-quality study. Only 4 studies achieved a maximum score of 9 (according to NewCastle Ottawa Scale, NOS). CONCLUSIONS: VADO is a technique with greater potential in vertical gain. The performance of dental implants has a success and survival rate similar to dental implants placed on bones that are not subject to increase techniques

Utilización de PRF Asociado a Materiales de Relleno Sintéticos (HA y Beta-TCP) en Reconstrucciones Óseas / Use of PRF in Combination with Synthetic Filling Materials (HA and Beta-TCP) for Bone Reconstructions

Introducción: Las cirugías reconstructivas del proceso alveolar con uso de injertos óseos son frecuentes, el gold standard en injertos óseos continua siendo el hueso autógeno, sin embargo, presenta limitaciones conocidas, por lo cual se ha trabajado en desarrollar nuevos materiales, como los injertos sinteticos, principalmente aquellos en base a hidroxiapatita o beta fosfato tricálcico, sin embargo, al ser éstos principalmente osteoconductores, el empleo de algunos coadyudantes en regeneración ósea pueden ser de utilidad para potenciar la regeneración ósea basada en materiales aloplásticos, como es el caso del PRF, hemoderivado de segunda generación obtenido a través de un protocolo específico de centrifugación de la propia sangre del sujeto. El objetivo de ésta revisión fue realizar un analisis de los resultados histológicos y ultraestructurales donde se asocie el empleo de injertos óseos sintéticos en conjunto con PRF y analizar la regeneración ósea descrita mediante una búsqueda sistemática. Material y Método: Se realizó una búsqueda sistemática de la literatura científica entre Diciembre del 2002 y Julio de 2017, en las bases de datos MEDLINE, EMBASE, LILACS y SciELO. Resultados: Se observó en los artículos analizados, que la calidad de la regeneración ósea fue superior al asociar el material aloplástico correspondiente con PRF. Conclusión: El uso de biomateriales sintéticos junto a PRF presenta resultados positivos en la estimulación de la neofofmación ósea. No obstante, los resultados no son totalmente concluyentes debido a la limitada cantidad de estudios y a la metodología variada empleada en diferentes modelos animales

Introduction: Reconstructive surgeries of the alveolar process using bone grafts are frequent, with the gold standard in bone grafts continues today to be autogenous bone; despite its known limitations, requiring the continuous development of new materials and alternatives, such as synthetic grafts, mainly those based on hydroxyapatite or beta tricalcium phosphate. Yet, are mainly osteoconductive; hence, the use of some bone regeneration adjuvants can be useful to enhance bone regeneration based on alloplastic materials, as is the case with PRF, a second-generation blood by-product obtained through a specific protocol for centrifugation of the subject's own blood. The aim of this review is to perform a systemic analysis of the histological and ultrastructural results for the use of synthetic bone grafts in combination with PRF and to analyze the resulting bone regeneration. Material and Method: A systematic search of the scientific literature was carried out between December 2002 and July 2017, in the MEDLINE, EMBASE, LILACS and SciELO databases. Results: The quality of the regenerated bone was superior when combined with the corresponding alloplastic material with PRF. Conclusion: The use of synthetic biomaterials together with PRF presents positive results in the stimulation of bone neoformation. However, the results are not totally conclusive due to the limited number of studies and the varied methodology used in different animal models

Implantes dentales cortos en la rehabilitación de los maxilares atróficos. Puesta al día / Short dental implants in atrophic jaws rehabilitation. Update

Los implantes dentales cortos, aunque históricamente se han asociado a un mal pronóstico en las rehabilitaciones orales implantosoportadas, con el paso de los años y los avances en implantología, se han convertido en un tratamiento habitual en la práctica diaria de muchos clínicos, obteniendo tasas de éxito que se han incrementado recientemente hasta prácticamente igualarse a los implantes convencionales para muchos autores. La necesidad de reducir tiempos de trabajo, costes económicos y morbilidad intraoperatoria unida a la creciente demanda derehabilitaciones implanto soportadas en pacientes de un rango de edad cada vez mayor hace necesario añadirlos entre nuestras opciones rehabilitadoras implantológicas. Para ello es necesario conocer sus pros y contras y establecer unos protocolos quirúrgicos y de selección del paciente receptor (AU)

Short dental implants, with the passage of time and advances in implantology, have become astandard treatment in clinical practice. The need to reduce intraoperative time, morbidity and economic costs, linked to the increasing demand for implant rehabilitation in patients with a range of growing old (elder patients) makes it necessary to add the min our rehabilitative implantology options. For this reason, it is important to know its advantages and disadvantages, to set up thesurgical protocols and to select the patients correctly (AU)

Expansión tisular por medio de polímeros superabsorbentes como terapia coadyuvante para el aumento de reborde alveolar atrófico / Tissue expansion using super-absorbent polymers as coadjuvant treatment to increase atrophic alveolar ridges

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Técnicas de preservación de alveolo y de aumento del reborde alveolar: Revisión de la literatura / Ridge preservation and ridge augmentation procedures: A literatura review

La pérdida dentaria produce una serie de cambios dimensionales que afectan tanto a los tejidos duros como a los tejidos blandos ocasionando frecuentemente defectos en el reborde alveolar. La prevención y el tratamiento de dichos defectos, tiene como objetivo la preservación o el aumento de los tejidos duros y/o blandos para mejorar las condiciones del reborde para una futura restauración protésica. Existen diversas técnicas quirúrgicas encaminadas a prevenir o minimizar los cambios dimensionales en alveolos postextracción (técnicas de preservación de alveolo) y otras destinadas a la reconstrucción de dichas alteraciones anatómicas. En general, en defectos pequeños o moderados una técnica de aumento de tejidos blandos puede ser suficiente. Sin embargo, en defectos más severos o en aquellas localizaciones en las que se planifique la posterior colocación de implantes, un enfoque combinado (aumento de tejido duros y blandos) y/o en distintas fases puede ser necesario. En este artículo se revisan los cambios dimensionales tras la extracción o pérdida dental, los tipos de la deformidad del reborde así como las diferentes técnicas de preservación de alveolo y de aumento de la cresta alveolar

The extraction of single as well as multiple teeth induces a series of adaptative changes in the soft and hard tissues that results in an overall regress of the edentulous site(s). The prevention and treatment of alveolar ridge deformities aims preserving and reconstructing soft and hard tissues of the edentulous ridge in order to render better conditions at the site for the future prosthesis installation. Different surgical techniques have been proposed to prevent ridge collapse after tooth extraction or to reconstruct the lost anatomy prior to prosthesis installation. In general terms, in mild defects, soft tissue augmentation may be sufficient to repair the deformity. However, in more severe deformities a combined or staged approach may be more appropriate. This article reviews the dimensional changes after tooth extraction, types alveolar ridge deformities and various techniques for the prevention and treatment of alveolar ridge defects

The role of angiogenesis in implant dentistry part II: The effect of bone-grafting and barrier membrane materials on angiogenesis

BACKGROUND: In implant dentistry, bone substitute materials and barrier membranes are used in different treatments including guided bone regeneration (GBR), socket preservation, alveolar ridge augmentation, maxillary sinus elevation, and filling bony defects around the inserted dental implant. One of the most important factors in prognosis of treatments using these materials is the growth of new blood vessels in applied areas. Present review was performed to evaluate the effect of the bone-grafting and barrier membrane materials on angiogenesis events. MATERIAL AND METHODS: An electronic search was performed in PubMed, MEDLINE, and EMBASE databases via OVID using the keywords mentioned in the PubMed and MeSH headings regarding the role of angiogenesis in implant dentistry from January 2000-April 2014. RESULTS: Of the 5,622 articles identified in our initial search results, only 33 met the inclusion criteria set for this review. Among bone substitute materials the autogenous bone-grafts, and among the barrier membranes the collagenous membranes, had the highest angiogenic potentials. Other bone-grafting materials or membranes were mostly used with pro-angiogenic factors to enhance their angiogenic properties. CONCLUSIONS: Angiogenesis is one of the key factors, which plays a critical role in success rate of GBR technique and is seriously considered in manufacturing bone-grafting and barrier membrane materials. However, there is still lack of clinical and in-vivo studies addressing the effect of angiogenesis in treatments using bone-grafting and barrier membrane materials

Surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft

BACKGROUND: A coronally advanced flap with subepithelial connective tissue graft is the gold standard surgical treatment of gingival recessions, since it offers a higher probability of achieving complete root coverage compared with other techniques. However, optimum short- and middle-term clinical results have also been obtained with coronally advanced flaps alone. The aim of the present study was to evaluate the results obtained by the surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft. MATERIAL AND METHODS: The reduction of recession height was assessed, together with the gain in gingival attachment apical to the recession, and total reduction of recession, in a comparative study of two techniques. Twentytwo gingival recessions were operated upon: 13 in the control group (coronally advanced flap) and 9 in the test group (coronally advanced flap associated to subepithelial connective tissue graft). RESULTS: After 18 months, the mean reduction of recession height was 2.2 ± 0.8 mm in the control group and 2.3 ± 0.7 mm in the test group, with a mean gain in gingival attachment of 1.3 ± 0.9 mm and 2.3 ± 1.3 mm, respectively. In percentage terms, the mean reduction of recession height was 84.6 ± 19.6% in the control group and 81.7 ± 17.8% in the test group, with a mean gain in gingival attachment of 20.5 ± 37.4% and 184.4 ± 135.5%, respectively. CONCLUSIONS: Significant reduction of gingival recession was achieved with both techniques, though the mean gain in gingival attachment (in mm and as a %) was greater in test group

Long-term outcome of dental implants after maxillary augmentation with and without bone grafting

BACKGROUND: This study aims to evaluate the technique of sinus bone reformation, which consists of elevating the sinus membrane and placement the implant without bone graft, compared with the widely-used technique involving raising the maxillary sinus and grafting, using animal hydroxyapatite as the filler, while simultaneously fixing the implants. MATERIAL AND METHODS: This is a retrospective study on two groups of patients who underwent elevation of the sinus membrane and simultaneous placement of the implant. The grafting technique was applied to one group, while the other had no graft. An alveolar ridge height of 4 to 7 mm was necessary. Radiological control was undertaken at 6 months and one year post-prosthetic loading. In each group 38 implants were placed. RESULTS: No significant behavioural differences were observed in the implants according to the Albrektsson success criteria. Implant failure was observed in 2 implants from the bone grafting group (success rate 93%) and in 1 implant from the reformation group (success rate 97%). In this group, bone formation was observed on both sides of each implant, the bone gain was measured using image management software (2.7±0.9mm mesial and 2.6±0.9mm distal). There was no correlation between mesial and distal bone gain and implant's length. CONCLUSIONS: The results indicate that bone reformation is a valid technique in cases involving atrophy of the posterior maxilla. Primary stability, maintenance of space by the implant, and the formation of a blood clot are crucial in this technique in order to achieve bone formation around the implant. It is an alternative to the conventional technique of sinus lift with filling material, and has several advantages over this procedure, including a lower infection risk, as it does not involve a biomaterial, reduced cost, a simpler technique, and better acceptance by the patient

Complications in the use of the mandibular body, ramus and symphysis as donor sites in bone graft surgery. A systematic review

BACKGROUND: To develop a systematic review by assessing and comparing the different complications that occurs in bone graft surgery using the mandibular body, ramus and symphysis as donor sites. MATERIAL AND METHODS: In order to respond to the following question, a systematic review was developed: does the use of intraoral mandibular body and ramus as donor sites in bone graft surgery, produce fewer and less severe complications in comparison to the use of the mandibular symphysis in patients that present bone resorption that needs augmentation using autologous grafts? The review was carried out between January 1990 and 2015, during which only clinical essays with a minimum follow-up period of six months were included. RESULTS: The initial search yielded a total of 2912 articles, of which 6 were finally selected. In total, 259 graft surgeries were performed; 118 using the mandibular body and ramus as donor sites, and 141, the symphysis. The most frequent complications that arose when using the mandibular symphysis were temporary sensory alterations in the anterior teeth (33.87%), followed by sensory alterations of the skin and mucosa (18.57%). As for the mandibular body and ramus donor sites, the most frequent complications relate to temporary sensory alterations of the mucosa (8.19%) and to minor postoperative bleeding (6.55%). CONCLUSIONS: The analyzed results show a higher prevalence and severity of complications when using mandibular symphysis bone grafts, producing more discomfort for the patient. Therefore, it would be advisable to perform further clinical essays due to the lack of studies found

Maxillary sinus augmentation with bovine hydroxyapatite alone: A safe technique with predictable outcomes in patients with severe maxillary atrophy / Elevación del seno maxilar con hidroxiapatita bovina sola: Una técnica segura con resultados predecibles en pacientes con atrofia maxilar grave

Sinus augmentation is a preprosthetic technique for rehabilitating posterior sector of the atrophied maxilla with implant-supported prosthesis. We retrospectively analyzed 34 consecutive sinus augmentations performed using only bovine hydroxyapatite. The presurgical height in 92% of the cases was 4 mm or less. The success rate of the maxillary sinus augmentation was 100% for this technique. 13.4% of the implants were placed immediately with a success rate of implants placement of 93.9%. The non-osseointegrated implants were all successfully replaced. Follow-up period was 1268 days. The success rate obtained using bovine hydroxyapatite alone is similar to that using other types of materials, while avoids morbidity of the autologous bone donor area (AU)

La elevación del seno es una técnica preprotésica para la rehabilitación del sector posterior atrofiado del maxilar con una prótesis de implantación. Analizamos retrospectivamente 34 casos consecutivos de elevación del seno maxilar con el empleo de tan solo hidroxiapatita bovina sola. La altura prequirúrgica era de 4 mm o menos en el 92% de los casos. El porcentaje de éxitos de la elevación del seno maxilar con esta técnica fue del 100%. Un 13,4% de los implantes se colocaron inmediatamente, con un porcentaje de éxitos de la implantación del 93,9%. Los implantes no osteointegrados se sustituyeron todos con éxito. El periodo de seguimiento fue de 1268 días. El porcentaje de éxitos obtenido con el empleo de hidroxiapatita bovina sola es similar al de otros tipos de materiales, al tiempo que se evita la morbilidad en el área donante de hueso autólogo (AU)

The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: a systematic review

AIM: The purpose of this study was to systematically review clinical studies examining the survival and success rates of implants placed with intraoral onlay autogenous bone grafts to answer the following question: do ridge augmentations procedures with intraoral onlay block bone grafts in conjunction with or prior to implant placement influence implant outcome when compared with a control group (guided bone regeneration, alveolar distraction, native bone or short dental implants.)?Material and METHOD: An electronic data banks and hand searching were used to find relevant articles on vertical and lateral augmentation procedures performed with intraoral onlay block bone grafts for dental implant therapy published up to October 2013. Publications in English, on human subjects, with a controlled study design -involving at least one group with defects treated with intraoral onlay block bone grafts, more than five patients and a minimum follow-up of 12 months after prosthetic loading were included. Two reviewers extracted the data. RESULTS: A total of 6 studies met the inclusion criteria: 4 studies on horizontal augmentation and 2 studies on vertical augmentation. Intraoperative complications were not reported. Most common postsurgical complications included mainly mucosal dehiscence (4 studies), bone graft or membrane exposures (3 studies), complete failures of block grafts (2 studies) and neurosensory alterations (4 studies). For lateral augmentation procedures, implant survival rates ranged from 96.9% to 100%, while for vertical augmentation they ranged from 89.5% to 100%. None article studied the soft tissues healing. CONCLUSIONS: Survival and success rates of implants placed in horizontally and vertically resorbed edentulous ridges reconstructed with block bone grafts are similar to those of implants placed in native bone, in distracted sites or with guided bone regeneration. More surgical challenges and morbidity arise from vertical augmentations, thus short implants may be a feasible option

Actualización en Preservación de Cresta Alveolar. Revisión de la literatura / Actualization in Ridge Preservation. Literature review

Inmediatamente después de la extracción de una pieza dental, comienzan a producirse una serie de cambios que originan una disminución tanto en altura como en anchura de la cresta ósea alveolar. Para minimizar dichos cambios se han ido proponiendo diferentes técnicas de "preservación de cresta alveolar". Esta se define como un procedimiento diseñado para mantener las dimensiones de la cresta ósea alveolar tras la extracción de una pieza dental; con estas técnicas se posibilita la correcta colocación de un implante dental osteointegrado, dismi-nuyendo la necesidad de una posibleregeneración ósea guiada a posteriori y con-siguiendo así los requerimientos estéticosnecesarios en prostodoncia.En esta revisión de la literatura se analiza-ron las diferentes técnicas y procedimientosclínicos para la preservación de la crestaalveolar; se compararán algunos de los dife-rentes tipos de biomateriales utilizados, larealización de exodoncias con o sin eleva-ción de un colgajo, el cierre primario, lautilización de membranas reabsorbibles o la colocación de un implante inmediato; se tratará de llegar a una serie de conclusionessobre el procedimiento más adecuadobasándonos en la evidencia científica (AU)

After tooth extraction the edentulous site begin a series of changes that affect height and width of the socket. To counteract these changes various "ridge preservation" techniques were purposed. It is defined as a advantageous procedure to maintain an acceptable ridge contour, after tooth extraction, this techniques allow the correct placement of an osteointegrated implant, lowering a consequent guided bone regeneration and reaching the esthetical requirements necessary for prosthodontics, In this literature review different ridge preser-vation techniques and clinical procedureshave been analyzed. Different types of bio-material, flap or flapless extractions, primaryclosure , use of resorbable membrane andimplants placed in the fresh extraction soc-ket will be compared; we will try to find aseries of conclusions about the most indicated clinical procedures, basing on thescientific literature (AU)