Peri-Implant Mucosal Fenestration and Histologic Observation of Bone Xenograft Material 7-Years After Implant Installation: A Case Report.

Bone augmentation is often required before the installation of dental implants. Here, we report a case for a patient who previously received bone augmentation at the upper right jaw using a xenogenic graft, followed by successful implant installation. Seven years later, the patient presented with mucosal fenestration with bone exposure at the area and gave a history of a recent diagnosis of cutaneous lichen planus. Several attempts were made to manage the situation, and finally, we resorted to connective tissue graft placement at the site. A piece of bone was sent for histologic evaluation, where the results indicated the presence of un-resorbed graft material surrounded by inflammatory cells, with no evidence of bone formation in the area. The case presents histologic evidence for the lack of new bone formation using xenograft over the evaluation period. The case also shows lichen planus, a possible cause for oral complication for patients undergoing augmentation and implant installation.

The influence of self-inflating soft tissue expander on the outcomes of horizontal alveolar ridge augmentation: A randomized controlled clinical and histological study.

OBJECTIVE: The present study was conducted to evaluate the effect of soft tissue augmentation using a self-inflating soft tissue expander when performed before horizontal alveolar ridge augmentation on the outcomes of the bone augmentation procedure. The primary outcome is the bucco-palatal radiographical changes in alveolar ridge width, while the secondary outcome is the quality of the augmented bone assessed histomorphometrically. MATERIALS AND METHODS: Sixteen patients underwent horizontal alveolar ridge augmentation using autogenous bone. For the test group, soft tissue expanders were used in a separate surgery before bone grafting surgery. For the control group, patients received treatment including single surgery of bone grafting associated with periosteal releasing incision. Implants were placed in both groups 6 months after bone augmentation. Bucco-palatal changes in alveolar ridge width were evaluated via cone-beam computed tomography. Augmented bone quality was assessed histomorphometrically. RESULTS: After 6 months, regarding radiographic bone width, there was no statistically significant difference between the two groups, as mean bone width in group I and group II were 8.57 mm and 8.75 mm, respectively. Regarding histomorphometric analysis, Group I showed significantly higher mean bone surface area fraction, higher median mature collagen area fraction, and higher median blood vessel count than Group II (p-value = .012), (p-value = .004), and (p-value = .014), respectively. CONCLUSION: Within the limitations of the present study, soft tissue expander has no influence on bone width gain after horizontal alveolar ridge augmentation with an autogenous bone block but may have a positive effect on the quality of augmented bone.

Applications of maxillary tuberosity block autograft.

OBJECTIVE: Autogenous bone grafts are considered the gold standard due to their compatibility and osteogenic potential to induce new bone formation through osteogenesis, osteoinduction, and osteoconduction. The aim of this paper was to describe clinical applications of the maxillary tuberosity block autograft in small and moderate localized defects of the alveolar process around implants and teeth. CLINICAL CONSIDERATIONS: Maxillary tuberosity is often used as a particulate graft for augmentation of deficient alveolar ridge or maxillary sinus prior to or simultaneously with implant insertion, but not as a bone block graft. The maxillary tuberosity block autograft may also provide a valuable bone source for challenging situations such as immediate implant placement into types II and III extraction sockets, treatment of horizontal and vertical bone defects with simultaneous implantation, reconstruction of circumferential defects around implants, and preservation of alveolar ridge. CONCLUSIONS: The advantages of the maxillary tuberosity include intraoral corticocancellous autogenous graft with fewer intraoperative difficulties, no need for donor site restoration, less morbidity, and an excellent correction of localized alveolar ridge defects. CLINICAL SIGNIFICANCE: Within the limitations of the presented case reports, the use of maxillary tuberosity block autograft has shown to be successful in alveolar ridges augmentation that lack both width and height.

Clinical and patient-reported outcomes of implants placed in autogenous bone grafts and implants placed in native bone: A case-control study with a follow-up of 5-16 years.

AIMS: To compare the radiographic marginal bone levels of implants placed in sites previously augmented with autogenous bone grafts and implants placed in native bone. Secondary outcomes included: implant survival, periodontal/peri-implant parameters as well as short- and long-term patient-reported outcome measures. MATERIALS AND METHODS: The study was designed as a case-control study including 38 patients equally distributed into two groups (previously augmented with autogenous bone blocks [AB] and implants placed in native bone [NB]). In total, 67 implants were placed. Clinical, radiographic and patient-reported outcome measures (PROMs), and complication rates were assessed based on a chart review and at a follow-up examination (≧5 years after implant placement). Nonparametric mixed models were applied for the comparison of the two groups because of the clustered data. The data were analyzed descriptively, and p-values were calculated using nonparametric mixed models to account for the clustered data. RESULTS: The mean follow-up time was 10.2 years (range 6-13 years; AB) and 8.3 years (range 5-16 years; NB). One implant was lost in group NB (97.5% survival rate) and none in group AB (100%). Following primary augmentation, six major complications (wound dehiscences, acute pulpitis, intra- and extraoral sensitivity disturbances) were observed at the donor sites. At time of implant placement, only minimal complications occurred and only in group NB. Median marginal bone levels at the follow-up were significantly higher in group NB (1.15; Q1: 0.50 mm/Q3: 1.83 mm) than in group AB (1.58; Q1: 1.01 mm/Q3: 2.40 mm; p = 0.0411). Probing depth, bleeding on probing and recession values were similar in both groups. PROMs revealed high visual analog scale values (i.e., high satisfaction) for both procedures. CONCLUSIONS: Dental implants placed in sites augmented with autogenous bone or in native bone revealed healthy peri-implant tissues after 5-16 years. Marginal bone levels were significantly higher for implant placed in native bone. Complications following primary augmentation encompassed every third patient but were mostly transient.

Synthetic Blocks for Bone Regeneration: A Systematic Review and Meta-Analysis.

This systematic review is aimed at evaluating the effectiveness of synthetic block materials for bone augmentation in preclinical in vivo studies. An electronic search was performed on Pubmed, Scopus, EMBASE. Articles selected underwent risk-of-bias assessment. The outcomes were: new bone formation and residual graft with histomorphometry, radiographic bone density, soft tissue parameters, complications. Meta-analysis was performed to compare new bone formation in test (synthetic blocks) vs. control group (autogenous blocks or spontaneous healing). The search yielded 214 articles. After screening, 39 studies were included, all performed on animal models: rabbits (n = 18 studies), dogs (n = 4), rats (n = 7), minipigs (n = 4), goats (n = 4), and sheep (n = 2). The meta-analysis on rabbit studies showed significantly higher new bone formation for synthetic blocks with respect to autogenous blocks both at four-week (mean difference (MD): 5.91%, 95% confidence intervals (CI): 1.04, 10.79%, p = 0.02) and at eight-week healing (MD: 4.44%, 95% CI: 0.71, 8.17%, p = 0.02). Other animal models evidenced a trend for better outcomes with synthetic blocks, though only based on qualitative analysis. Synthetic blocks may represent a viable resource in bone regenerative surgery for achieving new bone formation. Differences in the animal models, the design of included studies, and the bone defects treated should be considered when generalizing the results. Clinical studies are needed to confirm the effectiveness of synthetic blocks in bone augmentation procedures.

Surgical Restorative Decision Algorithm for Edentulous Condition in Implant Dentistry With Emphasis on Bone Augmentation.

Ridge preservation and bone augmentation techniques in implant dentistry are designed to preserve and augment existing alveolar ridge to prepare it for implant treatment. Bone stock is an essential component for a long-term success of dental implants. This article provides a prosthetically driven step-by-step surgical restorative decision tree algorithm to diagnose and treat an edentulous condition in implant dentistry.

Vertical Ridge Gain with Various Bone Augmentation Techniques: A Systematic Review and Meta-Analysis.

PURPOSE: The aim of this systematic review was to determine the most effective alveolar augmentation technique for vertical bone gain. MATERIALS AND METHODS: A systematic search to select clinical trials and retrospective studies done on patients with reduced vertical bone height was conducted. The intervention of interest was autogenous block graft done compared to procedures such as distraction osteogenesis (DO), particulate grafting, block plus particulate grafting with titanium mesh, and tent pole technique in systematically healthy adult patients age 18 and older. The following electronic databases were explored: PubMed, CINAHL, and Dental and Oral Science. A supplementary manual search of published full-text articles from January 2005 to December 2017 was done using Google Scholar. Grey literature was also sought using greylit.org. The review protocol was registered at the Prospero registry (CRD # 42017072432). The risk of bias of the included studies was assessed using EPOC criteria. Meta-analysis was performed using Review Manager for studies with quantitative data on mean values of vertical bone gain and bone resorption achieved with various bone augmentation techniques. Random effect model was used. Heterogeneity among studies was evaluated using the I2 statistic. RESULTS: A total of 2322 articles were found. After excluding the irrelevant papers, only 8 papers were finally selected for the detailed evaluation. Of these 8, 5 were clinical trials, and 3 were retrospective studies. Four studies were on DO, 2 on particulate grafting, 1 on autogenous block grafting plus particulate grafting, and 1 on tent pole grafting. The control group in all studies were autogenous block graft. Meta-analysis revealed no significant difference between DO and autogenous block grafting for vertical bone gain (mean difference 0.82 [-1.28, 2.91]). Similarly, no significant difference was observed in the 2 techniques for bone resorption (mean difference 0.38 [-0.23, 0.99]). CONCLUSIONS: DO was not superior to autogenous block grafting for vertical bone augmentation. Both techniques were associated with a number of complications. There was no difference in the bone resorption observed in the 2 techniques. No conclusive results can be drawn on other techniques on account of limited data.

Three-dimensional bone grafting in dental implantology using autogenous bone ring transplant: Clinical outcomes of a one-stage technique.

BACKGROUND: An insufficient bone volume at the maxillary anterior region often restricts dental implant treatment and commonly leads to poor aesthetic outcomes. The defective site requires bone grafting as an initial surgical intervention before dental implant placement. In dental implantology, reconstructing osseous defects using autologous block bone grafts, biomaterials, or a combination of both is a routine surgical procedure. This study aims to evaluate the efficacy of autogenous, symphyseal, bone ring block grafts after the augmentation of defective sockets and clinical application of grafts in the maxillary anterior region with immediate insertion of a dental implant in a single surgical procedure. MATERIALS AND METHODS: The study included eight patients (five females and three males) with 12 defective sockets. The technique included removing the bone from the chin region for transplant, fitting the three-dimensional bone rings in the prepared sockets of the maxillary anterior region, and screwing the dental implants through the rings. Patients underwent postoperative clinical examinations every day during the first week and then every month for 6 months. RESULTS: In two cases, the wound dehisced but healed by secondary intervention during the follow-up period. In one case, the ring graft sequestrated because of infection in postoperative month 2, the osseous defect was reconstructed with biomaterials. The remaining cases healed with no infection, and no other case failed during the first year. CONCLUSION: This technique showed promising and advantageous results, and thus, could be an alternative treatment to other autogenous graft techniques, particularly for defective sockets.

The Effect of Membrane Coverage on the Resorption of Autogenous Intraoral Block Grafts in Horizontal Ridge Augmentation: A Systematic Review of Literature and Meta-Analysis: Inevitability or an Iatrogenic Vulnerability?

BACKGROUND: Autogenous intraoral block grafting is the gold standard augmentation technique for moderate-to-severe horizontal ridge deficiency. However, the graft undergoes variable resorption during healing that might jeopardize the outcome of the procedure. Several studies hypothesized that covering the graft with a membrane decreases the amount of graft resorption, but this effect is not established in the literature. OBJECTIVE: The objective of this study is to assess the clinical value of covering intraoral block grafts with membranes in horizontal ridge augmentation regarding graft resorption (primary outcome), graft success, net bone gain, and complications (secondary outcomes). DATA SOURCES: Till August 2017, the review team conducted an electronic search including PubMed, EMBASE, Cochrane, and LILACS databases; we also identified other articles through hand searching. The search terms included alveolar ridge augmentation, bone transplantation, block graft, guided bone regeneration, membranes, resorbable membrane, and nonresorbable membrane. STUDY SELECTION: The review included human randomized controlled trials, controlled clinical trials, cohort studies, and case-control studies in English that compared membrane coverage to no membrane coverage of autogenous intraoral block grafts and reported the amount of graft resorption after > 3-month follow-up. STUDY APPRAISAL: Two authors independently assessed the risk of bias using the Cochrane risk of bias tool, and the third reviewer was the judge in case of conflict. DATA EXTRACTION: Two authors independently filled the effective practice and organization of care form for data extraction, and the third reviewer revised the data. DATA SYNTHESIS: The statistical method of choice was the generic inverse variance, and the results were pooled using random-effect models, with the effect size measure being mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes. RESULTS: The review members screened 2266 records; we excluded 2231 records by the title and abstract and screened 35 full-text records for eligibility, from which we excluded 32 articles for certain reasons (the most common were a different comparison and excluded study design). Three randomized controlled trials were included in the quantitative and qualitative analyses of this review, providing the data for 41 participants with 49 sites. Data analysis showed a statistically significant potential benefit of membrane coverage in decreasing the amount of graft resorption of intraoral block grafts (MD: -1.20 mm, 95% confidence interval [CI]: -2.11 to -0.30, P = .009). There was no statistically significant benefit from the use of membranes regarding graft success (RR: 1.02, 95% CI: 0.89-1.17, P = .79) and net bone gain (MD: 0.46, 95% CI: -0.16 to 1.09, P = .15). The use of membranes did not show a statistically significant increase in the incidence of complications (RR: 1.80, 95% CI: 0.55-5.96, P = .33). The reviewers judged all the studies as of fair quality regarding the risk of bias. CONCLUSION: The use of membranes decreased the graft resorption, but there was no difference regarding graft success and net bone gain. The use of membranes did not increase complications. Furthermore, properly conducted studies should be used to justify the adjunctive use of barrier membranes with block grafts.

Intermediate-term outcome of hemiarthroplasty for comminuted proximal humerus fractures.

BACKGROUND: The purpose of this study was to evaluate the outcome of hemiarthroplasty for comminuted proximal humerus fractures and to verify the risk factors for functional and radiologic outcomes. MATERIALS AND METHODS: We treated 29 comminuted proximal humerus fractures by hemiarthroplasty with a low-profile prosthesis and a bone block graft, with an average follow-up period of 53.9 (24-119) months. The patients' mean age at surgery was 71.7 (52-85) years. We evaluated visual analog scale (VAS) scores for pain and satisfaction, active range of motion, modified University of California-Los Angeles (UCLA) score, and shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographs were checked for stem position, loosening, and tuberosity union. The statistical evaluation was conducted to compare 2 demographics. RESULTS: The mean VAS score was 2.1 (0-5) for pain and 8.0 (4-10) for satisfaction. Mean active forward flexion was 125° (90°-170°); external rotation, 42° (25°-70°); and internal rotation, at T11 (T7-L2). The mean modified UCLA score was 20 (12-30), and the mean QuickDASH score was 25 (12-38). All stems were stable without any loosening. All tuberosities were united except 2 tuberosity absorptions. DISCUSSION: Patients older than 70 years and patients with chronic debilitating disease, >5-mm displacement of the prosthetic head from the glenoid, and a critical shoulder angle of >38° showed significantly poorer clinical outcome. CONCLUSION: Low-profile hemiarthroplasty with bone block graft had unique advantages for tuberosity union. During surgery, good prosthetic positioning with respect to the anatomic axis of the glenoid and critical shoulder angle (>38°) were essential. However, age (>70 years) and systemic comorbidity showed poor clinical outcome. These factors should be considered in standardizing the clinical results.

Horizontal Bone Augmentation Using Autogenous Block Grafts and Particulate Xenograft in the Severe Atrophic Maxillary Anterior Ridges: A Cone-Beam Computerized Tomography Case Series.

The aim of the present study was to use cone-beam computerized tomography (CBCT) to assess horizontal bone augmentation using block grafts, harvested from either the iliac crest (IC) or mandibular ramus (MR) combined with particulate xenograft and a collagen membrane for in the severe maxillary anterior ridge defects (cases Class III-IV according to Cadwood and Howell's classification). Fourteen healthy partially edentulous patients requiring extensive horizontal bone reconstruction in the anterior maxilla were selected for the study. Nineteen onlay block grafts (from IC or MR) were placed. The amount of horizontal bone gain was recorded by CBCT at 3 levels (5, 7, and 11 mm from the residual ridge) and at the time of bone grafting as well as the time of implant placement (≈5 months). Both block donor sites provided enough ridge width for proper implant placement. Nonetheless, IC had significantly greater ridge width gain than MR (Student t test) (4.93 mm vs 3.23 mm). This was further confirmed by nonparametric Mann-Whitney test (P = .007). Moreover, mean pristine ridge and grafted ridge values showed a direct association (Spearman coefficient of correlation = .336). A combination of block graft, obtained from the IC or MR, combined with particulate xenograft then covered with an absorbable collagen membrane is a predictable technique for augmenting anterior maxillary horizontal ridge deficiency.

Utilizing partially demineralized dentin plate for horizontal ridge augmentation: A case report.

BACKGROUND: This article intends to showcase a case of guided bone regeneration (GBR) utilizing a partially demineralized dentin plate processed from an extracted second molar for horizontal augmentation of the posterior ridge for implant placement. METHODS AND RESULTS: A 60-year-old patient presented with horizontal ridge deficiency at site #30 and an endodontically treated tooth #31 with recurrent decay. A treatment plan was proposed to extract tooth #31 and utilize a dentin graft from the tooth for ridge augmentation at site #30. Following the atraumatic extraction of tooth #31, it was sectioned into a 1 mm thick dentin plate, sterilized, and processed to obtain a demineralized dentin graft. Following a mid-crestal incision and full-thickness flap elevation, the dentin plate was adapted on the buccal defect of site #30 with 10 mm fixation screws, and the gap between the plate and the buccal bone was filled with 0.5 cc of 50/50 cortico-cancellous bone allograft hydrated with saline, covered with collagen membrane followed by primary closure. At 6 months, a postoperative cone-beam computed tomography (CBCT) was obtained to evaluate the ridge width revealing sufficient ridge width for optimal implant placement. The radio-opaque dentin plate was visible on the CBCT depicting integration with the alveolar ridge. Following surgical implant preparation protocol, a 4 mm diameter and 8.5 mm length implant was placed in a restoratively driven position. CONCLUSION: This case reports favorable outcomes for GBR using a partially demineralized dentin plate as an alternative to an autogenous bone block graft for horizontal ridge augmentation for future implant placement. KEY POINTS: This case introduces a novel method utilizing partially demineralized dentin plates derived from extracted teeth for guided bone regeneration, showcasing its potential efficacy in addressing ridge deficiencies. Success, in this case, relies on meticulous sectioning of the tooth and processing of the dentin graft, precise adaptation and fixation of the graft to the residual ridge, and achieving primary closure for undisturbed healing. Limitations to success include the availability of teeth for extraction coinciding with the need for ridge augmentation and unstable graft fixation.

Customized 3D printed nanohydroxyapatite bone block grafts for implant sites: A case series.

PATIENTS: A case series of 12 patients (mean age, 53.5 years) with horizontal ridge deficiencies had augmentations with customized 3D printed nanohydroxyapatite (3DHA) block grafts prior to implant placement. 3DHA graft materials were fabricated to fit the individual patient defects using DICOMs from CBCT images obtained from each patient. The CBCT images were then converted into the STL file format and 3DHA was reconstructed by 3D printing. Surgical bone augmentation consisted of 3DHA incorporating concentrated growth factors (CGFs) and platelet-rich fibrin (PRF) membrane. At 6 months, a bone biopsy and implantation were performed. The primary outcome was horizontal bone gain after 6 months. The secondary outcomes included information on the clinical outcomes, dimensions, and histomorphometric results. DISCUSSION: The 3DHA block graft was successful in 10 of 12 patients. Graft adjustment was not required. All 3DHA adapted and fit well at all defect sites. Maximum mean horizontal bone gains were 3.06 ± 1.02 and 3.56 ± 0.23 mm from the DICOMs and STL data sets, respectively. The volume gain was 229.8 ± 82.96 mm3. A low pain score after surgery was reported of 1.41 ± 0.51, while the healing index score increased with a maximum mean of 4.7 ± 0.67. Thirteen implants were placed with good primary stability (ISQ = 65 ± 4.08), without additional guided bone regeneration. Histomorphometric analysis revealed that new bone formation, bone tissue, residual grafts, and connective tissue were 28.6 ± 1.88, 30.48 ± 4.81, 19.82 ± 4.07, and 20.81 ± 4.41%, respectively. CONCLUSIONS: A customized 3DHA block graft is a viable treatment option for primary implant-site augmentation.

Low Donor Site Morbidity Associated With Tricortical Calcaneal Bone Graft.

BACKGROUND: Autologous grafting is widely used in orthopaedic surgery because of its high osteogenic capacity, immunologic compatibility, for the absence of risk of disease transmission, and for not requiring a bone bank. The posterior-superior calcaneal tuberosity is an option for obtaining a cortical and cancellous structural bone. This study aims to describe the operative technique and complications observed at the donor site of the posterior-superior calcaneal tuberosity. METHODS: Patients who underwent graft harvesting from the posterior-superior calcaneal tuberosity were retrospectively evaluated by pain outcomes, imaging tests, and intra- and postoperative complications. RESULTS: Twenty patients with a median age of 69 years (range 48-77) and follow-up of 16 months (12-26) were assessed. Median postoperative pain at the donor site was 0 (0-6), with 2 patients reporting persistent local pain. No case of Achilles tendon rupture or intra- or postoperative calcaneal fracture were identified. One patient developed a superficial infection that was quickly resolved using oral antibiotic therapy. CONCLUSION: The posterior-superior calcaneal tuberosity is an alternative source of autologous graft with low donor site morbidity. LEVEL OF EVIDENCE: Level IV, case series.

Alveolar Ridge Augmentation Using Autogenous Bone Graft and Platelet-Rich Fibrin to Facilitate Implant Placement.

The maxillary anterior region is considered to be the esthetic zone of human dentition. Missing teeth in this area leads to severely compromised esthetics and function. Endosseous implants are a viable treatment option in this scenario, but the placement of endosteal implants requires adequate bone volume for successful osseointegration. When the morphology of the bone does not allow proper implant placement, there are various bone augmentation procedures which aid in reconstruction of the residual alveolar ridge for ideal implant placement. The mandibular parasymphysis can act as an excellent source of autogenous bone for the augmentation of alveolar ridge deficiencies. This article describes successful augmentation of the maxillary alveolar ridge using block bone autografts harvested from the mandibular symphysis along with platelet-rich fibrin. At 6 months after surgery, implant was inserted, and after a healing period of 5 months, permanent restoration was placed.

Surgical management of autogenous bone block graft exposure followed by prosthetic rehabilitation of thin residual ridge.

Autogenous bone block graft is the gold standard technique for alveolar bone augmentation. However, it is technique sensitive and associated with several complications. Exposure of block graft can affect the outcome of surgery and is challenging to manage. A patient diagnosed with Seibert Class III residual alveolar ridge was managed with autogenous bone block graft. Two dental implants were placed after obtaining sufficient ridge augmentation. The patient presented with exposure of bone block graft after implant placement. A full-thickness mucoperiosteal flap was elevated. Exposed bone was shaved and contoured using piezosurgery. A connective tissue graft with epithelial striation from palate was employed to cover the exposed graft and augment the keratinized tissue. Treatment resulted in complete coverage of block graft and gain in keratinized mucosal dimensions. Prosthetic rehabilitation using screw-retained 3 Unit Bridge was delivered. The results are sustained after 2 years, and the patient is being followed up.

From a CAD/CAM-milled, allogeneic bone block to an implant-supported fixed partial denture with angulated screw channel: a case report.

Augmentation of alveolar ridge defects is a technique-sensitive procedure in dental implantology. Depending on the size of the defect, it may be necessary to use autogenous bone blocks. However, patients may be against these blocks as these procedures are surgically invasive.
Case report: This report describes the restoration of a partially edentulous mandible, which suffered a major bone defect from the right canine to the third molar site after multiple implant losses. The use of a CAD/CAM allogeneic cancellous bone block from a living donor bone was planned for the reconstruction of the alveolar ridge at the defected site. A CBCT scan was taken and the virtual planning of the bone augmentation and placement of four implants was performed. The milled bone block was fixed for augmentation and the implants were placed using a CBCT-generated surgical guide. After osseointegration, a CAD/CAM-fabricated screw-retained metal-ceramic implant fixed partial denture with angulated screw channels was delivered.
Results: The use of CAD/CAM-milled, allogeneic bone block resulted in a time-efficient and simplified reconstruction of the defect because no donor site was used, and the fit of the block on the native bone was uneventful and fast. At the 1-year follow-up, an average peri-implant vertical soft tissue decrease of 1 mm on buccal and 0.3 mm on lingual sites was observed and the peri-implant tissues were healthy.
Conclusions: The long-term success of this CAD/CAM cancellous bone block needs to be evaluated in well-designed clinical studies.

Synthesis of Thermo-Responsive Block-Graft Copolymer Based on PCL and PEG Analogs, and Preparation of Hydrogel via Click Chemistry.

Thermo-responsive cross-linkable mPEG-b-[PCL-g-(MEO2MA-co-OEGMA)]-b-mPEG was synthesized by ring-opening polymerization (ROP) and atom transfer radical polymerization (ATRP). Then, the cross-linkable block-graft copolymer was used to prepare hydrogel via a copper-catalyzed 1,3-dipolar azide-alkyne cycloaddition reaction. The chemical structure and composition of copolymer were characterized by proton nuclear magnetic resonance (1H NMR), Fourier-transform infrared (FT-IR) and gel permeation chromatography (GPC). The self-assembly behaviors of the copolymer in aqueous solution were studied by UV spectrophotometer, fluorescence probes, the surface tension method, dynamic light scattering, and transmission electron microscopy. The results proved that the copolymer has excellent solubility and better temperature response. The three-dimensional network structure of the gels, observed by scanning electron microscopy at different temperatures, indicated that the gels have temperature response.

Quality assessment of systematic reviews on vertical bone regeneration.

The aim of this study was to evaluate and compare the quality of systematic reviews of vertical bone regeneration techniques, using two quality-assessment tools (AMSTAR and ROBIS). An electronic literature search was conducted to identify systematic reviews or meta-analyses that would evaluate at least one of the following outcomes: implant survival, success rates, complications or bone gain after vertical ridge augmentation. Methodological quality assessment was performed by two independent evaluators. Results were compared between reviewers, and reliability measures were calculated using the Holsti's method® and Cohen's kappa. Seventeen systematic reviews were included, of which seven presented meta-analysis. Mean ±95% confidence interval AMSTAR score was 6.35 [4.74;7.97], with higher scores being correlated with a smaller risk of bias (Pearson's correlation coefficient=-0.84; P<0.01). Cohen's inter-examiner kappa showed substantial agreement for both checklists. From the available evidence, we ascertained that, regardless of the technique used, it is possible to obtain vertical bone gains. Implant success in regenerated areas was similar to implants placed in pristine bone with results equating between 61.5% and 100% with guided bone regeneration being considered the most predictable technique regarding bone stability, while distraction osteogenesis achieved the biggest bone gains with the highest risk of possible complications.

Surgical Algorithm for Alveolar Bone Augmentation in Implant Dentistry.

Replacement of failing and ailing natural teeth with dental implants has become a mainstream treatment option since the discovery of osseointegration by P.-I. Brånemark in the 1960s. The techniques and the variety of methods for alveolar bone reconstruction have evolved to address a restoratively driven approach in implant dentistry. Modern 3D cone-bean computed tomography has helped with the diagnosis and treatment of bone deficiencies to idealize implant positioning. This article focuses on bone augmentation techniques, classified into horizontal and vertical ridge augmentation, and discusses block grafting, guided bone regeneration particulate grafting, distraction osteogenesis, and ridge-split expansion procedures.