Periosteal Pocket Flap technique for lateral ridge augmentation. A comparative pilot study versus guide bone regeneration.

BACKGROUND: Implant rehabilitation of posterior mandibular defects is frequently associated to a horizontal bone loss. There exist several regenerative techniques to supply this bone deficiency, one of which is the Periosteal Pocket Flap Technique (PPF) proposed by Steigmann et al. to treat small horizontal bone defects. The present study proposes a modification of this technique based on the concurrent use of PPF with the use of xenogeneic and autologous bone and Plasma Rich in Growth Factors (PRGF). The aim of this study is to evaluate clinical and radiographic outcomes of the PPF with the use of xenogeneic and autologous bone and PRGF in comparison with conventional Guided Bone Regeneration (GBR) procedures. METHODS: Nine patients were enroled in the study (7 women and 2 men, mean age: 53 ± 2.74 years) and allocated to PPF or GBR. In both groups implant placement was performed simultaneously to bone regeneration. Preoperative CBCT scans were performed for each patient. Surgical time and postoperative pain were recorded, as well as tissue healing. Moreover, horizontal bone gain (mm), graft surface area (mm2) and graft volume (mm3) were evaluated. RESULTS: Nine surgeries were performed: 6 PPF and 3 GBR. Regarding clinical outcomes, operative time was significative greater in GBR group than in PPF group (51.67 ± 3.51 min vs. 37 ± 5.69 min; p = 0.008). Postoperative pain was higher in GBR compared to PPF (p = 0.011). Regarding radiographical results, there were not significant differences in horizontal bone gain (PPF: 9.43 ± 1.8 mm; GBR: 9.28 ± 0.42 mm), surface area (PPF: 693.33 ± 118.73 mm2; GBR: 655.61 ± 102.43 mm2), and volume (PPF: 394.97 ± 178.72 mm3; GBR: 261.66 ± 118 mm3) between groups. CONCLUSIONS: This prospective study demonstrates that the combination of autograft/xenograft and PRGF in PPF technique is a simpler, cheaper, and faster technique than GBR technique for achieving moderate lateral bone augmentation in implant treatment. Future randomised clinical studies are needed to confirm the results.

Split bone block technique: 4-month results of a randomised clinical trial comparing clinical and radiographic outcomes between autogenous and xenogeneic cortical plates.

PURPOSE: To evaluate short-term clinical and radiographic outcomes of bone regeneration procedures using thin cortical porcine xenogeneic bone plates in combination with autogenous bone chips compared with thin autogenous cortical plates and autogenous bone chips. MATERIALS AND METHODS: A total of 19 patients (12 women and 7 men, mean age 58.24 ± 3.09 years) were randomly allocated to two different groups regarding surgical procedure: autogenous cortical plates (ACP group) and xenogeneic cortical plates (XCP group). Preoperative CBCT scans were performed for each patient. Surgical time and postoperative pain were recorded, as well as tissue healing and graft resorption after 4 months, then another surgical procedure was performed to place dental implants. Data were analysed using an analysis of covariance. RESULTS: Twenty-one surgical procedures were performed on 19 patients (10 from the XCP group and 9 from the ACP group). The operative time was significantly lower in the XCP group (25.45 ± 3.88 minutes) than in the ACP group (44.10 ± 3.60 minutes). The XCP group also showed less pain, but not significantly less, than the ACP group. The graft resorption rate in the ACP and XCP groups was 2.03 ± 1.58% and 3.49 ± 2.38% respectively, showing no statistically significant difference. CONCLUSIONS: Despite the limited sample size and non-uniform distribution between the maxilla and mandible as surgical sites, the results suggest that XCP and ACP grafts are similar in terms of bone volume gain and graft resorption rate, with no significant differences in wound healing or complication rate. Nevertheless, the XCP group recorded lower pain levels and required significantly less operative time compared to the ACP group.