[Risk factors and prevention for implant treatment in patients with periodontitis].

In patients with periodontitis, due to problems of periodontal tissue infection as well as soft and hard tissues defects, it may lead to implant infection, gingival papilla loss, soft tissue recession and poor coordination with adjacent teeth. For such patients, periodontal infection should be actively controlled before dental implant therapy. In consideration of insufficient soft and hard tissues, alveolar ridge preservation and soft tissue augmentation procedure can be used to preserve or increase soft and hard tissues as much as possible. Multi-disciplinary treatment is often needed for occlusion problems and coordination with adjacent tooth. Periodontal maintenance treatment of implants and natural teeth is also necessary after implant therapy. This paper discussed these risk factors and strategies for prevention and control, in order to provide some clinical guidances for the implant treatment of periodontitis patients.

Comparison of morbidity-related parameters between autologous and allogeneic bone grafts for alveolar ridge augmentation from patients' perspective-A questionnaire-based cohort study.

INTRODUCTION: Alveolar ridge augmentation is often required before dental implant placement. In this context, autologous bone grafts are considered the biological gold standard. Still, bone block harvesting is accompanied by some serious potential disadvantages and possible complications, such as pain, bleeding, and nerve irritation. Several studies aimed to compare autologous to allogeneic bone grafts concerning bone quality and implant survival rates; this is the first prospective study analyzing and comparing morbidity-related parameters after alveolar ridge augmentation using autogenous and allogeneic bone blocks from patients' perspective. METHODS: Using a questionnaire, 36 patients were asked to evaluate the surgery as well as the post-operative period concerning pain, stress, sensibility deficits, satisfaction with, and consequences from the surgery as well as the preferred procedure for future alveolar ridge augmentations. RESULTS: No significant differences were shown regarding stress and pain during and after surgery, whereas the rate of nerve irritations was twice as high in the autologous group. The swelling was significantly higher in patients with autologous bone blocks (p = 0.001). Nevertheless, the overall satisfaction of patients of both groups was very high, with over 8/10 points. CONCLUSIONS: The swelling was the main reason for patients' discomfort in both groups and was significantly higher after autologous bone augmentation. Since this side effect seems to be a highly relevant factor for patients' comfort and satisfaction, it needs to be discussed during preoperative consultation to allow shared decision-making considering the anticipated morbidity.

Complications associated with vertical bone augmentation techniques in implant dentistry: A systematic review of clinical studies published in the last ten years.

Vertical bone augmentation procedures are increasingly necessary in daily practice. However, it has been reported that vertical ridge augmentation is one of the least predictable techniques in terms of complications. The aim of this systematic review was to evaluate and compare complications in relation to the different procedures used for vertical bone augmentation prior to implant placement. This review was conducted according to PRISMA guidelines. An electronic search was carried out in four databases: The National Library of Medicine (MEDLINE/PubMed); Web of Science; SCOPUS; and Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale, the Cochrane Collaboration tool for assessing risk of bias, and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. Twenty-five studies with a total of 749 vertically augmented sites were included in the review. Complication rates varied among the different procedures: 51.02% for distraction osteogenesis, 38.01% for bone blocks, and 16.80% for guided bone regeneration. Vertical bone augmentation procedures prior to implant placement are associated with frequent surgical complications and should be approached with caution due to their possible impact on clinical treatment success.

Current perspectives of residual ridge resorption: Pathological activation of oral barrier osteoclasts.

PURPOSE: Tooth extraction is a last resort treatment for resolving pathological complications of dentition induced by infection and injury. Although the extraction wound generally heals uneventfully, resulting in the formation of an edentulous residual ridge, some patients experience long-term and severe residual ridge reduction. The objective of this review was to provide a contemporary understanding of the molecular and cellular mechanisms that may potentially cause edentulous jawbone resorption. STUDY SELECTION: Clinical, in vivo, and in vitro studies related to the characterization of and cellular and molecular mechanisms leading to residual ridge resorption. RESULTS: The alveolar processes of the maxillary and mandibular bones uniquely juxtapose the gingival tissue. The gingival oral mucosa is an active barrier tissue that maintains homeostasis of the internal organs through its unique barrier immunity. Tooth extraction not only generates a bony socket but also injures oral barrier tissue. In response to wounding, the alveolar bone socket initiates regeneration and remodeling through coupled bone formation and osteoclastic resorption. Osteoclasts are also found on the external surface of the alveolar bone, interfacing the oral barrier tissue. Osteoclasts in the oral barrier region are not coupled with osteoblastic bone formation and often remain active long after the completion of wound healing, leading to a net decrease in the alveolar bone structure. CONCLUSIONS: The novel concept of oral barrier osteoclasts may provide important clues for future clinical strategies to maintain residual ridges for successful prosthodontic and restorative therapies.

Immediate postoperative complications after lateral ridge augmentation - a clinical comparison between bone shell technique and sticky bone.

Nowadays, implant dentistry is strongly interconnected to bone augmentation procedures. Lateral ridge augmentation is often an imperative treatment stage for successful, prosthetic-driven implant placement. This study aimed to comparatively analyze the immediate postoperative complications of two horizontal bone grafting procedures: sticky bone and bone shell technique. Records of patients with lateral ridge augmentation were analyzed to identify immediate postoperative complications. The study group included 80 patients divided into 40 control (bone-shell technique - BS) and 40 tests (sticky bone -SB). More patients reported moderate and severe pain in the BS - group (11 patients - 27.5%) than in the SB group (6 patients - 15%). In the BS group, the incidence of severe and moderate trismus, neurosensory disturbances, and important hematoma was higher. There was an increased inflammatory response following the bone shell technique, while the sticky bone technique proved reduced surgical morbidity. There was no difference between the two groups in the risk of dehiscence or infection.

Therapeutic Strategies in the Management of Nonresorbable Membrane and Titanium Mesh Exposures Following Alveolar Bone Augmentation: A Systematic Scoping Review.

PURPOSE: The exposure of nonresorbable membranes following alveolar bone augmentation is one of the most frequently occurring complications. This review aimed to investigate the treatments that can be adopted to manage the exposure of polytetrafluoroethylene-based membranes (PTFE-ms) and titanium meshes (TMs) and their outcomes. MATERIALS AND METHODS: Two independent reviewers electronically and manually searched the EMBASE, PubMed/MEDLINE, Scopus, and Cochrane bibliographic databases to retrieve pertinent articles available between January 2000 and March 2021. Only human studies describing the type of treatment and the soft tissue outcome following exposure of PTFE-ms or TMs were included. RESULTS: Overall, 11 articles in the PTFE-ms group and 24 in the TM group were included for data analysis. Results indicated that, in both groups, two distinct therapeutic strategies are mostly applied in case of exposure, namely, pharmacologic and mechanical treatments. Other options have been identified seldomly. Statistically significant evidence of an association between the type of barrier membrane and the exposure rate (28.7% vs 38.5% for TMs and PTFE-ms, respectively; P = .019) and between the type of exposed device and the treatment outcome in terms of removal rate following therapy (11.9% and 44.4% for TMs and PTFE-ms, respectively; P < .001) was noted. CONCLUSION: In both groups, chlorhexidine applications and meticulous plaque control may lead to improved healing conditions after exposure. Surgical removal of the exposed portion can be considered to promote secondary intention healing. The beneficial effects of systemic antibiotics could not be demonstrated in the management of the exposure but should be evaluated in case of graft infection.

Preliminary Clinical Data and the Comparison of the Safety and Efficacy of Autogenous Bone Grafts Versus Xenograft Implantations in Vertical Bone Deficiencies Before Dental Implant Installation.

Two different techniques of vertical bone augmentation were compared to apply them to immunocompromised patients. One of them used autogenous bone graft; the other used xenograft. Thirty patients were involved in the study. Fifteen received autogenous ring shape grafts harvested from the mental region, and 15 received xenograft vertical tunnel augmentation. They have a total of 60 implants placed in the posterior region of the mandible (2 for each patient). Fixed full ceramic crowns were delivered. Two-year follow-up appointments after implant placement were made. Both autogenous bone grafts and xenografts showed similar long-term clinical regeneration outcome of vertical bone defects. Using autogenous bone rings simultaneously fixed by dental implants, the total treatment time and cost were shortened, but the traumatic reactions and complication rates were higher when compared to xenograft vertical tunnel augmentation. Due to the less traumatic character of the procedure, smaller complication rates and higher safety for the patients receiving chronic immunosuppression should avoid bone block augmentation and reap the benefits from vertical tunnel bone augmentation using xenograft materials.

Case Report: Managing the postoperative exposure of a non-resorbable membrane surgically.

Alveolar ridge deformities can be caused by several factors. Managing alveolar deformities prior to implant placement is essential to increase bone width, height or both. Several techniques and materials are now available to perform ridge augmentation procedures. The postoperative exposure of the membrane is the most frequent postoperative complications of ridge augmentation procedures. The present case describes the horizontal ridge augmentation procedure and the outcome of surgical attempt to manage post-operative membrane exposure, and shows the unpredictability of managing postoperative membrane exposure surgically.

Lateral alveolar ridge augmentation with autogenous block grafts fixed at a distance versus resorbable Poly-D-L-Lactide foil fixed at a distance: A single-blind, randomized, controlled trial.

OBJECTIVES: The aim of this study was to compare bone block grafts fixed at a distance (BBG-D) with the SonicWeld Rx shell technique (Poly-D-L-Lactide foil fixed at a distance, augmented with autogenous and deproteinized bovine bone particles (SWST)) for lateral alveolar ridge augmentation. METHODS: In this single-blinded, randomized, controlled trial, 30 patients with a bucco-palatal bone width of ≤3 mm were randomized into the treatment groups: "BBG-D" and "SWST". Bone width was measured with cone beam computed tomography (CBCT). One implant was placed at each grafted site. Frequencies of complications, bone gain and bone resorption in the CBCT were assessed as outcomes. RESULTS: Fifteen sites were augmented in each treatment group. One graft (7%) in the BBG-D group and five (33%) in the SWST group were lost (p = 0.17). In the SWST group, two implants (20%) were lost and none in the BBG-D group (p = 0.18). The rate of pooled severe complications (loss of graft and/or implant) was different (p = 0.035). Five (33%) wound dehiscences happened in the SWST group and none in the BBG-D group (p = 0.042). Seven (47%) nonsevere complications (wound dehiscence, inflammation, transient nerve injury) happened in the SWST group and one (7%) in the BBG-D group (p = 0.035). At the one-year evaluation, there were no significant differences in bone loss at the mesial, distal or buccal implant shoulder between treatment groups. CONCLUSIONS: Within the limitations of this study, the BBG-D method remains the gold standard for lateral alveolar ridge augmentation compared to the shell technique because of the lower complication rates.

Long-term Retrospective Study based on Implant Success Rate in Patients with Risk Factor: 15-year Follow-up.

AIM: The purpose of this retrospective study is to assess implant success rates with various risk factors. MATERIALS AND METHODS: Two hundred patients with a total of 650 implants were selected. Risk factors, such as smoking, antidepressants, bruxism, diabetes, and bone augmentation procedures were considered, and patients were followed up for a period of 8 to 15 years. RESULTS: Of 650 implants placed, the success rate was 88%, i.e., a total of 572 implants were successful. A total of 78 implants were considered failure; and out of 78, twenty implants were surgically removed. CONCLUSION: Based on this study's results, it is concluded that risk factors, such as smoking, bruxism, diabetes, and bone augmentation play an important role in success rate of dental implants. CLINICAL SIGNIFICANCE: Several factors, such as bruxism, diabetes, and supporting bone can play an important role in dental implant success.

Safety and performance of a novel collagenated xenogeneic bone block for lateral alveolar crest augmentation for staged implant placement.

OBJECTIVES: To evaluate the performance and safety of placing a collagenated xenogeneic bone block (CXBB) graft for the lateral bone augmentation of the alveolar crest prior to implant placement. MATERIAL & METHODS: In patients with single or multiple tooth gaps and a severe horizontal collapse of the alveolar ridge, a ridge augmentation procedure was performed using CXBB fixated with osteosynthesis screws to the atrophic bone crest and complemented with deproteinized bovine bone mineral particles (DBBM) and a native bilayer collagen membrane (NBCM). Patients were examined with CBCT prior to and 24 weeks after the augmentation. Twenty-six weeks postoperatively, a re-entry procedure was performed to evaluate the bone width and availability for adequate implant placement. RESULTS: Fifteen patients received 28 CXBB, and in 13 patients, a re-entry procedure was performed. Eleven patients (84.6%) gained enough bone volume for implant insertion without additional contouring or secondary bone augmentation. The mean crest width at baseline was 2.83 mm (SD 0.57), and the mean crest width at re-entry was 6.90 mm (SD 1.22), with a mean ridge width increase of 4.12 mm (SD 1.32). Soft tissue dehiscence occurred during the follow-up in 5 of 14 patients (35.7%) at various time points. In addition, there was a high incidence of early implant loss (30.8% [patient-based]). CONCLUSIONS: CXBB achieved significant horizontal crestal width gains allowing a secondary implant placement in the majority of the patients. However, the occurrence of soft tissue dehiscence may notably affect the outcome of the subsequent implant therapy.

Efficacy of the split-thickness labial flap method for soft tissue management in anterior ridge horizontal augmentation procedures: A clinical prospective study in the anterior maxilla.

OBJECTIVE: To introduce a novel method of split-thickness labial flap in maxillary anterior ridge horizontal augmentation and to evaluate its efficacy and morbidity. MATERIALS AND METHODS: 230 patients were selected to receive either particulate or onlay grafting. A split-thickness labial flap was applied to cover the grafted area and close the wound. The incidence of postsurgical complications and the level of patient discomfort were evaluated. A visual analog scale was used to quantify the amount of pain and swelling in the patients. RESULTS: In all 375 surgical sites, passive primary closure was achieved with the split-thickness labial flap method. Membrane exposure after surgery was seen in 6 cases in the onlay group and in 4 in the particulate group. No long-lasting pain (>1 week), paresthesia, or signs of infection occurred during the follow-up period of 6 months. The mean pain and swelling scores in the particulate graft group (2.75 ± 3.01 and 2.02 ± 2.51, respectively) were lower than the scores in the onlay graft group (3.18 ± 2.79 and 3.85 ± 2.25, respectively). CONCLUSIONS: The flap advancement technique presented in this study facilitates clinically passive primary closure. This technique can be used successfully in both particulate and onlay horizontal graft procedures.

Risk factors for post-operative complications after procedures for autologous bone augmentation from different donor sites.

AIM: The aim of this study has been to identify risk factors for post-operative complications after grafting bone from different donor sites prior to implant placement. MATERIAL AND METHODS: The study encompassed 279 patients who underwent autologous bone augmentations in a 2-stage procedure, harvested from three intraoral and one extraoral donor sites, as well as sinus floor elevations prior to implant placement. The following complications were recorded: soft tissue dehiscence; wound infection; bone graft exposure; sensory disturbance; sinusitis symptoms; haemorrhage; graft failure; implant failure. Complications were correlated with: patient age; smoking status; history of gingivitis/periodontitis; cause of tooth loss; jaw area; dental situation; sinus membrane perforation; surgeons' experience. RESULTS: 279 patients underwent 456 augmentation procedures, involving 546 sites. 436 grafts were successful. 525 implants were inserted into 436 augmented sites in 273 patients. 20 grafts were lost due to complications. 2 implants were removed before prosthetic restoration. 2 implants were lost within 2 years after placement. Age (p = 0.0009, Odds Ratio = 2.44), smoking (p < 0.0001, Odds Ratio = 2.47), Approximal Plaque Index (p < 0.0001, Odds Ratio = 6.64), Sulcus Bleeding Index (p < 0.0001, Odds Ratio = 39.06) and dental situation (p < 0.0001) were significantly correlated with higher post-operative morbidity. Cause of tooth loss (p = 0.7399), jaw area (p = 0.6725), sinus membrane perforation (p = 0.0762) and surgeons' experience (p = 0.0939) did not influence complication rates. CONCLUSIONS: Patients over 40 years old, smokers, a history of periodontitis, and augmentation in tooth gaps involving more than one tooth represent a significantly increased risk of there being post-operative complications compared with patients younger than 40 years old, non-smokers, no history of periodontitis, only a single-tooth gap, or free-end arch situations.

Effect of Deproteinized Bovine Bone Mineral at Implant Dehiscence Defects Grafted by the Sandwich Bone Augmentation Technique.

The aim of this study was to compare the amount of radiographic horizontal buccal bone thickness (BBT) at implant dehiscence defects grafted with the sandwich bone augmentation (SBA) and modified sandwich bone augmentation (MSBA) techniques. Compared to the SBA technique, the MSBA approach involved an additional outer layer of deproteinized bovine bone mineral (DBBM) to maintain the space for bone regeneration for longer periods. A total of 19 patients, each with a buccal implant dehiscence defect, were recruited. The control group was treated with SBA technique (n = 10), while the test group was treated with MSBA technique. Cone beam computed tomography (CBCT) scans, taken at three time points (before and immediately after implant surgery, and 6 months post-treatment) were used to assess the BBT at the implant platform (-1.8 mm), the rough-smooth junction (0 mm), and 2, 4, 6, 8, and 10 mm apical to the rough-smooth junction. At 6 months postsurgery, the mean BBT in control and test groups was 1.69 ± 0.38 mm and 2.55 ± 0.21 mm, respectively. Mean BBT was significantly greater in the test group at 2, 4, 6, and 8 mm apical to the rough-smooth junction. There was no statistical difference in the mean BBT at the implant platform, the rough-smooth junction, and 10 mm apical to the rough-smooth junction between the two groups (P > .05). Within the limitations of this study, it was concluded that the additional layer of DBBM enhanced BBT along the implant, except at the smooth collar.

Neurophysiological changes associated with implant-associated augmentation procedures in the lower jaw.

BACKGROUND: Neurophysiological changes after oral and maxillofacial surgery remain one of the topics of current research. PURPOSE: This study evaluated if implant placement associated with augmentation procedures increases the possibility of sensory disturbances or result in impaired quality of life during the healing period. MATERIAL AND METHODS: Patients who had obtained an implant placement in the lower jaw in combination with augmentation procedures were examined by implementing a comprehensive Quantitative Sensory Testing (QST) protocol for extra- and intraoral use. As augmentation procedures, we used Guided Bone Regeneration (Group A) and Customized Bone Regeneration (Group B) techniques. Patients were tested bilaterally at the chin and mucosal lower lip. Results were compared to a group without augmentation procedures (Group C). Patients' quality of life and psychological comorbidity after the surgical procedures was assessed with the Oral Health Impact Profile and the Hospital Anxiety and Depression Scale. RESULTS: For groups A (n = 20) and B (n = 8), mechanical QST parameters showed no significant differences in all qualities of the inferior alveolar nerve compared to the contralateral side and compared to the nonaugmentation control group (n = 32) as well. Evaluation of quality of life and psychological factors showed no statistical differences. CONCLUSIONS: Augmentation procedures did not increase sensory disturbances, indicating no changes in the neurophysiological pathways. Extended augmentation procedures did not lead to sensory changes either or result in an impaired quality of life or modified anxiety and depression scores.

Alveolar Ridge Splitting Versus Autogenous Onlay Bone Grafting: Complications and Implant Survival Rates.

PURPOSE: To compare the complications and implant survival rates of localized alveolar ridge deficiencies in the horizontal dimension reconstructed by alveolar ridge splitting (ARS) or autogenous onlay bone grafting (OBG). MATERIALS AND METHODS: Twenty-eight ARS and 28 OBG were performed. The survival rate of the all included implants was evaluated using the clinical and radiographical evaluation criteria of Misch et al. Temporary exposure of graft, mild infection, temporary paresthesia, and bad split were defined as minor complications; permanent exposure of graft, loss of graft, and permanent paresthesia were defined as major complications. Major and minor complications of ARS and OBG groups were statistically compared. RESULTS: When the minor and major complication rates are considered, there was not any statistically significant difference between OBG (P = 0.099) and ARS (P = 0.241) groups. The satisfactory survival rate of OBG group was 92% and was 100% in the ARS group, and the difference was not statistically significant (P = 0.116). CONCLUSION: When reconstructing vertically sufficient but horizontally insufficient alveolar ridges, ridge splitting technique could shorten the treatment period, decrease postoperative swelling and pain, eliminate the need for a second surgical site, reduce the treatment cost, and ease the patient cooperation to the surgery.

Hard and soft tissue changes following alveolar ridge preservation: a systematic review.

OBJECTIVE: Two focused questions were addressed within this systematic review. Q1) What is the effect of alveolar ridge preservation on linear and volumetric alveolar site dimensions, keratinised measurements, histological characteristics and patient-based outcomes when compared to unassisted socket healing. Q2) What is the size effect of these outcomes in three different types of intervention (guided bone regeneration, socket grafting and socket seal). MATERIALS AND METHODS: An electronic search (MEDLINE, EMBASE, Cochrane Central Register LILACS, Web of Science) and hand-search was conducted up to June 2015. Randomised controlled trials (RCT) and controlled clinical trials (CCT); with unassisted socket healing as controls: were eligible in the analysis for Q1. RCTs, CCTs and large prospective case series with or without an unassisted socket healing as control group were eligible in the analysis for Q2. RESULTS: Nine papers (8 RCTs and 1 CCTs) were included in the analysis for Q1 and 37 papers (29 RCTs, 7 CCTs and 1 case series) for Q2. The risk for bias was unclear or high in most of the studies. Q1: the standardised mean difference (SMD) in vertical mid-buccal bone height between ARP and a non-treated site was 0.739 mm (95% CI: 0.332 to 1.147). The SMD when proximal vertical bone height and horizontal bone width was compared was 0.796mm (95% CI: -1.228 to 0.364) and 1.198 mm (95% CI: -0.0374 to 2.433). Examination of ARP sites revealed significant variation in vital and trabecular bone percentages and keratinised tissue width and thickness. Adverse events were routinely reported, with three papers reporting a high level of complications in the test and control groups and two papers reporting greater risks associated with ARP. No studies reported on variables associated with the patient experience in either the test or the control group. Q2: A pooled effect reduction (PER) in mid-buccal alveolar ridge height of -0.467 mm (95% CI: -0.866 to -0.069) was recorded for GBR procedures and -0.157 mm (95% CI: -0.554 to 0.239) for socket grafting. A proximal vertical bone height reduction of -0.356 mm (95% CI: -0.490 to -0.222) was recorded for GBR, with a horizontal dimensional reduction of -1.45 mm (95% CI: -1.892 to -1.008) measured following GBR and -1.613 mm (95% CI: -1.989 to -1.238) for socket grafting procedures. Five papers reported on histological findings after ARP. Two papers indicated an increase in the width of the keratinised tissue following GBR, with two papers reporting a reduction in the thickness of the keratinised tissue following GBR. Histological examination revealed extensive variations in the treatment protocols and biomaterials materials used to evaluate extraction socket healing. GBR studies reported a variation in total bone formation of 47.9 ± 9.1% to 24.67 ± 15.92%. Post-operative complications were reported by 29 papers, with the most common findings soft tissue inflammation and infection. CONCLUSION: ARP results in a significant reduction in the vertical bone dimensional change following tooth extraction when compared to unassisted socket healing. The reduction in horizontal alveolar bone dimensional change was found to be variable. No evidence was identified to clearly indicate the superior impact of a type of ARP intervention (GBR, socket filler and socket seal) on bone dimensional preservation, bone formation, keratinised tissue dimensions and patient complications.

Performance and safety of collagenated xenogeneic bone block for lateral alveolar ridge augmentation and staged implant placement. A monocenter, prospective single-arm clinical study.

OBJECTIVES: To assess the clinical safety and performance of collagenated xenogeneic bone block (CXBB) for lateral alveolar ridge augmentation and two-stage implant placement. MATERIAL & METHODS: In ten patients exhibiting a single-tooth gap, the surgical procedure included the preparation of mucoperiosteal flaps, a rigid fixation of CXBB (Geistlich Bio-Graft® ) using an osteosynthesis screw, and contour augmentation. After 24 weeks of submerged healing, the primary endpoint was defined as the final ridge width sufficient to place an adequately dimensioned titanium implant at the respective sites. Secondary outcomes included, for example, the gain in ridge width (mm). Clinical parameters (e.g., bleeding on probing - BOP, probing depth - PD, mucosal recession - MR) were assessed immediately after the cementation of the crown and at the final visit. RESULTS: At 24 weeks, implant placement could be achieved in 8 of 10 patients exhibiting a mean gain in ridge width (mean ± SD) of 3.88 ± 1.75 mm. Histological analysis has pointed to a homogeneous osseous organization of CXBB. The changes of mean BOP, PD, and MR values at the final visit amounted to 16.62 ± 32.02%, 0.04 ± 0.21 mm, and -0.04 ± 0.12 mm, respectively. CONCLUSIONS: CXBB may be successfully used to support lateral alveolar ridge augmentation and two-stage implant placement.

Analysis of Resorption and Need for Overcorrection in Alveolar Distraction Osteogenesis.

PURPOSE: The aim of this study was to evaluate the degree of resorption that occurs following a period of consolidation in alveolar distraction osteogenesis and assess the amount of overcorrection necessary to achieve the planned height. MATERIALS AND METHODS: A retrospective observational study was conducted comprising 19 surgically treated patients, where a total of 19 extraosseous distractors were placed. All patients undergoing surgery had a panoramic radiograph and a computed tomography scan, both at the end of distraction and at the end of the consolidation period. To assess the degree of resorption, the distance from the mandibular border, maxillary sinus floor, or nasal floor to the limit of the crestal bone following consolidation was compared with the height recorded at the end of the distraction period. RESULTS: Resorption occurred in all cases ranging from 7% to 25%. CONCLUSION: The presence of resorption reported from this study indicates that an overcorrection of at least 20% may be necessary when distraction osteogenesis is performed.

Bilamina cortical tenting grafting technique for three-dimensional reconstruction of severely atrophic alveolar ridges in anterior maxillae: A 6-year prospective study.

OBJECTIVE: To evaluate the efficacy and long-term outcome of the bilaminar cortical tenting grafting technique for reconstruction of vertical and horizontal alveolar ridge defects. MATERIAL AND METHODS: A bone block harvested from the lateral aspect of the mandibular ramus was bisected into two cortical laminae, which were then used to reconstruct the buccal and palatal walls of an alveolar ridge defect. The inter-laminar space was filled with particulate autogenous bone and the whole graft was covered with anorganic bone graft and collagen membrane. After 4-6 months, the width and height of the augmentation were recorded. The study sample consisted of 21 patients who were followed up for 6.09 ± 1.18-years. RESULTS: Vertical and horizontal bone gain was 5.70 ± 1.09 and 8.45 ± 0.87 mm, respectively, and respective resorption rates were 10.20% and 6.15%. One patient showed soft-tissue dehiscence, while all others healed without complication. After an average follow-up of 6-years, the block grafts were well integrated into the recipient sites and there was only a small reduction in the peri-implant bone level (0.77 ± 0.50 mm). CONCLUSION: This technique was effective and reliable for three-dimensional reconstruction of severely atrophic alveolar ridges in anterior maxillae.