3/29/23 Jo_6 bone aug articles Flashcards
WHich study describes a decision tree for horizontal ridge augmentation?
Yu & Wang ‘22 IJPRD
Minor ridge deficiency:
< 3.0 mm of horizontal bone augmentation required.
* GBR, protected bone augmentation with titanium mesh, autogenous or allogenic block
grafting, ridge splitting or expansion, and subperiosteal tunneling.
Moderate ridge deficiency:
3.0 to 6.0 mm of horizontal bone augmentation required
* Sites that require 3.0 to 6.0 mm of horizontal bone augmentation can be predictably
reconstructed with GBR, protected bone augmentation with a titanium mesh, block graft, or
ridge splitting.
* A sub-periosteal tunnel surgical design may not be a viable option in this category based
upon current evidence.
Severe ridge deficiency:
≥ 6.0 mm of horizontal bone augmentation required
* Sites that require at least 6 mm of horizontal bone gain may be treated reliably with one of
three options: GBR, protected bone augmentation with a titanium mesh, or block grafting.
Approximately how much bone is gained through various GBR techniques?
Yu ‘22 IJPRD
GBR and protected bone augmentation:
* * GBR utilizes membranes (non-resorbable or resorbable) in conjunction with bone fill materials (autograft, allograft, xenograft, or
alloplast) to promote cell occlusivity, create a protected space for augmentation, and encourage osteogenesis.
* * In 12 patients, Buser et al employed GBR using non-resorbable expanded PTFE (e-PTFE) membranes and observed 1.5 to 5.5 mm of
new bone formation after a healing period of 6 to 10 months.
Titanium Mesh:
* * Titanium mesh is another material commonly used for bone augmentation, as its rigidity allows it to maintain space extremely well.
* * Malchiodi et al. reported data from 25 patients who received titanium mesh–driven horizontal augmentation, and the average gain in
bone width was 5.65 mm (range: 5.20 to 6.10 mm).
Block grafting:
* * Gultekin et al. compared the regenerative potential of autogenous iliac block grafting to that of GBR in patients with atrophic maxillae;
they found that patients who received iliac block grafts gained statistically significantly more bone width (6.52 mm) compared to those
in the GBR group (5.31 mm).
Ridge splitting and ridge expansion:
* * A systematic review described a weighted width gain of 3.2 ± 12 mm (range: 2.0 to 4.0 mm) using the ridge splitting approach.
Subperiosteal tunneling:
* * Nevins et al. 8 conducted a case series with 12 patients (maxillary sites) using tunneling with different grafting combinations: group A
comprised allograft + collagen membrane + recombinant human platelet-derived growth factor-BB (rhPDGF-BB); group B comprised
anorganic bovine bone graft (ABBG) + collagen membrane + rhPDGF-BB; and group C comprised ABBG/mineralized collagen bone
substitute alone.
* * CBCT scans showed the average bone gain of groups A, B, and C to be 5.1mm, 4.9 mm, and 8.4 mm, respectively.
* Dr. Wang says this subperiosteal tunneling does not form any bone according to histology
What is the effect of collagen membrane fixation on ridge stability and new bone formation?
Park ‘22 JCP
Dog histology study
Horizontal box defects (simulating a Siebert I deficiency) grafted with BioOss
Test: Fixation of membranes
* Bioguide (Porcine Type I and III)
* Biocover (Porcine Type I)
Control: No fixation
Results: Only difference in this short-term dog study is the crestal 2mm.
Dr. Wang says; fixation will help you preserve the extra 2mm at the crestal 2mm of the ridge. No fixation, you might lose that 2mm
Which study examined bone particle size effects on horizontal ridge augmentation?
Basma ‘22 JOP
Aim: To compare (clinically and histologically) the quantity and quality of bone gained following LRA
procedures using small-particle (SP)-sized (0.25–1.0 mm) versus large-particle (LP)-sized
(1.0–2.0 mm) mineralized corticocancellous bone allografts.
Findings: NSSD in all measurements, except for Soft Tissue Area (in favor of the large particle size).
There was a trend towards greater width gain when using large particle sizes
How does particle size affect the integration of the graft material?
Dr. Wang says: Anything < 250 µm will result in foreign body reaction. Anything > 2 mm will result in sequestrum.
Large particles will maintain the space more than the small particles.
If no membrane, Dr Wang advises using small particle since it heals much more smoothly
If yes membrane, advise using larger particles
For socket aug - if waiting 3 months for implant placement, use small particle cancellous bone. If waiting 6 months , use large particle cortical bone.
Dr. Wang advocates covering the outside of the lateral sinus lift with a membrane as it results in more vital bone formation
What is the effectiveness of Bichat’s buccal fat pad (BFP) to cover the nonresorbable membranes in vertical ridge aug in the maxilla?
Cucchi ‘22 IJPRD
Aim: To evaluate the efficacy of buccal fat pads (BFP) as a natural barrier to cover nonresorbable
devices for vertical ridge augmentation (VRA).
12 patients with 14 vertical defects needing vertical aug in the maxilla
* Average size of the buccal fat pad: 13.5 cm^2
* Vertical bone gain: 4.2 mm +/- 1.8 mm
* Healing time: ~9 months
Surgical complication rate ~ 14.3%
* 1 intra-operative hemorrhage
* 1 transitory paresthesia (< 1 month)
* Healing complication rate 0%
(no early or late exposures, no abscess
without exposure)
A shallow vestibular sulcus depth was found
in all pedicle cases = need APF and/or FGG
at implant uncovering
Which study compared GBR of peri-implant defects using soft-type blocks vs. particulate bone? (6 month followup)
Benic ‘22 JCP
RCT- 40 patients (17 test, 18 control)
* Control = particulate BCP. BCP made of 60% hydroxyapatite and 40% beta tricalcium phosphate (HA/TCP)
* Test = (BCP) + collagen. BCP embedded into a native porcine-derived type I collagen matrix
Average horizontal bone growth: 1 mm gain
At 6 months, 7.1% of contained defects and 61.9% of non-contained defects showed incomplete vertical defect fill
= it does not work
Which study classified bone grafting complications?
Sanz-Sanchez ‘22 (Perio 2000)
Soft tissue dehiscences:
* Class 0: No dehiscence
* Class 1: From aug to 4 wks healing
* Class 2: From 4 wks to implant placement at 26 wks
* Class 3: From implant placement to abutment connection
* Class 4: From abutment connection to implant loading
Bone blocks:
* Class 0: Good soft tissue, but nerve issues
* Class 1: Small exposure (≤ 5 mm) without infection
* Class 2: Large exposure (≥ 5mm) without infection
* Class 3: No exposure with infection
* Class 4: Small exposure (≤5 mm) with infection
* Class 5: Large exposure (≥5 mm) with infection
dPTFE has been used to minimize complications
* Smaller pore size 0.2-0.3 um (vs. ePTFE 0.5-30 um)
* Greater resistance to bacterial penetration
Postoperative infections in guided bone regeneration
* Incidence: 2-11 %
