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Calvarial bone grafts to augment the atrophied maxilla: experience, morbidity and histology
21st ICOMS 2013 - Abstracts: Oral Papers
1345
T29.OR007
T29.OR009
A new approach to the alveolar ridge reconstruction (ARR) using a bony plate from the lateral maxillary sinus wall (BP)
Alveolar sandwich osteotomy in resorbed alveolar ridges for dental implants: a 4-year prospective study
G. Omerca 1,∗ , T. Nimcenko 1 , A. Puiˇsys 2 , J. Paulauskas 3 , G. Omercaitë-Paulauskienë 3
H. Rushinek 1,∗ , A. Laviv 1 , O.T. Jensen 2 , E. Tarazi 3 , N. Casap 1
1
1 Department of Oral and Maxillofacial Surgery, School of Dental Medicine Hebrew University, Hadassah, Israel 2 ClearChoice Dental Implant Center, Greenwood Village, CO, USA 3 Department of Prosthodontics, School of Dental Medicine Hebrew University, Hadassah, Israel
LSMULKK Facial and Jaw Surgery Clinic, Kaunas, Lithuania Vilnius Implantology Center Clinic, Vilnius, Lithuania 3 LSMUL Faculty of Odontology, Lithuania 2
Background and objectives: Resorption of the alveolar bone creates anatomically less favorable foundation for ideal implant placement. Many different predictable ARR techniques have been developed and autogenous bone is still considered ‘the golden standard’ for oral bone reconstruction. However, its application in some cases is objectionable due to an unavoidable second surgical-donor site, meaning morbidity and possible complications related to it and relatively invasive procedure. Still, recently developed ARR according to ‘shell’ technique is preferred for regeneration of small to medium defects for its optimal outcome results. Therefore, when ARR and open sinus floor elevation procedures are indicated for the same patient, it is reasonable to perform both procedures simultaneously. In such case, BP can be used for ARR, thus, the second surgical-donor site can be avoided. The aim of this study was to develop and apply clinically a new surgical protocol that optimizes the clinical outcome results of ARR: by reducing operation morbidity, risk of complications, time and cost compared to conventional ARR techniques. Methods: A systematic review of the latests research data was conducted and fundamental principles allowing to achieve optimal clinical results for ARR were excluded. An ARR according to ‘shell’ technique was modified and tested in 4 clinical cases. Results: The clinical results of modified technique were identical to conventional ARR techniques, but the big advantage was the avoidance of the second surgical-donor site and all the negative effects associated with it. Conclusions: In certain clinical situations this modified ARR technique helps to avoid the second surgical-donor site. Herewith, it provides the predictable clinical outcomes with a minimum resorption, reduced operation time, price and a post-operative morbidity. The results emphasize the possible use of BP for ARR, but stress the need for further clinical studies. Key words: reconstruction of the alveolar ridge; sinus wall http://dx.doi.org/10.1016/j.ijom.2013.07.613 T29.OR008 Calvarial bone grafts to augment the atrophied maxilla: experience, morbidity and histology T. Putters 1 , J. Schortinghuis 2 , G. Raghoebar 3 , A. Bronckers 4 1 Refaja
Hospital Stadskanaal, The Netherlands Scheper Hospital Emmen, The Netherlands Univerity Medical Centre Groningen, The Netherlands 4 Oral Cell Biology, ACTA, Amsterdam, The Netherlands 2 3
Background and objectives: Iliac crest grafts to augment the maxilla are associated with considerable pain complaints. Therefore, we decided to investigate calvarial bone grafting to augment the maxilla. Methods: In 19 patients calvarial grafts were taken.2 Complications were scored, including daily pain levels (Visual Analogue Scale, VAS) at both the donor site and intra-orally. At 4 months, implants were placed and a bone biopsy was taken. Results: During surgery, 3 times a dural exponation occurred and one time a small dural tear; this was of no consequence. Wound healing progressed uneventful. The first day, pain levels at the calvarial donor site were lower (VAS 1.4 ± 1.7 SD) than of the iliac crest (VAS 7.0 ± 1.5).1 After 6.5 days both scalp and maxilla were free of pain, whereas iliac crest pain persisted for 30 days. The calvarial grafts healed well and a total of 112 dental implants were inserted without complications. Histologically, active bone remodelling was present. Conclusion: Calvarial bone grafting seems a safe procedure. Key words: calvarial graft; morbidity; maxilla-augmentation
References Nkenke, E., et al. (2004). Int J Oral Maxillofac Surg, 33, 157–163. Schortinghuis, J., et al. (2012). Int J Oral Maxillofac Surg, 70, 963–965. http://dx.doi.org/10.1016/j.ijom.2013.07.614
Purpose: To answer whether severe vertical alveolar defects can be resolved using the sandwich osteotomy technique with xenograft material as filler, and to evaluate the predictability of the this procedure. Patients and methods: Ten graft sites (five mandibular and five maxillary) in nine patients, treated in the Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, were included in the study. The patients underwent vertical bone augmentation using the sandwich osteotomy technique filled with xenograft. The degree of bone augmentation was analyzed clinically at surgery, and 4–6 months later from the computerized tomographic images taken just before the dental implants insertion. A trephine histological analysis was performed during implantation on one maxillary site. Results: The mean vertical bone gain was 6 mm (range 4–10 mm), and it remained stable after 4–6 months. In two cases, further horizontal bone augmentation was needed. All graft sites were rehabilitated using dental implants with satisfactory results. In three cases, gingival porcelain was required for the final prosthesis. Histology revealed vital bone and the remodeling of the filled gap. Conclusion: The sandwich osteotomy technique appears to be a viable and predictable alternative, resulting in good final results, even for challenging cases. http://dx.doi.org/10.1016/j.ijom.2013.07.615 T29.OR010 Maxillary alveolar ridge reconstruction with allograft bone blocks: a clinical and histological study M. Vannucci ∗ , P. Kreisner, N. Boscato, R.C. Almeida UFPel, Brazil Several non-grafting and bone-grafting implant protocols have been reported in the literature, however implant treatment in severe maxillary bone atrophy remains a challenge. Objectives: This clinical report describes clinically and histologically the use of demineralized bovine bone blocks for reconstruction of maxillary alveolar ridges to placement of dental implants. Methods: A 43-year-old, female, non-smoking with good general health status presented as her primary complaint lacking of aesthetics and poor masticatory function. Severe atrophy of the maxilla was diagnosed through clinical and preoperative computed tomography scan examination. The treatment plan was developed for placement of 6 implants, after healing of the transversal bone augmentation which was carried out with bovine bone block grafts (OrthoGen; Baumer, São Paulo, Brazil). A maxillary prototype was used as a guide for this purpose. Eight months after bone grafting the reopening surgery was carried out. At this time, bone cores from the graft were removed with a trephine bur for histologic analysis. Next, the miniscrews were removed, and titanium implants (Neodent Sistema de Implantes Osseointegrados, Curitiba, Brazil) were placed. Six months after surgery for titanium implants placement, the reopening surgery and prosthetic rehabilitation were performed. Results: During surgical procedures, well vascularized and incorporated bone blocks were observed. Histologically adhesion, growth and maturation of osteoblasts, as well as new osteoid tissue deposition directly onto the surface of the bone graft, were observed. Conclusion: Although bone grafting procedures with autologous bone are the gold standard,often the use of bone substitutes presents the advantages of reducing discomfort and morbidity donor site to patients. Moreover it decreases operative trauma, surgical procedures and operative time. http://dx.doi.org/10.1016/j.ijom.2013.07.616
1345
T29.OR007
T29.OR009
A new approach to the alveolar ridge reconstruction (ARR) using a bony plate from the lateral maxillary sinus wall (BP)
Alveolar sandwich osteotomy in resorbed alveolar ridges for dental implants: a 4-year prospective study
G. Omerca 1,∗ , T. Nimcenko 1 , A. Puiˇsys 2 , J. Paulauskas 3 , G. Omercaitë-Paulauskienë 3
H. Rushinek 1,∗ , A. Laviv 1 , O.T. Jensen 2 , E. Tarazi 3 , N. Casap 1
1
1 Department of Oral and Maxillofacial Surgery, School of Dental Medicine Hebrew University, Hadassah, Israel 2 ClearChoice Dental Implant Center, Greenwood Village, CO, USA 3 Department of Prosthodontics, School of Dental Medicine Hebrew University, Hadassah, Israel
LSMULKK Facial and Jaw Surgery Clinic, Kaunas, Lithuania Vilnius Implantology Center Clinic, Vilnius, Lithuania 3 LSMUL Faculty of Odontology, Lithuania 2
Background and objectives: Resorption of the alveolar bone creates anatomically less favorable foundation for ideal implant placement. Many different predictable ARR techniques have been developed and autogenous bone is still considered ‘the golden standard’ for oral bone reconstruction. However, its application in some cases is objectionable due to an unavoidable second surgical-donor site, meaning morbidity and possible complications related to it and relatively invasive procedure. Still, recently developed ARR according to ‘shell’ technique is preferred for regeneration of small to medium defects for its optimal outcome results. Therefore, when ARR and open sinus floor elevation procedures are indicated for the same patient, it is reasonable to perform both procedures simultaneously. In such case, BP can be used for ARR, thus, the second surgical-donor site can be avoided. The aim of this study was to develop and apply clinically a new surgical protocol that optimizes the clinical outcome results of ARR: by reducing operation morbidity, risk of complications, time and cost compared to conventional ARR techniques. Methods: A systematic review of the latests research data was conducted and fundamental principles allowing to achieve optimal clinical results for ARR were excluded. An ARR according to ‘shell’ technique was modified and tested in 4 clinical cases. Results: The clinical results of modified technique were identical to conventional ARR techniques, but the big advantage was the avoidance of the second surgical-donor site and all the negative effects associated with it. Conclusions: In certain clinical situations this modified ARR technique helps to avoid the second surgical-donor site. Herewith, it provides the predictable clinical outcomes with a minimum resorption, reduced operation time, price and a post-operative morbidity. The results emphasize the possible use of BP for ARR, but stress the need for further clinical studies. Key words: reconstruction of the alveolar ridge; sinus wall http://dx.doi.org/10.1016/j.ijom.2013.07.613 T29.OR008 Calvarial bone grafts to augment the atrophied maxilla: experience, morbidity and histology T. Putters 1 , J. Schortinghuis 2 , G. Raghoebar 3 , A. Bronckers 4 1 Refaja
Hospital Stadskanaal, The Netherlands Scheper Hospital Emmen, The Netherlands Univerity Medical Centre Groningen, The Netherlands 4 Oral Cell Biology, ACTA, Amsterdam, The Netherlands 2 3
Background and objectives: Iliac crest grafts to augment the maxilla are associated with considerable pain complaints. Therefore, we decided to investigate calvarial bone grafting to augment the maxilla. Methods: In 19 patients calvarial grafts were taken.2 Complications were scored, including daily pain levels (Visual Analogue Scale, VAS) at both the donor site and intra-orally. At 4 months, implants were placed and a bone biopsy was taken. Results: During surgery, 3 times a dural exponation occurred and one time a small dural tear; this was of no consequence. Wound healing progressed uneventful. The first day, pain levels at the calvarial donor site were lower (VAS 1.4 ± 1.7 SD) than of the iliac crest (VAS 7.0 ± 1.5).1 After 6.5 days both scalp and maxilla were free of pain, whereas iliac crest pain persisted for 30 days. The calvarial grafts healed well and a total of 112 dental implants were inserted without complications. Histologically, active bone remodelling was present. Conclusion: Calvarial bone grafting seems a safe procedure. Key words: calvarial graft; morbidity; maxilla-augmentation
References Nkenke, E., et al. (2004). Int J Oral Maxillofac Surg, 33, 157–163. Schortinghuis, J., et al. (2012). Int J Oral Maxillofac Surg, 70, 963–965. http://dx.doi.org/10.1016/j.ijom.2013.07.614
Purpose: To answer whether severe vertical alveolar defects can be resolved using the sandwich osteotomy technique with xenograft material as filler, and to evaluate the predictability of the this procedure. Patients and methods: Ten graft sites (five mandibular and five maxillary) in nine patients, treated in the Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, were included in the study. The patients underwent vertical bone augmentation using the sandwich osteotomy technique filled with xenograft. The degree of bone augmentation was analyzed clinically at surgery, and 4–6 months later from the computerized tomographic images taken just before the dental implants insertion. A trephine histological analysis was performed during implantation on one maxillary site. Results: The mean vertical bone gain was 6 mm (range 4–10 mm), and it remained stable after 4–6 months. In two cases, further horizontal bone augmentation was needed. All graft sites were rehabilitated using dental implants with satisfactory results. In three cases, gingival porcelain was required for the final prosthesis. Histology revealed vital bone and the remodeling of the filled gap. Conclusion: The sandwich osteotomy technique appears to be a viable and predictable alternative, resulting in good final results, even for challenging cases. http://dx.doi.org/10.1016/j.ijom.2013.07.615 T29.OR010 Maxillary alveolar ridge reconstruction with allograft bone blocks: a clinical and histological study M. Vannucci ∗ , P. Kreisner, N. Boscato, R.C. Almeida UFPel, Brazil Several non-grafting and bone-grafting implant protocols have been reported in the literature, however implant treatment in severe maxillary bone atrophy remains a challenge. Objectives: This clinical report describes clinically and histologically the use of demineralized bovine bone blocks for reconstruction of maxillary alveolar ridges to placement of dental implants. Methods: A 43-year-old, female, non-smoking with good general health status presented as her primary complaint lacking of aesthetics and poor masticatory function. Severe atrophy of the maxilla was diagnosed through clinical and preoperative computed tomography scan examination. The treatment plan was developed for placement of 6 implants, after healing of the transversal bone augmentation which was carried out with bovine bone block grafts (OrthoGen; Baumer, São Paulo, Brazil). A maxillary prototype was used as a guide for this purpose. Eight months after bone grafting the reopening surgery was carried out. At this time, bone cores from the graft were removed with a trephine bur for histologic analysis. Next, the miniscrews were removed, and titanium implants (Neodent Sistema de Implantes Osseointegrados, Curitiba, Brazil) were placed. Six months after surgery for titanium implants placement, the reopening surgery and prosthetic rehabilitation were performed. Results: During surgical procedures, well vascularized and incorporated bone blocks were observed. Histologically adhesion, growth and maturation of osteoblasts, as well as new osteoid tissue deposition directly onto the surface of the bone graft, were observed. Conclusion: Although bone grafting procedures with autologous bone are the gold standard,often the use of bone substitutes presents the advantages of reducing discomfort and morbidity donor site to patients. Moreover it decreases operative trauma, surgical procedures and operative time. http://dx.doi.org/10.1016/j.ijom.2013.07.616